Populations and Settings Served. The
ASSIST was developed to serve patients in
primary care settings and has been used
successfully as the screening component of a
screening and brief intervention program.^19 The
instrument also is appropriate for use in
outpatient clinics, emergency departments,
general hospital wards, psychiatric offices,
antenatal and prenatal clinics, criminal justice
settings and welfare facilities.^20
Clinical Utility. According to a government
review conducted by the Agency for Healthcare
Research and Quality (AHRQ), research
supports the ASSIST’s reliability; in a subgroup
of WHO study participants,* the ASSIST
demonstrated both internal reliability and test-
retest reliability.^21 When testing the validity of
the ASSIST, WHO researchers studied its
efficacy at identifying substance involvement
across populations of seven countries.† 22 The
ASSIST was able to discriminate among levels
of risky substance use and addiction for each
substance individually and for total substance
involvement.‡ 23 Scores on the ASSIST strongly
correspond to scores on other related screening
instruments.^24 The ASSIST also has
demonstrated acceptable sensitivity and
specificity, particularly with regard to its ability
to distinguish accurately between those who
engage in alcohol and illicit drug§ use versus
abuse^25 and slightly lower sensitivity and
specificity in distinguishing between abuse and
dependence.^26
Simple Screening Instrument for
Substance Abuse (SSI)
The Simple Screening Instrument for Substance
Abuse is a 16-item yes/no questionnaire that was
- 236 participants (60 percent from addiction
treatment programs, 40 percent from a general
medical facility).
† Australia, Brazil, India, Thailand, the United
Kingdom, the United States of America and
Zimbabwe.
‡ The WHO study group (n= 1047) answered
questions from other validated instruments and gave
hair samples for purposes of comparison.
§ Including marijuana, cocaine, amphetamine-type
stimulants, sedatives and opioids.
developed in 1994 by the Center for Substance
Abuse Treatment (CSAT) of the Substance
Abuse and Mental Health Services
Administration (SAMHSA) to screen for risky
substance use in adult and adolescent
populations.^27 SSI measures an individual’s
alcohol and other drug consumption (excluding
nicotine), preoccupation and loss of control,
adverse consequences, problem recognition and
tolerance and withdrawal levels.^28 The
screening can be conducted through an interview
or self-administered.^29A cut-off score of four is recommended for
identifying individuals at high to moderate risk
who may be in need of further assessment.^30SSI is in the public domain and can be copied
and administered free of charge. Minimal
training is needed to administer and score it.^31Populations and Settings Served. SSI was
developed for use in adult and adolescent
populations regardless of gender, ethnicity,
cultural background, literacy level or
socioeconomic status. Originally it was
designed to be used by outreach workers, health
professionals and paraprofessionals in
populations with infectious diseases^32 and to
encompass a broad spectrum of signs and
symptoms of addiction; it may be particularly
useful for screening patients in mental health
settings for co-occurring substance-related
problems.^33Clinical Utility. SSI has not been tested as
rigorously as some other instruments. While
one study found that it was valid and reliable in
an inmate population,^34 another study found that
it had low validity in a college population: in a
group of 201 college students, the SSI correctly
classified only 58.9 percent of cases that met
DSM criteria for substance abuse.^35 The SSI
also has lower sensitivity (it is more likely to
produce false positives) than similar
instruments.^36