Validation and performance of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) among adolescent primary care patients

Abstract

Background and aims The World Health Organization’s Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) has strong support as a clinical screening tool and research instrument, but has only been validated with adults. This study evaluated the ASSIST and ASSIST-Lite in an adolescent population. Design Internal consistency, concurrent validity, discriminant validity, and diagnostic accuracy were examined for tobacco, alcohol, and cannabis ASSIST scores. An abbreviated version (the ASSIST-Lite) was evaluated for cannabis. Setting Three community health centers in Baltimore, Maryland, USA. Participants 525 primary care patients, ages 12-17. Measurements Measures included the ASSIST, the CRAFFT screening tool, and items from the Composite International Diagnostic Interview (CIDI) corresponding to substance use disorder criteria in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition. Findings The ASSIST had good internal consistency (αs=.68-.88), good concurrent validity with the CRAFFT (r=.41-.76; ps<.001), and was able to discriminate between gradations of cannabis problem severity. In receiver operating characteristics analysis of optimal clinical cut-points, the ASSIST accurately identified tobacco, alcohol, and cannabis use disorders (sensitivities=95%-100%; specificities=79%-93%; area under the curve [AUC]=.90-.94), but did so at minimally low cut-points (indicative of any use in the past 3 months). The ASSIST-Lite performed similarly to the ASSIST in identifying cannabis use disorders (sensitivity=96%; specificity=88%; AUC=.92), also at a minimally low cut-point. However, confirmatory factor analysis of the ASSIST indicated poor model fit. Conclusions The Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) is promising as a research and screening/brief assessment tool with adolescents, but revisions to clinical risk thresholds are warranted. The ASSIST-Lite is sufficiently informative for rapid clinical screening of adolescents for cannabis use disorders.

Validation of a substance and alcohol use assessment instrument among orphans and vulnerable children in Zambia using Audio Computer Assisted Self-Interviewing (ACASI)

“…Reported use of tobacco and alcohol and mean SSI scores for tobacco, alcohol, and cannabis were higher in this sample than in a validity study of the ASSIST among a sample of youth in an urban health center the U.S. (Gryczynski et al, 2014), but reported use was lower than a second U.S.-based ASSIST validity study, which included a sample of HIV-infected youth (Nichols et al, 2014). The high number of adolescents reporting use in our study is a concern given studies suggesting that there is a strong association between substance use and HIV risk as well as other adverse consequences among youth (Kalichman et al, 2007; Morojele et al, 2006; Shuper et al, 2010; UNODC, 2012).…”

“…For the present psychometric study, we included all adolescents enrolled in the trial by December, 2015 (n=502). Based on our previous psychometric studies in Zambia with mental and behavioral health assessment instruments (Michalopoulos et al, 2015; Murray et al, 2011), and other studies evaluating the ASSIST with adolescent populations (Gryczynski et al, 2014; Nichols et al, 2014), we believed this sample size was adequate to detect moderate mean ASSIST score differences between those with and without substance use problems.…”

“…Gryczynski et al (2014) found good internal consistency for the tobacco (α=.87), alcohol (α=.72), and cannabis (α=.88) scales and concurrent validity with the CRAFFT screening tool, but the ASSIST was only able to discriminate between levels of severity for cannabis. Nichols et al (2014), using an ACASI-based ASSIST, found high concordance of ASSIST-reported marijuana and tobacco with toxicology reports.…”

Validación empírica del CRAFFT Abuse Screening Test en una muestra de adolescentes españoles

“…A nivel de consistencia interna, la revisión de numerosos trabajos revela unos valores más bien discretos con índices α de Cronbach que en algunos casos no llegan al ,70 (Bertini et al, 2015;Knight, Sherritt, Shrier, Harris y Chang, 2002;Skogen, BØe, Knudsen y Hysing, 2013;Wartberg, Kriston, Diestelkamp, Arnaud y Thomasius, 2016). En cuanto a su capacidad de cribado, es posible señalar que el CRAFFT posee unas propiedades psicométricas adecuadas (Dhalla, Zumbo y Poole, 2011) con unos índices de sensibilidad y especificidad, por lo general, elevados (Gryczynski et al, 2015;Kandemir et al, 2015;Knight, Sherritt, Harris, Gates y Chang, 2003;Pereira, Schram y Azevedo, 2016). No obstante, en aquellos trabajos en los que se incluyen además los valores predictivos, por lo general alguno de los cuatro indicadores presenta un resultado más pobre (Cook, Chung, Kelly y Clark, 2005;Kelly, Donovan, Chung, Cook y Delbridge, 2004;Knight et al, 1999).…”

Psychoactive substance use in a sample of community outreach participants; prevalence, correlates and ease of incorporating care

“…Consistent with some previous studies in which the ASSIST was proved to be an effective primary health care substance screening tool with good discriminative validity, particularly for alcohol, cannabis, ATS, opioids and cocaine specific substance involvement; ASSIST cutpoints in this study also were able to provide substancespecific appraisal based on use and misuse with a high degree of accuracy among the study participants. 14,30 Potential substance abuse and dependence was noted for tobacco, marijuana, Amphetamine, inhalants, sedatives, hallucinogens, and opioid, based on ASSIST and confirmed by MINI.…”