Reliability and Validity of the Addiction Severity Index with a Homeless Sample

William Penn University, Filadelfia, Pennsylvania, United States
Journal of Substance Abuse Treatment (Impact Factor: 3.14). 11/1994; 11(6):541-8. DOI: 10.1016/0740-5472(94)90005-1
Source: PubMed


The Addiction Severity Index (ASI) is an instrument widely used to assess the treatment problems of substance users. Its psychometric properties have been tested and found satisfactory for many types of substance abusers entering treatment. However, there are many other subgroups of substance users not in formal treatment, such as homeless substance users. While the ASI has been used with this subgroup, its psychometric properties remain questionable. This study examined the reliability and validity of the ASI in a sample of 98 homeless substance users awaiting temporary housing placement. Test-retest reliability found the ASI to have moderate to high reliability coefficients in each of the seven domains assessed. Both composite score and severity rating measures were found to be quite independent with low intercorrelations. Three of the seven ASI composite scores were tested for and found to have moderate concurrent validity: alcohol (r = .31 to .36), drug (r = .46), and psychiatric (r = .53 to .66). Composite score interitem correlations were .70 or greater in each of the domains except for employment (.50) and family (.52). These data suggest that, although there are some limitations in using the ASI with homeless substance users, it demonstrated acceptable reliability and validity.

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    • "Under-reporting of drug use may vary according to drug class, though there is little consensus on which classes are more affected (Brown et al., 1992; Darke, 1998; Falck, Siegal, & Carlson, 1992; Magura et al., 1987; Perrone et al., 2001; Sherman & Bigelow, 1992; Solbergsdottir et al., 2004; Zanis et al., 1994). Over-reporting use (reporting positive when urine screen is negative) may also occur but is less frequent than under-reporting, and findings of over-reporting may be due to the inaccuracy of the assay procedure (Akinci et al., 2001; Brown et al., 1992; Jain, 2004; Magura et al., 1987; Perrone et al., 2001; Sherman & Bigelow, 1992; Solbergsdottir et al., 2004; Zanis et al., 1994). Contingencies also affect the validity of self-reports. "
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    ABSTRACT: Objective measures of drug use are very important in treatment outcome studies of persons with substance use disorders, but obtaining and interpreting them can be challenging and not always practical. Thus, it is important to determine if, and when, drug-use self-reports are valid. To this end we explored the relationships between urine drug screen results and self-reported substance use among adolescents and young adults with opioid dependence participating in a clinical trial of buprenorphine-naloxone. In this study, 152 individuals seeking treatment for opioid dependence were randomized to a 2-week detoxification with buprenorphine-naloxone (DETOX) or 12weeks of buprenorphine-naloxone (BUP), each with weekly individual and group drug counseling. Urine drug screens and self-reported frequency of drug use were obtained weekly, and patients were paid $5 for completing weekly assessments. At weeks 4, 8, and 12, more extensive assessments were done, and participants were reimbursed $75. Self-report data were dichotomized (positive vs. negative), and for each major drug class we computed the kappa statistic and the sensitivity, specificity, positive predictive value, and negative predictive value of self-report using urine drug screens as the "gold standard". Generalized linear mixed models were used to explore the effect of treatment group assignment, compensation amounts, and participant characteristics on self-report. In general, findings supported the validity of self-reported drug use. However, those in the BUP group were more likely to under-report cocaine and opioid use. Therefore, if used alone, self-report would have magnified the treatment effect of the BUP condition.
    Addictive behaviors 06/2013; 38(10):2568-2574. DOI:10.1016/j.addbeh.2013.05.015 · 2.76 Impact Factor
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    • "The Addiction Severity Index (ASI) [15-17] is a well-documented instrument for the assessment of substance use and related problems. It is well established as a tool in addiction research, and has acceptable validity [15-19]. Annually, around 10,000 clients enter the Swedish prison system, and around 66 percent of prisoners are estimated to suffer from a substance abuse problem. "
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    ABSTRACT: Background Substance use in general has been shown to predict criminal recidivism. The present study aimed to examine potential predictors of criminal recidivism, including substance-specific substance use patterns, in prisoners with substance use. Methods A cohort of prisoners with substance use problems (N = 4,152) were assessed with the Addiction Severity Index (ASI) in the Swedish criminal justice system. Clients were followed for an average of 2.7 years. Criminal recidivism was defined as any return to the criminal justice system. Results During follow-up, 69 percent (n = 2,862) returned to the criminal justice system. Recidivism was associated with amphetamine and heroin use, with an additive risk for injectors, and with polysubstance use. Also, recidivism was negatively associated with alcohol, other opioids than heroin/methadone and with hallucinogenic drugs, and positively associated with previous psychiatric in-patient treatment, violent behaviour, and with a shorter index sentence. Associations remained when controlling for type of crime. Conclusions Even when controlling for type and severity of crime, and for psychiatric problems, risk of criminal relapse was increased by substance use variables, including amphetamine, heroin and polysubstance use, and an additional risk was shown for injection drug users. These findings have implications for the need for substance abuse treatment after release from prison.
    BMC Psychiatry 08/2012; 12(1):111. DOI:10.1186/1471-244X-12-111 · 2.21 Impact Factor
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    • "for the ASI, and its test–retest reliability ranged from .64 to .95 in studies of people with substance abuse problems (Daeppen et al., 1996; Drake, McHugo, & Biesanz, 1995). Other studies reporting ASI development and psychometric properties include: Fanzese, 2005; Mäkelä, 2004; McLellan, Cacciola, Alterman, Rikoon, and Carise, 2006; and Zanis, McLellan, Cnaan, and Randall, 1994. Especially, Fanzese (2005) reviewed studies of ASI reliability and validity with different samples over a 15-year period and concluded that it is a reliable and valid instrument. "
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    ABSTRACT: Objective: A pilot randomized clinical trial (RCT) examined effectiveness of HIV/STD Safer Sex Skills Building + Alcohol (SSB+A) intervention for women with Alcohol Use Disorders (AUDs) in a residential treatment setting. Method: After randomizing thirty-six women with AUDs and reporting having intercourse with a male partner in the past 180 days to SSB+A or HE (standard HIV/STD education) groups, rates of penetrative intercourse with and without condoms at 60 day and 180 day follow-up were compared between SSB+A or HE groups. Results: There was a significant difference in mean number of sex acts with condoms between SSB+A and HE groups over time. Specifically, SSB+A and HE groups did not differ at 60 day follow-up, but at 180 day follow-up, mean sex acts with condoms among SSB+A group was significantly higher than HE. Conclusion: Pilot study findings affirm the effectiveness of the SSB+A in reducing sexual risk behaviors of AUD women and support the need for further research, testing the SSB+A intervention in a larger sample of women and across different treatment modalities. The present study also illustrates the critical link between practice and use of a step by step model of intervention research.
    Research on Social Work Practice 06/2012; 22(4):367-379. DOI:10.1177/1049731512441683 · 1.53 Impact Factor
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