Pritika C Kumar1, Charles M Cleland2, Marc N Gourevitch3, John Rotrosen4, Shiela Strauss5, Linnea Russell6, Jennifer McNeely7. 1. New York University, School of Medicine, Department of Population Health, New York, NY, United States. Electronic address: pritika.kumar@nyumc.org. 2. New York University, Rory Meyers College of Nursing, New York, NY, United States. Electronic address: chuck.cleland@nyu.edu. 3. New York University, School of Medicine, Department of Population Health, New York, NY, United States. Electronic address: marc.gourevitch@nyumc.org. 4. New York University, School of Medicine, Department of Population Health, New York, NY, United States. Electronic address: john.rotrosen@nyumc.org. 5. New York University, Rory Meyers College of Nursing, New York, NY, United States. Electronic address: shiela.strauss@nyu.edu. 6. New York University, School of Medicine, Department of Population Health, New York, NY, United States. Electronic address: linneacr@gmail.com. 7. New York University, School of Medicine, Department of Population Health, New York, NY, United States. Electronic address: Jennifer.McNeely@nyumc.org.
Abstract
BACKGROUND: An Audio Computer-assisted Self Interview (ACASI) version of the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) could reduce barriers to substance use screening and assessment in primary care settings. This study evaluated the diagnostic accuracy of an ACASI ASSIST for identification of unhealthy substance use and substance use disorders (SUD). METHODS: 399 adult patients were consecutively recruited from an urban safety-net primary care clinic. ACASI ASSIST scores for tobacco, alcohol, marijuana, and cocaine were compared against reference standard measures to assess the instrument's diagnostic accuracy for identifying unhealthy use and SUD, first using empirically-derived optimal cutoffs, and second using the currently recommended ASSIST cutoffs. RESULTS: For identifying any unhealthy use, at the empirically-derived cutoffs the ACASI ASSIST had 93.6% sensitivity and 85.8% specificity (AUC=0.90) for tobacco, 85.9% sensitivity and 60.3% specificity (AUC=0.73), for alcohol in men, 100% sensitivity and 62.4% specificity (AUC=0.81) for alcohol in women, 94.6% sensitivity and 81.6% specificity (AUC=0.88) for marijuana, and 86.1% sensitivity, 84.0% specificity (AUC=0.85) for cocaine. For SUD, sensitivity ranged from 79% (for alcohol in males), to 100% (for tobacco), and specificity was 83% or higher (AUCs ranged 0.83-0.91). For substances other than tobacco, empirically-derived cutoff scores were lower than the standard cutoffs, and resulted in higher sensitivity and lower specificity for identifying unhealthy substance use. CONCLUSIONS: The ACASI ASSIST is a valid measure of unhealthy use and SUD for substances that are commonly used by primary care patients, and could facilitate effective and efficient screening for substance use in medical settings.
BACKGROUND: An Audio Computer-assisted Self Interview (ACASI) version of the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) could reduce barriers to substance use screening and assessment in primary care settings. This study evaluated the diagnostic accuracy of an ACASI ASSIST for identification of unhealthy substance use and substance use disorders (SUD). METHODS: 399 adult patients were consecutively recruited from an urban safety-net primary care clinic. ACASI ASSIST scores for tobacco, alcohol, marijuana, and cocaine were compared against reference standard measures to assess the instrument's diagnostic accuracy for identifying unhealthy use and SUD, first using empirically-derived optimal cutoffs, and second using the currently recommended ASSIST cutoffs. RESULTS: For identifying any unhealthy use, at the empirically-derived cutoffs the ACASI ASSIST had 93.6% sensitivity and 85.8% specificity (AUC=0.90) for tobacco, 85.9% sensitivity and 60.3% specificity (AUC=0.73), for alcohol in men, 100% sensitivity and 62.4% specificity (AUC=0.81) for alcohol in women, 94.6% sensitivity and 81.6% specificity (AUC=0.88) for marijuana, and 86.1% sensitivity, 84.0% specificity (AUC=0.85) for cocaine. For SUD, sensitivity ranged from 79% (for alcohol in males), to 100% (for tobacco), and specificity was 83% or higher (AUCs ranged 0.83-0.91). For substances other than tobacco, empirically-derived cutoff scores were lower than the standard cutoffs, and resulted in higher sensitivity and lower specificity for identifying unhealthy substance use. CONCLUSIONS: The ACASI ASSIST is a valid measure of unhealthy use and SUD for substances that are commonly used by primary care patients, and could facilitate effective and efficient screening for substance use in medical settings.
Authors: Jan Gryczynski; Robert P Schwartz; Shannon Gwin Mitchell; Kevin E O'Grady; Steven J Ondersma Journal: Drug Alcohol Depend Date: 2014-05-17 Impact factor: 4.492
Authors: Jennifer McNeely; Shiela M Strauss; John Rotrosen; Arianne Ramautar; Marc N Gourevitch Journal: Addiction Date: 2015-10-26 Impact factor: 6.526
Authors: R P Schwartz; J McNeely; L T Wu; G Sharma; A Wahle; C Cushing; C D Nordeck; A Sharma; K E O'Grady; J Gryczynski; S G Mitchell; R L Ali; J Marsden; G A Subramaniam Journal: J Subst Abuse Treat Date: 2017-01-31
Authors: Jennifer McNeely; Sean J Haley; Allison J Smith; Noelle R Leonard; Charles M Cleland; Marcy Ferdschneider; Michele Calderoni; Luke Sleiter; Carlo Ciotoli; Angéline Adam Journal: J Am Coll Health Date: 2018-09-21
Authors: Juan Pablo Arab; Manhal Izzy; Lorenzo Leggio; Ramon Bataller; Vijay H Shah Journal: Nat Rev Gastroenterol Hepatol Date: 2021-11-01 Impact factor: 73.082