More efficient screening of substance abuse disorders using an audio computer-assisted self-interview yields diagnostic validity without compromising the accuracy of more time-consuming tools, found a recent study in Drug and Alcohol Dependence.
Brief screenings can capture those at risk of substance abuse disorders, but the one third of patients who will test positive for unhealthy substance use require further assessment. The World Health Organization’s Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) effectively does this but requires care providers to interview patients in person for 5-15 minutes, plus computing the score—a drain on time in resource-challenged clinics.
Pritika C. Kumar, PhD, and her colleagues at New York University recruited 399 ethnically and racially diverse patients, ages 18-65, to compare the accuracy of an Audio Computer-assisted Self Interview (ACASI) version of the ASSIST to that of validated gold-standard measures in identifying substance abuse disorders, including the Fagerström Test for Nicotine Dependence and the MINI Plus Version 6.0. Previous research had already shown the ACASI ASSIST and the traditional ASSIST had comparable results.
The ACASI ASSIST assesses current and lifetime use of tobacco, alcohol, marijuana, cocaine, stimulants, inhalants, sedatives, hallucinogens, and opioids, plus problems related to use and failure to stop or reduce use.
The ACASI ASSIST was 93.6% sensitive and 85.3% specific for unhealthy tobacco use (cutoff of >4), 94.6% sensitive and 81.6% specific for marijuana (cutoff of >2), and 86.1% sensitive and 84% specific for cocaine (cutoff of >2). For unhealthy alcohol use in men, its sensitivity was 85.9% and its specificity 60.3% with a cutoff of >5. In women, it was 100% sensitive for unhealthy alcohol use and 62.4% specific with a cutoff of >3.
For substance abuse disorders across the board, the range of sensitivity began at 79% for men’s alcohol substance abuse to 100% for all tobacco substance abuse. The specificity range for all substance abuse disorders was at least 83%.
“With increasing use of handheld devices, tablets and smart phones in health care, and of web-based patient portals into the electronic health record, the use of electronic self-administered questionnaires could greatly increase the efficiency and accuracy of screening for these behaviors in health care settings,” the authors wrote. “The self-administered approach may be particularly important for identifying stigmatized behaviors such as substance use, which patients are less likely to report in a face-to-face interview with clinical staff.”
Kumar PC, Cleland CM, Gourevitch MN, et al. Accuracy of the Audio Computer Assisted Self Interview version of the Alcohol, Smoking and Substance Involvement Screening Test (ACASI ASSIST) for identifying unhealthy substance use and substance use disorders in primary care patients. Drug Alcohol Depend. 2016. doi: 10.1016/j.drugalcdep.2016.05.030. [Epub ahead of print]