can be administered via an interview or self-
administered.^91
The instrument is scored on a scale from zero to
- Practitioners tally relative scores across
each domain to identify which areas of life have
been affected most severely by a patient’s
substance use.^92 Scoring the instrument takes up
to 10 minutes.^93
The revised version of the DUSI also includes a
“lie scale,” allowing practitioners to verify the
truthfulness of patients’ responses and identify
inconsistencies. The instrument does not require
training to administer.^94
The DUSI is copyrighted. Paper and online
questionnaires are available at a low cost and
software licenses for online scoring and
monitoring of progress over time can be
purchased.^95
Populations and Settings Served. The
instrument is recommended for use among
known or suspected alcohol and other drug users
and for identifying adolescents at risk.^96
Clinical Utility. The DUSI substance use scale
was found to be valid in an adolescent sample^97
and scores on the DUSI in adolescence
significantly correlated with the presence of
addiction in young adulthood.^98 The DUSI also
has demonstrated good internal reliability as
well as good sensitivity and specificity rates in
an adult population.^99
The Addiction Severity Index (ASI)
Developed in 1982, the Addiction Severity Index
is an assessment instrument that not only
measures self-reported lifetime and current
alcohol and other drug use (excluding nicotine),
but also related domains including medical
status, employment and financial status, legal
status, family history, social relationships and
psychiatric status.^100 This information can help
practitioners determine the best course of
treatment for patients.^101
The instrument is a 200-item semi-structured
interview that takes a trained practitioner about
one hour to conduct and five minutes to score. It
also can be self-administered on paper or a
computer.^102Practitioners can be trained to administer and
score the index using manuals provided by the
developers. On-site trainings run by
experienced trainers also are available. The
index and basic manuals are available for a
minimal fee.^103Populations and Settings Served. The ASI
primarily is used in treatment planning. It has
been used with psychiatric, homeless, pregnant
and prisoner populations.^104 The ASI also is
used by researchers to assess patient outcomes in
clinical studies or by clinicians to assess the
progress of a patient’s disease during and after
treatment.^105 Thus far, the validity of the ASI
has been studied only in adult populations;^106
however, a version for adolescents, the Teen
Addiction Severity Index (T-ASI), has been
developed.^107 The T-ASI is helpful for
identifying adolescents with addiction and co-
occurring mental health conditions.^108Clinical Utility. The ASI has demonstrated
adequate test-retest reliability,^109 but the validity
of the ASI at identifying addiction varies among
studies.^110 The ASI measures aimed at
identifying addiction involving alcohol and other
drugs are significantly correlated with DSM-IV
diagnostic criteria. The alcohol and other drug
composite scores accurately identify 85 percent
of individuals with addiction and 80 percent of
individuals without addiction.^111However, the specificity of the instrument has
been questioned in certain studies--
misidentifying some patients as having addiction
when they do not--particularly among certain
psychiatric and international populations.^112The index frequently is used by researchers to
track the progress of treatment patients over
time. However, its length and complexity in
administering and scoring make it impractical
for use in primary care and emergency
department settings.^113