Najavits L M, Weiss R D, Reif S, Gastfriend D R, Siqueland L, Barber J P, Butler S F, Thase M, Blaine J
Harvard Medical School & McLean Hospital, Belmont, Massachusetts 02178, USA.
J Stud Alcohol. 1998 Jan;59(1):56-62. doi: 10.15288/jsa.1998.59.56.
The Addiction Severity Index (ASI) includes items to assess patients' history of trauma (physical or sexual). The goal of this study was to assess the sensitivity and specificity of those questions in relation to the Trauma History Questionnaire (THQ), a more thorough measure of lifetime trauma and, in addition, to an actual posttraumatic stress disorder (PTSD) diagnosis.
At the start of treatment cocaine dependent outpatients (N = 110, 65.5% male) were assessed on the ASI, the THQ and a PTSD symptom checklist as part of a multisite clinical trial.
Specificity of the ASI questions was higher than sensitivity for both sexual trauma (specificity = .96, sensitivity = .46) and physical trauma (specificity = .71, sensitivity = .50), while for PTSD the sensitivity of the ASI (.91) was higher than its specificity (.43). Other findings indicated that patients were more likely to report trauma on the THQ than on the ASI (which may be due to the self-report format of the THQ); that the ASI was better at assessing sexual than assessing physical trauma; and that the higher the number of ASI trauma items endorsed, the more likely was the PTSD diagnosis. Finally, PTSD patients had greater severity than non-PTSD patients on other ASI items (e.g., psychological severity, need for treatment).
The ASI trauma questions show stronger utility as a screen for PTSD than for trauma. Results of the study are discussed in light of ways to modify the ASI to screen more accurately for trauma, clinical implications, and limitations of the study method.
成瘾严重程度指数（ASI）包含评估患者创伤史（身体创伤或性创伤）的项目。本研究的目的是评估这些问题相对于创伤史问卷（THQ，一种对终生创伤更全面的测量工具）以及实际创伤后应激障碍（PTSD）诊断的敏感性和特异性。
作为一项多中心临床试验的一部分，在治疗开始时，对110名可卡因依赖门诊患者（65.5%为男性）进行了ASI、THQ和PTSD症状清单评估。
ASI问题对性创伤（特异性 = 0.96，敏感性 = 0.46）和身体创伤（特异性 = 0.71，敏感性 = 0.50）的特异性均高于敏感性，而对于PTSD，ASI的敏感性（0.91）高于其特异性（0.43）。其他研究结果表明，患者在THQ上比在ASI上更有可能报告创伤（这可能是由于THQ的自我报告形式）；ASI在评估性创伤方面比评估身体创伤方面表现更好；并且认可的ASI创伤项目数量越多，PTSD诊断的可能性就越大。最后，PTSD患者在其他ASI项目（如心理严重程度、治疗需求）上比非PTSD患者严重程度更高。
ASI创伤问题作为PTSD筛查工具比作为创伤筛查工具更具实用性。根据修改ASI以更准确筛查创伤的方法、临床意义和研究方法的局限性对研究结果进行了讨论。
