Ultra rapid screening for substance use disorders: the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST Lite)
BACKGROUND The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST 3.0; index test) is a structured interview for alcohol, tobacco, cannabis, stimulants, sedatives and opioid use disorders in general medical settings. Perceived administration time deters routine use. This study releases a short form: the ASSIST Lite. METHODS Diagnostic accuracy study among 2082 adults recruited from general medical (70% and specialist mental health/addiction treatment services (22% Current DSM IV substance dependence (MINI International Neuropsychiatric Interview) and moderate severe tobacco dependence (Fagerstrom Nicotine Dependence Test) were reference standards. Exploratory factor and item response theory models re calibrated ordinal test items. Items for the ASSIST Lite were selected by diagnostic accuracy evaluation (area under the receiver operating characteristic [AUC] curve =0.7] sensitivity, specificity, positive and negative predictive values [PVP, NVP] kappa, likelihood ratios [LR+ LR and clinical utility index [CU+ CU RESULTS For each substance an item pair was selected (AUC [0.8 1.0] sensitivity [0.8 1.0] specificity [0.7 0.8] PVP [0.8 1.0] NVP [0.7 1.0] kappa [0.5 0.9] LR+ [2.5 5.9] LR [0.0 0.2] CU+ [0.7 0.9] and CU [0.5 0.8] Gender, age and recruitment setting (specialist mental health versus general medical) did not moderate accuracy, with the exception of opioids (AUC <0.7, participants =59 years) Male opioid users had more severe substance involvement scores that females (differential item functioning analysis, P=0.00) There was no evidence of differential accuracy between countries (AUC range, 0.8 1.0) CONCLUSION The ASSIST Lite is an ultra rapid screener which has been optimised for general medical settings. Optionally, a criterion question can be added to capture hazardous drinking, and to capture use of another type of mood altering substance.
Drug and alcohol dependence