Validation of the Alcohol, Smoking and Substance Involvement Screening Test in a low- and middle-income country cross-sectional emergency centre study.

Abstract

Given the high prevalence and detrimental consequences of alcohol or other drug (AOD) use in low- and middle-income countries, a screening tool for early detection in health care, including emergency care, is critical. We set out to validate the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) for the South African context. We interviewed emergency centre patients (n = 200) in Cape Town for this cross-sectional study conducted from January to March 2013 utilising a questionnaire battery, including the ASSIST and Mini International Neuropsychiatric Interview. Internal consistency (Cronbach's alpha) and screening properties of the ASSIST (receiver operating characteristic analysis) were examined utilising the Mini International Neuropsychiatric Interview AOD use modules as the gold standard. Cronbach's alpha for alcohol and illicit drugs ranged from 0.81 to 0.95 indicating good internal consistency. ASSIST cut-off scores show a good sensitivity and specificity for discrimination particularly when distinguishing between substance use and abuse, rather than dependence. For alcohol, the area under the curve was 0.94 for distinguishing between use and abuse, and this dropped to 0.68 for distinguishing between abuse and dependence, while the statistic remained high for both use/abuse and abuse/dependence for illicit drugs: 0.95 and 0.96. AOD abuse was associated with cut-off scores below the World Health Organization recommended levels, in keeping with various international studies suggesting that individuals with lower scores be offered interventions. The ASSIST was found to be useful for South African health care and holds promise for cost-effective task-shifting approaches in lower resourced settings. [van der Westhuizen C, Wyatt G, Williams JK, Stein DJ, Sorsdahl K. Validation of the Alcohol, Smoking and Substance Involvement Screening Test in a low- and middle-income country cross-sectional emergency centre study. Drug Alcohol Rev 2016;35:702-709].