title: Ultra-rapid screening for substance-use disorders: the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST-Lite).
abstract: BACKGROUND
  The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST 3.0; index test) is a structured interview for alcohol, tobacco, cannabis, stimulants, sedatives and opioid use disorders in general medical settings. Perceived administration time deters routine use. This study releases a short-form: the ASSIST-Lite.
  
  
  METHODS
  Diagnostic accuracy study among 2082 adults recruited from general medical (70%) and specialist mental health/addiction treatment services (22%). Current DSM-IV substance dependence (MINI International Neuropsychiatric Interview) and moderate-severe tobacco dependence (Fagerstrom Nicotine Dependence Test) were reference standards. Exploratory factor and item-response theory models re-calibrated ordinal test items. Items for the ASSIST-Lite were selected by diagnostic accuracy evaluation (area under the receiver-operating characteristic [AUC] curve [≤0.7]), sensitivity, specificity, positive and negative predictive values [PVP, NVP], kappa, likelihood ratios [LR+, LR-], and clinical utility index [CU+, CU-]).
  
  
  RESULTS
  For each substance an item pair was selected (AUC [0.8-1.0], sensitivity [0.8-1.0], specificity [0.7-0.8], PVP [0.8-1.0], NVP [0.7-1.0], kappa [0.5-0.9], LR+ [2.5-5.9], LR- [0.0-0.2], CU+ [0.7-0.9], and CU- [0.5-0.8]). Gender, age and recruitment setting (specialist mental health versus general medical) did not moderate accuracy, with the exception of opioids (AUC <0.7, participants ≥59 years). Male opioid users had more severe substance involvement scores that females (differential item functioning analysis, P=0.00). There was no evidence of differential accuracy between countries (AUC range, 0.8-1.0).
  
  
  CONCLUSIONS
  The ASSIST-Lite is an ultra-rapid screener which has been optimised for general medical settings. Optionally, a criterion question can be added to capture hazardous drinking, and to capture use of another type of mood-altering substance.
authors.affiliation: Discipline of Pharmacology, School of Medical Sciences, University of Adelaide, South Australia 5005, Australia. robert.ali@adelaide.edu.au
authors.forename: Robert
authors.initials: R
authors.lastname: Ali
authors.forename: Sonali
authors.initials: S
authors.lastname: Meena
authors.forename: Brian
authors.initials: B
authors.lastname: Eastwood
authors.forename: Ian
authors.initials: I
authors.lastname: Richards
authors.forename: John
authors.initials: J
authors.lastname: Marsden
mesh_terms: D000293:Adolescent; D000328:Adult; D000437:Alcoholism / Q000523:psychology*; D015982:Bias; D026661:Clinical Trials Data Monitoring Committees; D019970:Cocaine-Related Disorders / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011594:Psychometrics; D015203:Reproducibility of Results; D012907:Smoking / Q000523:psychology*; D015813:Substance Abuse Detection / Q000523:psychology*; D055815:Young Adult
keywords: ASSIST-Lite; Alcohol, Smoking and Substance Involvement Screening Test; Alcohol, tobacco, cannabis, stimulant, sedative, opioid, substance use disorder; Screening; Substance dependence