Validation of the Alcohol Smoking and Substance Involvement Screening Test (ASSIST) in acute psychiatric inpatients

Authors

  • Ana Isabel López-Lazcano Grup Recerca Addicions Clínic (GRAC-GRE). Department of Psychiatry, Clinical Institute of Neuroscience. Hospital Clínic i Universitari de Barcelona. Universitat de Barcelona. IDIBAPS. RTA (RETICS) http://orcid.org/0000-0002-4365-2688
  • Hugo López-Pelayo Grup Recerca Addicions Clínic (GRAC-GRE). Department of Psychiatry, Clinical Institute of Neuroscience. Hospital Clínic i Universitari de Barcelona. Universitat de Barcelona. IDIBAPS. RTA (RETICS)
  • Mercè Balcells-Oliveró Grup Recerca Addicions Clínic (GRAC-GRE). Department of Psychiatry, Clinical Institute of Neuroscience. Hospital Clínic i Universitari de Barcelona. Universitat de Barcelona. IDIBAPS. RTA (RETICS)
  • Lidia Segura Program on Substance Abuse, Public Health Agency of Catalonia, Department of Health, Government of Cataloni
  • Antoni Gual Solé Grup Recerca Addicions Clínic (GRAC-GRE). Department of Psychiatry, Clinical Institute of Neuroscience. Hospital Clínic i Universitari de Barcelona. Universitat de Barcelona. IDIBAPS. RTA (RETICS)

DOI:

https://doi.org/10.20882/adicciones.1496

Keywords:

Addiction, alcohol use disorder, substance use disorder, ASSIST, mental health, screening.

Abstract

The aims of this study were to examine the psychometric properties of The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in psychiatric inpatients, due to the scarcity of screening instruments validated in this population. Patients from Hospital Clínic’s psychiatric ward (n = 202) completed: ASSIST, Addiction Severity Index (ASI), MINI-International Neuropsychiatric Interview (MINI), Alcohol Use Disorders Identification Test (AUDIT), Fagerström Test for Nicotine Dependence (FTND), Severity of Dependence Scale (SDS), and Drug Abuse Screening Test (DAST). Reliability and validity evidences based on internal structure (Exploratory and Confirmatory Factor Analyses) and on the relation to other variables were obtained. Excellent internal consistency was found for Total Substance Involvement (TSI) (α = .92 and ω = .93) and for Specific Substance Involvement (SSI) scores (α = .88 - .96 and ω = .89 - .95). Analysis of internal structure for tobacco, alcohol and cannabis subscales resulted in unidimensional models with adequate goodness-of-fit indices. ASSIST scores were significantly correlated with those of ASI (r = .795 to r = .953), AUDIT (r = .864), FTND (r = .808), DAST (r = .831), SDS (r = .519) and with “number of diagnoses of abuse/dependence” in MINI-Plus (TSI: r = .857 to r = .862; SSI: r = .646 to r = .834). Receiver operating characteristic analysis (ROC) and Mann-Whitney’s U test found good discriminative validity evidences. ASSIST scores showed good reliability and there were validity evidences that support its use for identifying risk levels of tobacco, alcohol and other substance use in psychiatric patients.

Author Biography

Ana Isabel López-Lazcano, Grup Recerca Addicions Clínic (GRAC-GRE). Department of Psychiatry, Clinical Institute of Neuroscience. Hospital Clínic i Universitari de Barcelona. Universitat de Barcelona. IDIBAPS. RTA (RETICS)

Especialista en Psicología Clínica. Unidad de Conductas Adictivas. Psiquiatría y Psicología de Adultos. Institut de Neurociencies. Hospital Clinic i Universitari de Barcelona.

References

Ali, R., Awwad, E., Babor, T. F., Bradley, F., Butau, T., Farrell, M.,… Vendetti, J. (2002). The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): Development, reliability and feasibility. Addiction, 97, 1183–1194. doi:10.1046/j.1360-0443.2002.00185.x.

American Educational Research Association, American Psychological Association, & National Council on Measurement in Education. (2014). Standards for Educational and Psychological Testing. Washington, DC: American Educational Research Association.

Bascarán, M. T. B., Flórez, G., Seijo, P. & García, J. B. (2019). Does icd-11 improve the epidemiological and nosological purposes of mental, behavioral and developmental disorders? Adicciones, 31, 183–188. doi:10.20882/adicciones.1368.

Becoña, E. & Vázquez, F. L. (1998). The Fagerström Test for Nicotine Dependence in a Spanish sample. Psychological Reports, 83, 1455–1458. doi:10.2466/pr0.1998.83.3f.1455.

Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences. New York: Routledge Academic.

Conway, K. P., Compton, W., Stinson, F. S. & Grant, B. F. (2006). Lifetime comorbidity of DSM-IV mood and anxiety disorders and specific drug use disorders: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry, 67, 247–257. doi:10.4088/jcp.v67n0211.

Crome, I. B., Bloor, R. & Thom, B. (2006). Screening for illicit drug use in psychiatric hospitals: Whose job is it? Advances in Psychiatric Treatment, 12, 375–383. doi:10.1192/apt.12.5.375.

Cronbach, L. J. (1951). Coefficient alpha and the internal structure of tests. Psychometrika, 16, 297–334. doi:10.1007/BF02310555.

Degenhardt, L., Bharat, C., Glantz, M. D., Sampson, N. A., Scott, K., Lim, C. C. W.,… Kessler, R. C. (2019). The epidemiology of drug use disorders cross-nationally: Findings from the WHO’s World Mental Health Surveys. International Journal of Drug Policy, 71, 103–112. doi:10.1016/j.drugpo.2019.03.002.

Degenhardt, L., Glantz, M., Evans-Lacko, S., Sadikova, E., Sampson, N., Thornicroft, G.,… Zaslavsky, A. M. (2017). Estimating treatment coverage for people with substance use disorders: An analysis of data from the World Mental Health Surveys. World Psychiatry, 16, 299–307. doi:10.1002/wps.20457.

Díaz-Mesa, E., Portilla, P. G., Sáiz, P. A., Bascarán, T. B., Casares, M. J., Fonseca, E.,… Bobes, J. (2010). Psychometric performance of the 6th version of the Addiction Severity Index in Spanish (ASI-6). Psicothema, 22, 513–519.

Dixon, L. (1999). Dual diagnosis of substance abuse in schizophrenia: Prevalence and impact on outcomes. Schizophrenia Research, 35, 93–100. doi:10.1016/s0920-9964(98)00161-3.

Dunn, T. J., Baguley, T. & Brunsden, V. (2014). From alpha to omega: A practical solution to the pervasive problem of internal consistency estimation. British Journal of Psychology, 105, 399–412. doi:10.1111/bjop.12046.

Ferrando, L., Franco, A., Soto, M., Bobes, J., Soto, O., Franco, L. & Gubert, J. (1998). MINI International Neuropsychiatric Interview (Spanish version 5.0.0.) DSM-IV. Madrid: Instituto IAP.

González-Sáiz, F. & Carulla-Salvador, L. (1998). Estudio de fiabilidad y validez de la versión española de la escala Severity of Dependence Scale (SDS). Adicciones, 10, 223–232.

Greenberg, G. A. & Rosenheck, R. A. (2014). Psychiatric correlates of past incarceration in the national co-morbidity study replication. Criminal Behaviour and Mental Health, 24, 18–35. doi:10.1002/cbm.1875.

Gryczynski, J., Kelly, S. M., Mitchell, S. G., Kirk, A., O’Grady, K. E. & Schwartz, R. P. (2015). Validation and performance of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) among adolescent primary care patients. Addiction, 110, 240–247. doi:10.1111/add.12767.

Harris, M. G., Bharat, C., Glantz, M. D., Sampson, N. A., Al-Hamzawi, A., Alonso, J.,… Degenhardt, L. (2019). Cross-national patterns of substance use disorder treatment and associations with mental disorder comorbidity in the WHO World Mental Health Surveys. Addiction, 114, 1446–1459. doi:10.1111/add.14599.

Hides, L., Cotton, S. M., Berger, G., Gleeson, J., O’donnell, C., Proffitt, T.,… Lubman, D. I. (2009). The reliability and validity of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in first-episode psychosis. Addictive Behaviors, 34, 821–825. doi:10.1016/j.addbeh.2009.03.001.

Hu, L. T. & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1–55. doi:10.1080/10705519909540118.

Humeniuk, R., Ali, R., Babor, T. F., Farrell, M., Formigoni, M. L., Jittiwutikarn, J.,… Simon, S. (2008). Validation of the alcohol, smoking and substance involvement screening test (ASSIST). Addiction, 103, 1039–1047. doi:10.1111/j.1360-0443.2007.02114.x.

IBM Corp. Released. (2019). IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp.

Langås, A. M., Malt, U. F. & Opjordsmoen, S. (2011a). Comorbid mental disorders in substance users from a single catchment area - a clinical study. BMC Psychiatry, 11, 25. doi:10.1186/1471-244X-11-25.

Langås, A. M., Malt, U. F. & Opjordsmoen, S. (2011b). Substance use disorders and comorbid mental disorders in first-time admitted patients from a catchment area. European Addiction Research, 18, 16–25. doi:10.1159/000332234.

Lobo, A., Ezquerra, J., Gómez, F., Sala, J. & Seva, A. (1979). El Mini Examen Cognoscitivo. Un test sencillo y práctico para detectar alteraciones intelectuales en pacientes médicos. Actas Luso-Españolas de Neurología, Psiquiatría y Ciencias Afines, 3, 189–202.

López-Pelayo, H., Batalla, A., Balcells, M. M., Colom, J. & Gual, A. (2015). Assessment of cannabis use disorders: A systematic review of screening and diagnostic instruments. Psychological Medicine, 45, 1121–1133. doi:10.1017/S0033291714002463.

Merikangas, K. R., Jin, R., He, J. P., Kessler, R. C., Lee, S., Sampson, N. A.,… Zarkov, Z. (2011). Prevalence and correlates of bipolar spectrum disorder in the World Mental Health Survey Initiative. Archives of General Psychiatry, 68, 241–251. doi:10.1001/archgenpsychiatry.2011.12.

Morisano, D., Babor, T. F. & Robaina, K. A. (2014). Co-occurrence of substance use disorders with other psychiatric disorders: Implications for treatment services. Nordic Studies on Alcohol and Drugs, 31, 5–25. doi:10.2478/nsad-2014-0002.

Muñiz, J. & Fonseca-Pedrero, E. (2019). Ten steps for test development. Psicothema, 31, 7–16. doi:10.7334/psicothema2018.291.

Nunnally, J. C. & Bernstein, I. H. (1994). Psychometric theory. New York: McGraw-Hill.

Pérez-Gálvez, B., García-Fernández, L., de Vicente-Manzanaro, M. P., Oliveras-Valenzuela, M. A. & Lahoz-Lafuente, M. (2010). Spanish validation of the Drug Abuse Screening Test (DAST-20 y DAST-10). Health and Addictions, 10, 35–50. doi:10.21134/haaj.v10i1.35.

Pérez-Moreno, P., Calzada-Álvarez, N., Rovira-Guardiola, J. & Torrico Linares, E. (2012). Estructura factorial del test ASSIST: Aplicación del análisis factorial exploratorio y confirmatorio. Trastornos Adictivos, 14, 44–49. doi:10.1016/S1575-0973(12)70043-0.

R Core Team. (2020). R: A Language and Environment for Statistical Computing, version 3.5. Vienna, Austria.

Rosenberg, S. D., Drake, R. E., Wolford, G. L., Mueser, K. T., Oxman, T. E., Vidaver, R. M.,… Luckoor, R. (1998). Dartmouth Assessment of Lifestyle Instrument (DALI): A substance use disorder screen for people with severe mental illness. American Journal of Psychiatry, 155, 232–238. doi:10.1176/ajp.155.2.232.

Rubio Valladolid, G., Bermejo Vicedo, J., Caballero Sánchez-Serrano, M. C. & Santo-Domingo Carrasco, J. (1998). Validación de la prueba para la identificación de trastornos por uso de alcohol (AUDIT) en Atención Primaria. Revista Clinica Española, 198, 11–14.

Rubio Valladolid, G., Martínez-Raga, J., Martínez-Gras, I., Ponce Alfaro, G., de la Cruz Bértolo, J., Jurado Barba, R.,… Zarco Montejo, J. (2014). Validación de la versión española del Test de Detección de Uso de Alcohol, Tabaco y otras Sustancias (ASSIST). Psicothema, 26, 180–185. doi:10.7334/psicothema2013.172.

Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E.,… Dunbar, G. C. (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59, 22–33.

Tiburcio Sainz, M., Rosete-Mohedano, M. G., Natera Rey, G., Martínez Vélez, N. A., Carreño García, S. & Pérez Cisneros, D. (2016). Validity and reliability of the alcohol, smoking, and substance involvement screening test (ASSIST) in university students. Adicciones, 28, 19–27. doi:10.20882/adicciones.786.

Torrens, M., Martin-Santos, R. & Samet, S. (2006). Importance of clinical diagnoses for comorbidity studies in substance use disorders. Neurotoxicity Research, 10, 253–261. doi:10.1007/BF03033361.

Torrens, M., Serrano, D., Astals, M., Pérez-Domínguez, G. & Martín-Santos, R. (2004). Diagnosing comorbid psychiatric disorders in substance abusers: Validity of the Spanish versions of the psychiatric research interview for substance and mental disorders and the structured clinical interview for DSM-IV. American Journal of Psychiatry, 161, 1231–1237. doi:10.1176/appi.ajp.161.7.1231.

Vargas-Cáceres, S., Mantilla, M. F., Ortega, G., Bruguera, E., Casas, M., Ramos-Quiroga, J.-A. & Braquehais, M. D. (2020). Diagnóstico dual en médicos residentes: Una revisión sistemática. Adicciones, 32, 281–290. doi:10.20882/adicciones.1253.

Vélez-Moreno, A., González-Saiz, F., Rojas, A. J., Torrico-Linares, E., Fernández-Calderón, F., Ramírez-López, J. & Lozano, Ó. M. (2015). Reliability and validity of the Spanish version of the substance dependence severity scale. European Addiction Research, 21, 39–46. doi:10.1159/000365282.

World Medical Association Declaration of Helsinki. (2013). World Medical Association declaration of Helsinki: Ethical principles for medical research involving human subjects. Journal of the American Medical Association, 310, 2191–2194. doi:10.1001/jama.2013.281053.

Published

2021-06-14

Issue

Section

Originals