Evaluating an Addictions Assessment Tool, Essay Example

The Addiction Severity Index (ASI) is an assessment tool that hs been used for several decades to assess largely self-reported data provided by patients. The target goal of the ASI is to determine through the screening and assessment processes how to best provide treatment for those with substance abuse issues. The ASI has been translated into multiple languages and modified for cultural and cultural-sensitivity concerns for use with a variety of demographic populations both in the U.S. and in countries around the world. The ASI was initially designed as a research tool, but in the years since it was first developed it has made its way into clinical settings and in other practical settings, and has become a common tool for screening and assessing patients with substance abuse issues. Numerous studies have been conducted to assess the validity of the ASI; such studies have largely demonstrated that the ASI is a reliable, flexible, and cost-effective assessment tool for screening patients and clients with substance abuse issues.

The ASI is used to elicit information in seven primary areas to garner self-reported feedback from patients about how their substance abuse issues affect those areas. The seven areas are: physical health or medical status, employment and financial support, illegal or criminal activity, family and social relationships, psychiatric symptoms, and drug and alcohol use. The ASI interview subjects are asked to provide feedback about how their substance abuse issues have affected each of those seven areas over the last 30 days as well as over a lifetime; such responses are used to assess both the potentially chronic nature of the substance abuse issues as well as the potentially urgent nature of those issues (Makela, 2004).

The interview process is guided with the use of a form that prompts the interviewer to ask the necessary and appropriate questions related to the assessments in each of the seven areas. The interview is described as “semi-structured” because it is guided by the assessment form, yet leaves room for the interviewer to ask follow-up questions and to draw patients out when their responses are too brief or lacking in specificity. For this reason, it is necessary for ASI interviewers to be properly and adequately trained in the administration of the ASI. Because the ASI involves self-reporting, each assessment will necessarily be different from others; as such, the skills and experience of the interviewer are paramount in ensuring that adequate and appropriate information is gathered in each assessment (Makela).

The typical time for an ASI interview runs 45-60 minutes, with additional 10-15 minutes set aside afterwards for the administrator to review and assess the data. The ASI administrator or technician administers the ASI using pencil and paper and computer; the software used for the composite assessment is typically available at no cost or reduced cost, and is not subject to copyright, which helps to reduce costs in those settings where the availability of computers and other such tools may be limited (nih.gov; n.d.). The primary costs involved in the administration of the ASI are those related to the training of the administrator or technician, making the ASI an affordable and readily-available assessment tool in a variety of contexts.

The ASI is primarily used to assess substance abuse issues related to the use of alcohol, opiates, and cocaine, though it has also been modified for other purposes such as to assess the severity of gambling addiction and other issues (Makela). The data collected during the ASI is used to develop two scores. First are the severity ratings compiled from responses from clients or patients used by the administrator to develop a subjective analysis of the clients’ needs for treatment (nih.gov). Composite scores are developed by computer scoring, using normative data from a variety of subgroups, and the computer score determines the severity of a client’s substance abuse issues over the last 30 days; this score is combined with the administrator’s score to determine what course of action or form of treatment will be recommended to or provided for each client (nih.gov).

Numerous studies have been conducted on the ASI in an effort to determine whether it is a reliable and valid tool for use in clinical settings and other settings in which substance abusers will seek treatment. One such study, the results of which were published in 2000, examined the use of the ASI in a variety of inner-city alcohol- and drug-abuse clinics in several major U.S. cities. The primary purpose of the study was to look for evidence of internal consistency among each set of results garnered at individual clinics, as well as to weigh the combined results from each individual clinic against the results gathered at other clinics.

Then study found a number of results that were encouraging for users of the ASI. The conditions in each clinic were not always ideal; the quality of training and amount of experience for administrators varied from one setting to another, and in some cases the administrators were largely untrained. These conditions produced results among different clinics that varied to some degree; the study did determine, however, that there was a significant level of internal consistency within each individual clinic. The researchers in this case concluded that such internal consistency proved the ASI to be a fairly reliable assessment tool (Leonard, 2000).

A number of other studies conducted in the U.S. and around the world have supported similar conclusions regarding the validity and reliability of the ASI. With the varying conditions of each individual setting in which the ASI is administered, it is to be expected that some variations will be evident in assessment results. Overall, however, the ASI has demonstrated fairly reliable internal consistency in most settings, indicating that when the parameters in each setting are followed as closely as possible, the results of the assessment can be considered reliable. This consistent level of reliability, coupled with the low cost and ready availability of the ASI for a variety of settings, makes it a valuable assessment tool for determining how to best provide treatment for those with substance abuse issues.

References

Leonard, C. et al (2000). The Addiction Severity Index: A field study of internal consistency and validity. Journal of Substance Abuse Treatment , 18(2), 129-135.

Makela, K. (2004). Studies of the reliability and validity of the Addiction Severity Index. Addiction, 99(1), 398-410.

National Institute of Health (n.d.). Addiction Severity Index. Retrieved May 12, 2012, from http://pubs.niaaa.nih.gov/publications/AssessingAlcohol/InstrumentPDFs/04_ASI.pdf