We ask authors to describe their impressions regarding the implications of their accepted work, how their findings will change practice, and what is noteworthy about the work.
Usefulness and validity of the modified Addiction Severity Index: A focus on alcohol, drugs, tobacco, and gambling
Cécile Denis , Mélina Fatséas , Virginie Beltran , Fuschia Serre , Jean-Marc Alexandre , Romain Debrabant , Jean-Pierre Daulouède , Marc Auriacombe
Substance Abuse
Vol. 37, Iss. 1, 2016
Among patients who seek treatment for addiction, comorbid substance use problems sometimes combined with non-substance addictive disorders such as gambling disorder are common. The lack of use of a unique severity assessment instrument by clinicians might be an obstacle for patients to access integrated and comprehensive treatment. This paper presents a modified version of the 5th version of the Addiction Severity Index (mASI) to assess all substance use disorders, including tobacco and non-substance addictive disorders such as gambling disorder. Although the 6th version of the ASI added items relative to tobacco use and gambling, these new items did not generate specific scores and were not taken into account in the computation of the scores of the ASI domains. In its 6th version the ASI is still focused on assessment of alcohol and/or drugs and items relative to tobacco and gambling are only to assess side-use to other main alcohol and/or drug use and is not suited for assessment of individuals with tobacco or gambling as their declared main problem use. In this study, 833 participants were interviewed with the mASI and completed a validity battery questionnaire. The mASI was reliable and its nine assessed domains showed a relative independence supporting its multi-dimensionality. The standardized properties of this mASI permit a comprehensive and systematic assessment of all addictions independently of patients’ perceived problems and treatment settings, hence facilitating better-personalized treatment planning. A more systematic use of the mASI may be helpful for clinicians to design the best treatment plans for a patient, for policy makers to objectively understand the needs in treatment, care centers or other institutions but also for researchers to measure contemporary issues in addiction treatment. For research purposes, the use of a unique instrument allows researchers to better address the similarities and differences between addictions by avoiding potential artifact due to a multiplication of tools needed to assess a same individual. The difficulty to conclude about the impact of addictive behavior on the treatment outcome of another addictive behavior may be explained by the heterogeneity of the assessment tools. Treatment programs focused on promoting abstinence from substance use might consider monitoring all possible addictive behaviors including tobacco use and gambling as it is possible that the addictive disorder might still be active and individuals may switch their addictive behaviors to tobacco, gambling or other addictive behaviors.
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