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Addiction Severity Index

User Information

Author/Developer / Address:

A.T. McLellan, L. Luborski, J. Cacciola, J. Griffith, P. McGRahan, Ch. P. O'Brien, The University of Pennsylvania / VA Administration / Center for Studies of Addiction.

Publication dates:

1992.

Description / Type of Assessment:

Objective face-to-face structured interview. It is a 161-item multidimensional clinical and research instrument.

Primary use / Purpose:

Designed to provide basic diagnostic information on a client prior, during and after treatment for substance use-related problems, and for the assessment of change in client status and treatment outcome.

Domains measured / Life Areas / Problems Assessed:

General information
Medical status
Chemical use (alcohol / drug use)
Employment/support
Family / social relationships
Legal status
Psychiatric / psychological status

Population:

Adults.

Administration / Completion Time:

30 - 45 minutes for a skilled and trained technician.

Scoring Procedures:

Not specified.

Scoring Time:

One minute (by computer). Five minutes (by hand).

Credentials/Training:

Assessors will require training in interviewing troubled clients with substance use-related problems.

Source of Psychometrics:

See relevant studies.

Languages:

Englis, Czech, Danish, English, French, Italian, Lithuanian, Hungarian, Dutch, Polish, Portuguese, Swedish, and, Russian.

Availability / Inquiries:

Treatment Research Institute
600 Public Ledger Building
150 South Independence Mall West
Philadelphia, PA  19106   USA
Phone:  00 1 215 399 0980
Fax:  00 1 215 399 0987
www.tresearch.org

Email contacts should be addressed to: asihelpline@tresearch.org

Price:

The ASI is in the public domain.

Practicability / usefulness:

The ASI is probably the most widely used standardised instrument in the field. It is used for client clinical assessment and research purposes. ASI data have been published on many different samples of drug abuse clients.
The ASI can be used for different purposes in assessing substance abuse clients: a) to assess the problem severity of the interviewee, and b) for periodic repeated administrations to monitor and quantify change in problems commonly associated to substance abuse.

Relevant Studies
Addiction Severity Index: Experience in the Field
Grissom, G.R., & Bragg, A. Addiction Severity Index: Experience in the Field. The International Journal of the Addictions, 26(1), 55-64, 1991.

Since its introduction in 1979, the Addiction Severity Index (ASI) has become one of the world's most widely used instruments in substance abuse treatment and research. Its wide acceptance suggests that enhancements of the ASI based upon users' experience would be of considera le value to clinicians and researchers. ASI users are the best source of information regarding the strengths and weakness of the instrument, adequacy of the ASI manual, requirements for training ASI interviewers, etc. This paper reports findings from a survey of 25 ASI users in the United States. Topics covered include reasons for selecting the ASI, modifications to the instrument made in response to site-specific requirements, and suggestions regarding enhancements which would promote its appropriate use by well-trained interviewers.

New Data from the Addiction Severity Index
McLellan, A.T., Luborsky, L., Cacciola, J., Griffith, J., Evans, F., Barr, H., O'Brien, Ch.P. New Data from the Addiction Severity Index. Reliability and Validity in Three Centers. The Journal of Nervous and Mental Disease, 173, 7, 412-423.

The Addiction Severity Index (ASI) is a clinical/research instrument which has been in wide use during the past 6 years to assess the treatment problems found in alcohol- and drug-abusing patients. In a study of male veterans, a preliminary evaluation of the ASI has indicated reliability and validity. The present report presents an expanded examination of these issues; 181 subjects from three treatment centers were studied. Results of concurrent reliability studies indicate that trained technicians can estimate the severity of patients' treatment problems with an average concordance of .89. Test-retest studies show that the information obtained from the ASI is consistent over a 3-day interval, even with different interviewers. Comparisons of the ASI severity ratings and composite measures with a battery of previously validated tests indicate evidence of concurrent and discriminant validity. The reliability and validity results were consistent across subgroups of patients categorized by age, race, sex, primary drug problem, and treatment center. The authors discuss the strengths and limitations of the instrument based upon 5 years of use. The overall conclusion is that the ASI is a reliable and valid instrument that has a wide range of clinical and research applications, and that it may offer advantages in the examination of important issues such as the prediction of treatment outcome, the comparison of different forms of treatment, and the "matching" of patients to treatments.

The Effects of Psychosocial Services in Substance Abuse Treatment.
McLellan, A.T., Arndt, I., Metzger, D., Woody, G.E., O'Brien, Ch.P. The Effects of Psychosocial Services in Substance Abuse Treatment. JAMA, 269, 15, 1953-1959, 1993.

Objective.-To examine whether the addition of counseling, medical care, and psychosocial services improves the efficacy of methadone hydrochloride therapy in the rehabilitation of opiate-dependent patients.

Design.-Random assignment to one of three treatment groups for a 6-month clinical that: (1) minimum methadone services (MMS)-methadone alone (a minimum of 60 mg/d) with no other services-, (2) standard methadone services (SMS) -same dose of methadone plus counseling-, or (3) enhanced methadone services (EMS)-same dose of methadone plus counseling and on-site medical/psychiatric, employment. and family therapy.

Setting.-The methadone maintenance program of the Philadelphia (Pa) Veterans Affairs Medical Center.

Subjects.-Ninety-two male intravenous opiate users in methadone maintenance treatment

Results.-While methadone treatment alone (MMS) was associated with reductions in opiate use, 69% of these subjects had to be "protectively transferred" from the that because of unremitting use of opiates or cocaine, or medical/ psychiatric emergencies. This was significantly different from the 41% of SMS subjects and 19% of EMS subjects who met the criteria. End-of-treatment data (at 24 weeks) showed minimal improvements among the 10 MMS patients who completed the trial. The SMS group showed significantly more and larger improvements than did the MMS group; and the EMS group showed significantly better outcomes than aid the SMS group. Minimum methadone services subjects who had been " protectively transferred" to standard care showed significant reductions in opiate and cocaine use within 4 weeks.

Conclusions.-Methadone alone (even in substantial doses) may only be effective for a minority of eligible patients. The addition of basic counseling was associated with major increases in efficacy; and the addition of on-site professional services was even more effective.

 

The Fifth Edition of the Addiction Severity Index
McLellan, A.T., Kushner, H., Metzger, D., peters, R., Smith, I., Grissom, G., Pettinati, H., Argeriou, M. The Fifth Edition of the Addiction Severity Index. Journal of Substance Abuse Treatment, 9, 199-213, 1992.

The Addiction Severity Index (ASI) is 12 years old and has been revised to include anew section on family history of alcohol, drug, and psychiatric problems. New items were added in existing sections to assess route of drug administration; additional illegal activities; emotional, physical, and sexual abuse, quality of the recovery environment; and history of close personal relationships. No changes were made in the composite scoring to maintain comparability with previous editions. This article discusses the clinical and research uses of the ASI over the past 12 years, emphasizing some special circumstances that affect its administration. The article then describes the rationale for and description of the changes made in the ASI. The final section provides "normative data" on the composite scores and severity ratings for samples of opiate, alcohol, and cocaine abusers as well as drug abusing inmates, pregnant women, homeless men, and psychiatrically ill substance abusers.

Predicting Relationships to a Hospital and a Professional.
Rogalski, C.J. The Addiction Severity Index: Predicting Relationships to a Hospital and a Professional.

The Addiction Severity Index was developed to be a useful instrument in treatment planning for the substance abuser. Multivariate statistical tests were conducted on the questionnaire for a clinical sample of 190 males at a Veterans Administration hospital. When the desire for psychological treatment with a specific person was taken into consideration, the overall predictive validity of the instrument in designating discharge accounted for 69% of the variance rather than 24% of the variance. This finding could challenge the myth that substance abusers and patients from lower socio-economic levels are not psychologically minded and not capable of being engaged in psychological process treatment. This finding is also relevant to governmental concerns for quality assurance and cost effectiveness, since it can be utilized to both improve treatment planning and delete irrelevant documentation and assessment procedures.

Page last updated: Monday, 04 April 2005