Addiction Severity Index (ASI)

The [Addiction Severity Index](http://www.enotes.com/drugs-alcohol-encyclopedia/addiction-severity-index-asi) (ASI) is a semi-structured interview for substance abuse assessment and treatment planning. The ASI is designed to gather valuable information about areas of a client’s life that may contribute to their substance-abuse problems.

The ASI was developed in 1980 by [A. Thomas McLellan](http://en.wikipedia.org/wiki/A._Thomas_McLellan), along with collaborators from the University of Pennsylvania’s Center for the Studies of Addiction. The ASI was the first standardized assessment tool of its kind to measure the multiple dimensions of substance abuse.

Today, the ASI is the most commonly used addiction assessment tool by state agencies and treatment providers. It is simple to use and cost effective. The ASI is conducted in an interview format by clinicians, researchers, and trained technicians worldwide. It has been translated into 18 languages, including Japanese, French, Spanish, German, and Dutch. Different versions, such as the [Teen-Addiction Severity Index (T-ADI)](http://www.emcdda.europa.eu/html.cfm/index4004EN.html) and the [Addiction Severity Index North Dokota State adaptation for use with Native-Americans (ASI_ND/NAV)](http://www.tresearch.org/resources/pubs/01_ASI-ND_Paper.pdf), have also been developed. Both are modified versions of the original ASI, and take into account age appropriateness and cultural sensitivities.

How the ASI works
The ASI focuses on the _big picture_. It takes into consideration that addiction to drugs or alcohol can result from life events that precede, occur at the same time as, or result from substance abuse problems. Rather than focusing on the client’s substance abuse, the ASI highlights seven potential problem areas. It covers medical status, employment and support, drug use, alcohol use, legal status, family/social status, and psychiatric status. This broad overview helps to determine the client’s level of stability. It has also proven useful for understanding life events that contribute to alcohol and drug dependency.

The Addiction Severity Index is a 1 hour face-to-face interview that takes place when a client is admitted for treatment. The ASI interviewer collects data in two parts: lifetime severity ratings and 30 day composite scores.

ASI Severity Ratings
Severity ratings are based on the following 10 point scale (0-9):

* __0-1__ No real problem, treatment not indicated
* __2-3__ Slight problem, treatment probably not necessary
* __4-5__ Moderate problem, some treatment indicated
* __6-7__ Considerable problem, treatment necessary
* __8-9__ Extreme problem, treatment absolutely necessary

The severity ratings scale allows for the interviewer to determine the seriousness of a client’s problem. The higher the score is, the greater the need for treatment in each area or immediate intervention. The ASI scores can be used to profile a client’s problem areas and then plan an effective course of treatment.

ASI Composite Scores
Composite scores were developed for measuring the treatment outcomes. Composite scores are indicators of change, and take into account only questions that pertain to the previous 30 days. The scores are computer generated, and represent mathematically sound measures of change in the problem status. The composite scores are considered a reliable and valid measurement because they can track the progress of treatment, or the lack thereof.

Reliability and Validity of the ASI
Overall, studies typically conclude that the Addiction Severity Index is a consistent and accurate tool for assessing clients and their substance abuse issues. The ASI is able to successfully identify the client’s problem area in which they are experiencing the greatest difficulties, such as alcohol or drug addiction, or legal or familial problems. Once a client’s psycho-social issues are identified, an appropriate course of treatment may be administered.

One study notes additional [useful applications of the ASI](http://www.ncbi.nlm.nih.gov/pubmed/4009158). These include predicting the treatment outcome, comparing different forms of treatment, and the ability to match a client with a specific treatment. However, as society changes, future studies of the ASI will be needed to demonstrate its value as an important assessment tool.

ASI and the Future
The ASI is evolving with technology into self-reporting formats via the Internet and automated telephone responses. These new formats provide the client with a greater sense of anonymity, as well as save agencies time and money. This technology has the potential for creating a national database to track effective treatments.

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