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Addiction Severity Index

Module by: David Gustafson. E-mail the author

Addiction Severity Index

Another assessment tool that is widely used in the evaluation of substance abuse treatment is the Addiction Severity Index (ASI), which has been established as the standard assessment tool for alcohol and other addictions (Leonhard et al, 2000). The ASI is an interview that assesses history, frequency, and consequences of alcohol and drug use, as well as five additional domains that are commonly associated with drug use: medical, legal, employment, social/family, and psychological functioning. The higher the score on the ASI indicates a greater need for treatment in each of these areas. The ASI scores can be used to profile patients’ problem areas and then plan effective treatment.

In a recent study, Makela, K., (2004) reviewed the available literature to determine the reliability and validity of the ASI. The author included 37 studies which reported empirical data on the efficacy of the ASI in his review. The results show that high internal consistencies have been reported for only three of the seven composite scores. The author points to four studies in which the remaining four composite scores showed low internal consistencies. The substance abusing population is wide and varied and a standardized assessment tool is not going to produce consistent results in all studies. That being said, the author concludes that the ASI should not be used in research or clinical decision making. He feels that the ASI is too rigid in its design and asking the same questions of alcoholics and intravenous drug users is inappropriate. The author would like to see the ASI used as a “system of building blocks” in which “different sets of questions could be put to clients with different user profiles…”

In response to the review by Makela, McClellan et al (2004) agree with some of the issues raised, though they feel the ASI is still a valid assessment tool. The authors point out that three studies which would have strengthened the results were not included in the review. They also acknowledge the fact that the ASI does have some weaknesses but point out that they have been informing potential users of problems they have discovered. Additionally, feedback from ASI users has suggested a major revision is needed and they are currently developing ASI-6.

Recently, the validity of the ASI as an internet and automated telephone self-report were tested. The theory was that if the ASI could be used in these new environments it would save time and money and increase patient substance abuse reporting by providing a greater sense of anonymity. The results indicate that the internet and interactive voice response (IVR) formats of the ASI represent valid and reliable alternatives to the clinician-administered version. Also, the use of these technologies did not result in under reporting of problems. Subjects had no difficulty using the technology with the Internet interview lasting approximately 45 minutes. Patients did prefer the face to face interviews with clinicians citing ease of use. The authors also discussed the potential this technology would have for tracking patient progress or relapse, as well as facilitating the creation of a national outcomes tracking database which could be used to identify effective treatments (Brody et al, 2004).

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