Accuracy of the Audio Computer Assisted Self Interview version of the Alcohol, Smoking and Substance Involvement Screening Test (ACASI ASSIST) for identifying unhealthy substance use and substance use disorders in primary care patients
Accuracy of the Audio Computer Assisted Self Interview version of the Alcohol, Smoking and Substance Involvement Screening Test (ACASI ASSIST) for identifying unhealthy substance use and substance use disorders in primary care patients
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DOI：
10.1016/j.drugalcdep.2016.05.030
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发表时间：
2016-08-01
影响因子：
4.2
通讯作者：
McNeely, Jennifer
中科院分区：
文献类型：
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作者：
Kumar, Pritika C.;Cleland, Charles M.;McNeely, Jennifer
背景：音频计算机辅助自我访谈（ACASI）版本的酒精、吸烟和物质介入筛查测试（ASSIST）可以减少初级保健机构中物质使用筛查和评估的障碍。本研究评估了ACASI ASSIST识别不健康物质使用和物质使用障碍（SUD）的诊断准确性。方法：从城市安全网初级保健诊所连续招募399例成年患者。将烟草、酒精、大麻和可卡因的ACASI ASSIST评分与参考标准措施进行比较，以评估仪器在识别不健康使用和SUD方面的诊断准确性，首先使用经验推导的最佳截止值，其次使用目前推荐的ASSIST截止值。结果：对于识别任何不健康的使用，在经验衍生的截止点上，ACASI ASSIST对烟草的敏感性为93.6%，特异性为85.8% (AUC=0.90)；对男性酒精的敏感性为85.9%，特异性为60.3% (AUC=0.73)；对女性酒精的敏感性为100%，特异性为62.4% (AUC=0.81)；对大麻的敏感性为94.6%，特异性为81.6% (AUC=0.88)；对可卡因的敏感性为86.1%，特异性为84.0% （AUC=0.85）。对于SUD，敏感性从79%（男性酒精）到100%（烟草）不等，特异性为83%或更高（auc范围为0.83-0.91）。对于烟草以外的物质，经验推导的截止分数低于标准截止分数，导致识别不健康物质使用的灵敏度更高，特异性较低。结论：ACASI ASSIST是衡量初级保健患者常用物质不健康使用和SUD的有效指标，可促进医疗机构中物质使用的有效筛查。2016爱思唯尔爱尔兰有限公司版权所有。
Background: An Audio Computer-assisted Self Interview (ACASI) version of the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) could reduce barriers to substance use screening and assessment in primary care settings. This study evaluated the diagnostic accuracy of an ACASI ASSIST for identification of unhealthy substance use and substance use disorders (SUD).Methods: 399 adult patients were consecutively recruited from an urban safety-net primary care clinic. ACASI ASSIST scores for tobacco, alcohol, marijuana, and cocaine were compared against reference standard measures to assess the instrument's diagnostic accuracy for identifying unhealthy use and SUD, first using empirically-derived optimal cutoffs, and second using the currently recommended ASSIST cutoffs.Results: For identifying any unhealthy use, at the empirically-derived cutoffs the ACASI ASSIST had 93.6% sensitivity and 85.8% specificity (AUC=0.90) for tobacco, 85.9% sensitivity and 60.3% specificity (AUC=0.73), for alcohol in men, 100% sensitivity and 62.4% specificity (AUC=0.81) for alcohol in women, 94.6% sensitivity and 81.6% specificity (AUC=0.88) for marijuana, and 86.1% sensitivity, 84.0% specificity (AUC=0.85) for cocaine. For SUD, sensitivity ranged from 79% (for alcohol in males), to 100% (for tobacco), and specificity was 83% or higher (AUCs ranged 0.83-0.91). For substances other than tobacco, empirically-derived cutoff scores were lower than the standard cutoffs, and resulted in higher sensitivity and lower specificity for identifying unhealthy substance use.Conclusions: The ACASI ASSIST is a valid measure of unhealthy use and SUD for substances that are commonly used by primary care patients, and could facilitate effective and efficient screening for substance use in medical settings. (C) 2016 Elsevier Ireland Ltd. All rights reserved.