Measuring “addiction” in Europe: The diffusion of the Addiction Severity Index, and its purposes and functions

Abstract

This paper discusses what an instrument like the Addiction Severity Index (ASI) offers to various actors in the diverse addiction treatment systems of Europe and what the use of the ASI means and implies at the treatment system level. It is concluded that the adoption of the ASI can be linked to a number of factors, including the demands for cost‐efficiency, scientific legitimacy of addiction treatment, professionalization, internationalism, and unification of a diverse system. Furthermore, it considers the specific choices embedded in the structure and content of the ASI—how the use of the ASI structures the user's view of the situation and life‐trajectory of the individual client. Features such as the length of the interview, the time frames of the question, the exclusion of measures of dependence and alcohol‐/drug‐attributable problems and the inclusion of client's rating, are discussed. It is concluded that the opinions about the usefulness of the ASI in Europe vary. For the future of measurement of alcohol and drug problems in Europe, for system monitoring and international comparisons, shorter instruments seem to be the likely path forward. The article draws to a large extent on the papers presented at a conference, “Measuring ‘addiction’ in Europe: clinical, sociological, cultural and policy aspects of Addiction Severity Index (ASI) and other international instruments”, at Skarpö, Sweden, in January 2003.