The Alcohol, Smoking and Substance Involvement Screening Tool is a short questionnaire developed by the World Health Organization in order to identify people likely affected by significant problems with alcohol, drugs/medications or nicotine/tobacco. This questionnaire was designed for use in adult populations, and no one knows for sure how well it works for teenagers.
In a study published in October 2014 in the journal Addiction, a team of American researchers sought to determine the accuracy and usefulness of ASSIST in preteens and teenagers between the ages of 12 and 17.
Teenagers And Substance Use
Substantial numbers of U.S. teenagers drink alcohol, smoke cigarettes or abuse a drug or medication, according to the 2013 results of an ongoing, federally sponsored survey project called Monitoring the Future. About 39 percent of high school seniors consume at least some alcohol in the typical month. In addition, roughly 26 percent of seniors use marijuana or some other illicit or illegal drug or medication. Roughly 16 percent of American high school seniors smoke cigarettes in the typical month.
Younger teenagers consistently drink, smoke and abuse drugs/medications at a lower rate than older teenagers. For example, only 26 percent of 10th graders and 10 percent of eighth graders consume alcohol on a monthly basis. Nineteen percent of 10th graders and 9 percent of eighth graders use marijuana or another drug or medication in the average month, while 9 percent of 10th graders and 5 percent of eighth graders smoke cigarettes.
Cigarette and alcohol use are on the decline among U.S. teens. In the case of cigarettes, this trend extends back more than 15 years. In the case of alcohol, it extends back about 14 years, although not as consistently as the overall pattern for cigarette use. Conversely, illicit/illegal drug use is on the rise among U.S. teens. Increased marijuana consumption largely accounts for this upward trend.
ASSIST Substance Screening
The Alcohol, Smoking and Substance Involvement Screening Tool poses eight questions on substance use/abuse. Topics covered by these questions include lifetime use of any substance, recent use of any substance, level of desire for substance intake, recent exposure to any seriously negative consequences of substance use, level of concern that a person’s substance use generates in friends or family, lack of the ability to control substance use and any level of involvement with injection drug use. Depending on the responses given to the eight questions, a person can have an overall ASSIST score that ranges from 0 to 31 for nicotine/tobacco and from 0 to 39 for any other single substance. With the exception of alcohol-related matters, anyone with a score of 4 or higher is either at-risk for substance problems (a score of 4 to 26) or likely already has a substance problem (a score of 27 or higher). People at-risk for alcohol problems have an ASSIST score of 11 to 26, while people likely already affected by such problems have a score of 27 or higher.
ASSIST’s Usefulness For Teens
In the study published in Addiction, researchers from the University of Maryland, Friends Research Institute and Total Health Care used information gathered from 525 preteens and teens between the ages of 12 and 17 to gauge the usefulness of ASSIST for adolescents potentially affected by substance problems. All of these participants filled out the questionnaire. The researchers compared the results of this testing to results from two other screening procedures: the Composite International Diagnostic Interview and an adolescent-specific test called the CRAFFT screening tool.
The researchers concluded that the results of ASSIST match up fairly well with the results of the adolescent-specific CRAFFT screening tool. In particular, ASSIST can uncover current or possible future problems with cannabis abuse/addiction, alcohol abuse/addiction and nicotine addiction. However, the researchers note, ASSIST can only accurately identify short-term issues associated with these conditions, not lifetime issues. The researchers also tested the usefulness of a simplified form of ASSIST known as ASSIST-Lite. They concluded that this version of the screening may help identify some cannabis-related issues, but not with a sufficient amount of consistency.
ASSIST Screening Tool’s Effectiveness
Overall, the study’s authors believe that the Alcohol, Smoking and Substance Involvement Screening Tool may be useful both as a research tool and as a practical means of identifying preteens and teens either at-risk for substance problems or currently affected by substance problems. However, they note, the test will need to be modified somewhat before it provides benefits for adolescents in a research or real-world setting.
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