Gryczynski Jan, Kelly Sharon M, Mitchell Shannon Gwin, Kirk Arethusa, O'Grady Kevin E, Schwartz Robert P
Friends Research Institute, Baltimore, MD, USA.
Addiction. 2015 Feb;110(2):240-7. doi: 10.1111/add.12767. Epub 2014 Nov 20.
The World Health Organization's Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) has strong support as a clinical screening tool and research instrument, but has only been validated with adults. This study evaluated the ASSIST and ASSIST-Lite in an adolescent population.
Internal consistency, concurrent validity, discriminant validity and diagnostic accuracy were examined for tobacco, alcohol and cannabis ASSIST scores. An abbreviated version (the ASSIST-Lite) was evaluated for cannabis.
Three community health centers in Baltimore, MD, USA.
A total of 525 primary care patients, ages 12-17 years.
Measures included the ASSIST, the CRAFFT screening tool and items from the Composite International Diagnostic Interview (CIDI) corresponding to substance use disorder criteria in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition.
The ASSIST had good internal consistency (α = 0.68-0.88), good concurrent validity with the CRAFFT (r = 0.41-0.76; P < 0.001), and was able to discriminate between gradations of cannabis problem severity. In receiver operating characteristics analysis of optimal clinical cut-points, the ASSIST accurately identified tobacco, alcohol and cannabis use disorders (sensitivities = 95-100%; specificities = 79-93%; area under the curve [AUC] = 0.90-0.94), but did so at minimally low cut-points (indicative of any use in the past 3 months). The ASSIST-Lite performed similarly to the ASSIST in identifying cannabis use disorders (sensitivity = 96%; specificity = 88%; AUC = 0.92), also at a minimally low cut-point. However, confirmatory factor analysis of the ASSIST indicated poor model fit.
The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) is promising as a research and screening/brief assessment tool with adolescents, but revisions to clinical risk thresholds are warranted. The ASSIST-Lite is sufficiently informative for rapid clinical screening of adolescents for cannabis use disorders.
世界卫生组织的酒精、吸烟及物质使用筛查测试（ASSIST）作为一种临床筛查工具和研究手段获得了大力支持，但仅在成年人中得到验证。本研究在青少年人群中对ASSIST和简化版ASSIST（ASSIST-Lite）进行了评估。
对烟草、酒精和大麻的ASSIST评分进行了内部一致性、同时效度、区分效度和诊断准确性的检验。对大麻评估了一个简化版本（ASSIST-Lite）。
美国马里兰州巴尔的摩的三个社区卫生中心。
总共525名年龄在12至17岁的初级保健患者。
测量指标包括ASSIST、CRAFFT筛查工具以及与《精神疾病诊断与统计手册》第5版中物质使用障碍标准相对应的综合国际诊断访谈（CIDI）项目。
ASSIST具有良好的内部一致性（α = 0.68 - 0.88），与CRAFFT具有良好的同时效度（r = 0.41 - 0.76；P < 0.001），并且能够区分大麻问题严重程度的不同等级。在最佳临床切点的受试者工作特征分析中，ASSIST准确识别了烟草、酒精和大麻使用障碍（敏感度 = 95 - 100%；特异度 = 79 - 93%；曲线下面积[AUC] = 0.90 - 0.94），但切点极低（表明过去3个月内有任何使用情况）。ASSIST-Lite在识别大麻使用障碍方面的表现与ASSIST相似（敏感度 = 96%；特异度 = 88%；AUC = 0.92），切点同样极低。然而，ASSIST的验证性因素分析表明模型拟合不佳。
酒精、吸烟及物质使用筛查测试（ASSIST）有望作为青少年的研究及筛查/简短评估工具，但有必要修订临床风险阈值。ASSIST-Lite对于快速临床筛查青少年大麻使用障碍具有足够的信息量。
