Addiction severity index
[1] One of its major applications is as a clinical assessment tool for clinicians to determine the severity of the addictions and the necessity for treatment through probing the patients' conditions in both health and social issues.
The ASI offers a more complete assessment of patients' conditions than other tools as the authors believed that the detrimental effects in health and social aspects are not merely the results of addictions and these issues could not be simply resolved by reducing the use of substances.
Before the development of the ASI, it was assumed that the addiction could be characterized by measuring the nature, amount, and duration of their substance use and would directly lead to health and social problems or even criminal behaviors.
[1] This shows the previous assumption was only partially correct and reflected a more complex relationship between substance addiction and health and social problems.
[1][3] Coupled with findings depicting that variation in the substance abuse treatment showed little effect on outcomes while the addition of health and/ or social services showed improved outcomes, the development of ASI funded by the Veterans Administration (VA) began in 1977 with an emphasis on analyzing patients' health and social background.
In the beginning, around 250 questions were prepared for the target population of 524 male veterans with alcohol and drug addictions from Coatesville and Philadelphia VA Medical Centers.
The "asking, listening, re-asking, and re-thinking" procedures would eventually narrow the survey down to 164 items categorized into 7 aspects.
However, several drawbacks of ISR, such as subjective data and low flexibility made it hard to apply in clinical practice.
The ASI-5 survey contains a total of 164 items inquiring about the general background of the patients (n= 28), their conditions in the respective areas would be asked in the following according to the participants' preference on privacy recorded during the development of ASI: 1) Medical health (n= 11) 2) Employment/ support status (n= 24) 3 & 4) Drug/ alcohol use (n= 35) 5) Illegal activity/ legal status (n= 32) 6) Family/ social relationships (n= 38) and 7) Psychiatric health (n= 23).
[1] The original purpose of ASI was to serve as a standardized data collection instrument for clinical staff for the determination of the severity of the addiction of patients through objective and subjective information.
[13] Lastly, the ASI is adopted in several pharmacovigilance studies by pharmaceutical companies to test for products abuse liability.
In addition, it is of paramount importance to understand that the ratings do not indicate the potential benefits from treatments but depict the extent to which some forms of effective interventions are needed regardless of their existence and availability.
[5] In clinical practice, two scores would be derived for each section by reviewing the patient's situation in two time frames, including lifetime and past-30 days from the date of the interview.
The system would be listed below:[1][5][15] Once a specific range is selected, the exact score would be determined based on the subjective information provided by the patient.
It would be related to their subjective perceptions of their addictions only for the past 30 days before the initiation of the interview and they would be asked to grade by themselves based on a 5-point system.
Once the interviewers have selected the suitable range of severity rating, they would further derive the exact score based on the patients' subjective judgement.
[1] Despite the tested reliability and validity of the ISR and its ability to summarize patients' overall status in clinical admission, it has several drawbacks that made it not favourable for research purposes.
[1][5] With reference to the shortcomings of ISR, composite scores (CSs) are derived specifically to evaluate changes over time and relativity to different population groups in research.
CSs are used in a scoring system that could be calculated for each of the 7 aspects by combining items from specific questions inquiring about the past 30-day status with equal weighting.
As clinicians gained more experience with the use of ASI-5 in real-life practice, it was pointed out that some questions in the questionnaire might be overlapping with information collected during admission.
[1] The principle of the revision is to add more content in each domain while shortening training and testing time, as well as retaining the essential element in ASI.
