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Validation and performance of the A lcohol, S moking and S ubstance I nvolvement S creening T est ( ASSIST ) among adolescent primary care patients
Author(s) -
Gryczynski Jan,
Kelly Sharon M.,
Mitchell Shan Gwin,
Kirk Arethusa,
O'Grady Kevin E.,
Schwartz Robert P.
Publication year - 2015
Publication title -
addiction
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.424
H-Index - 193
eISSN - 1360-0443
pISSN - 0965-2140
DOI - 10.1111/add.12767
Subject(s) - medicine , receiver operating characteristic , cannabis , population , psychiatry , environmental health
Background and Aims The W orld H ealth O rganization's A lcohol, S moking and S ubstance I nvolvement S creening T est ( 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 ‐ L ite 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 ‐ L ite) was evaluated for cannabis. Setting Three community health centers in B altimore, MD , USA . Participants A total of 525 primary care patients, ages 12–17 years. Measurements Measures included the ASSIST , the CRAFFT screening tool and items from the C omposite I nternational D iagnostic I nterview ( CIDI ) corresponding to substance use disorder criteria in the D iagnostic and S tatistical M anual of M ental D isorders, 5th edition. Findings The ASSIST had good internal consistency (α = 0.68–0.88), good concurrent validity with the CRAFFT ( r = 0.41–0.76; P < 0.001), 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 ] = 0.90–0.94), but did so at minimally low cut‐points (indicative of any use in the past 3 months). The ASSIST ‐ L ite performed similarly to the ASSIST in identifying cannabis use disorders (sensitivity = 96%; specificity = 88%; AUC = 0.92), also at a minimally low cut‐point. However, confirmatory factor analysis of the ASSIST indicated poor model fit. Conclusions The A lcohol, S moking and S ubstance I nvolvement S creening T est ( ASSIST ) is promising as a research and screening/brief assessment tool with adolescents, but revisions to clinical risk thresholds are warranted. The ASSIST ‐ L ite is sufficiently informative for rapid clinical screening of adolescents for cannabis use disorders.