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Addiction Severity Index (ASI)

ADDICTION SEVERITY INDEX (ASI)

This is a semistructured interview designed to provide important information about aspects of the life of patients that may contribute to their substance-abuse problems. The Addiction Severity Index (ASI) provides a general overview of substance-abuse problems rather than a focus on one particular area (200 questions on 7 subscales). Developed by McLellan and coworkers in 1981, the ASI has been translated into seventeen languagesJapanese, French, Spanish, German, Dutch, and Russian among themand was designed to be administered by a technician or counselor. Consistent guidelines for each question on the ASI have been compiled in training materials including two videos and three instructional manuals. Self-training can be accomplished by using the video along with the administration manual, although a one-day formal training seminar is recommended. (Since the instrument is in the public domain, there is no charge for it; only a minor fee is charged for copies of the administration materials and the computer scoring disk.)

The interview is based on the idea that addiction to drugs or alcohol is best considered in terms of the life events that preceded, occurred at the same time as, or resulted from the substance-abuse problem. The ASI focuses on seven functional areas, or subscales, that have been widely shown to be affected by the substance abuse: medical status, employment and support, drug use, alcohol use, legal status, family and social status, and psychiatric status. Each of these areas is examined individually by collecting information regarding the frequency, duration, and severity of symptoms of problems both historically over the course of the patient's lifetime and more recently during the thirty days prior to the interview. Within each of the problem areas, the ASI provides both a 10-point, interviewer-determined severity rating of lifetime problems as well as a multi-item composite score (computer-calculated) that indicates the severity of the problems in the past thirty days.

The ASI is widely used clinically for assessing substance-abuse patients at the time of their admission for treatment. It takes about an hour to gather the basic information that forms the first step in the development of a patient profile for subsequent use by the staff in planning treatment. Researchers have found the ASI useful because the composite scores and the individual variables can be compared within groups over time as a measure of improvement, or between groups of patients at a posttreatment follow-up point as a measure of outcome of treatment. The ASI has shown excellent reliability and validity across a range of types of patients and treatment settings in this country and abroad, although reliability in patients with severe mental illness varies considerably.

The ASI is particularly useful in the diagnosis and treatment of alcohol problems. It provides information on the frequency, duration, and intensity of alcohol and drug use. The ASI also examines psychosocial functioning (medical, legal, employment, psychological, and social/family), which is crucial to understanding alcohol dependency. The ASI is also a cost-effective alternative for the as[fj]sessment of alcohol problemswhen compared to the Structured Clinical Interview for DSM-III-R (SCID), a more formal and more expensive approach.

The ASI has been used in many studies, including one in the late 1990s, involving cocaine-dependent pathological gamblers. This particular study used the ASI to determine socioeconomic characteristics of the subjects. Another late-1990s study (involving methadone patients) used results of the ASI in comparison with criminal history and personality traits to support the idea that antisocial behavior is more than just a personality disorder. In 2000, the outcome of a study on cocaine dependents illustrated, by comparing Spielberger State-Trait Anxiety Inventory and the Alcohol Composite Index of the ASI, that high anxiety scores decrease with time, regardless of clinical management.

To further increase the usefulness of the ASI, clinicians and researchers have added questions to supplement the "old" version, including questions about leisure time activities, childhood religion, childhood illnesses, age of first drug/alcohol use, sexual orientation, and military service. The addition of these questions is thought to supplement the already-sought information, since much of the impetus for these questions is from those who administrate the ASI and deal directly with the tested individuals. Also, a T-ASI (Teen-Addiction Severity Index) has been developed to help adolescents. It is an age-appropriate modification of the original ASI with 133 questions in 7 domains: Psychoactive Substance Use, Family Function, Peer-Social Relationships, School-Employment Status, Legal Status, and Psychiatric Status.

BIBLIOGRAPHY

Alterman, A., et al. A typology of antisociality in methadone patients. Journal of Abnormal Psychology, 107, August 1998, 412.

Ball, J. C., et al. (1986). Medical services provided to 2,394 patients at methadone programs in three states. Journal of Substance Abuse Treatment, 3, 203-209.

Carey, K. B, et al. Reliability and validity of the addition severity index among outpatients with severe mental illness. Psychological Assessment, December 1997, 422.

Hall, G. W., et al. Pathological Gambling Among Cocaine-Dependent Outpatients. American Journal of Psychiatry, 157, July 2000, 1127.

Hendricks, V. M. (1989). The Addiction Severity Index: Reliability and validity in a Dutch addict population. Journal of Substance Abuse Treatment.

Kosten, T. R., Rounsaville, B., & Kleber, H. D. (1983). Concurrent validity of the Addiction Severity Index. Journal of Nervous & Mental Disease, 171, 606-610.

La Porte, D., et al. (1981). Treatment response in psychiatrically impaired drug abusers. Comprehensive Psychiatry, 22 (4), 411-419.

Mc Lellan, A. T., et al. (1992). The fifth edition of the Addiction Severity Index: Cautions, additions and normative data. Journal of Substance Abuse Treatment, 9 (5), 461-480.

Mc Lellan, A. T., et al. L. Harris (Ed.) (1991). Using the ASI to compare cocaine, alcohol, opiate and mixed substance abusers. Problems of drug dependence 1990 (NIDA Research Monograph). Washington, DC: U.S. Government Printing Office.

Mc Lellan, A. T., et al. (1985). New data from the Addiction Severity Index: Reliability and validity in three centers. Journal of Nervous and Mental Disease, 172, 84-91.

Mc Lellan, A. T., et al. (1983). Increased effectiveness of substance abuse treatment: A prospective study of patient-treatment "matching." Journal of Nervous and Mental Disease, 171 (10), 597-605.

Mc Lellan, A. T., et al. (1983). Predicting response to alcohol and drug abuse treatments: Role of psychiatric severity. Archives of General Psychiatry, 40, 620-625.

Mc Lellan, A. T., et al. (1981). Are the addiction-related problems of substance abusers really related? Journal of Nervous and Mental Disease, 169 (4), 232-239.

Mc Lellan, A. T., et al. (1981). Psychological severity and response to alcoholism rehabilitation. Drug and Alcohol Dependence, 8 (1), 23-35.

Mc Lellan, A. T., et al. (1980). An improved diagnostic instrument for substance abuse patients: The Addiction Severity Index. Journal of Nervous and Mental Disease, 168, 26-33.

NIAAA. (1901). Alcohol alert: Assessing alcoholism. ADAMHA Press, no. 12, PH 294, April. Washington, DC: U.S. Government Printing Office.

O' Leary, Tracy A., et al. The Relationship Between Anxiety Levels and Outcome of Cocaine Abuse Treatment. American Journal of Drug and Alcohol Abuse, 26, May 2000, 179.

Rogalski, C. J. (1987). Factor structure of the Addiction Severity Index in an inpatient detoxification sample. International Journal of Addiction, 22 (10). 981-992.

Rounsaville, B. J., et al. (1987). Psychopathology as a predictor of treatment outcome in alcoholism. Archives of General Psychiatry.

Saxe, L., et al. (1983). The effectiveness and costs of alcoholism treatment (Health Technology Case Study 22). Washington, DC: Office of Technology Assessment.

Stoffelmayr, B., Harwell, M., & Mavis, B. (1991). Interrater reliability and validity of the Addiction Severity Index. Journal of Educational Measurement.

Svikis, Dace S., et al. Detecting alcohol problems in drug-dependent women of childbearing age. American Journal of Drug and Alcohol Abuse, November 1996, 563.

A. Thomas McLellan

Revised by Rebecca Marlow-Ferguson

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