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New Data from the Addiction Severity Index Reliability and Validity in Three Centers
Abstract
The Addiction Severity Index (ASI) is a clinical/research instrument which has been in wide use during the past 6 years to assess the treatment problems found in alcohol- and drug-abusing patients. In a study of male veterans, a preliminary evaluation of the ASI has indicated reliability and validity. The present report presents an expanded examination of these issues; 181 subjects from three treatment centers were studied. Results of concurrent reliability studies indicate that trained technicians can estimate the severity of patients' treatment problems with an average concordance of .89. Test-retest studies show that the information obtained from the ASI is consistent over a 3-day interval, even with different interviewers. Comparisons of the ASI severity ratings and composite measures with a battery of previously validated tests indicate evidence of concurrent and discriminant validity. The reliability and validity results were consistent across subgroups of patients categorized by age, race, sex, primary drug problem, and treatment center. The authors discuss the strengths and limitations of the instrument based upon 5 years of use. The overall conclusion is that the ASI is a reliable and valid instrument that has a wide range of clinical and research applications, and that it may offer advantages in the examination of important issues such as the prediction of treatment outcome, the comparison of different forms of treatment, and the "matching" of patients to treatments…
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“The ASI has demonstrated reliability and validity (Kosten, Rounsaville & Kleber, 1983; McLellan et al., 1985), including in PGs (Petry, 2007).”
From Subtyping Pathological Gamblers Based on Impulsivity, Depression, and Anxiety (2010) · cites this paper as McLellan et al., 1985
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Self-citationUses of diverted methadone and buprenorphine by opioid-addicted individuals in Baltimore, Maryland
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“The reliability and validity of the instrument has been found to be high across a wide range of substance users (McLellan et al., 1985, 1992).”
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“The first questionnaire was the Addiction Severity Index (ASI), which is a structured interview that addressed seven major aspects of the interviewee's life: medical history, legal history, psychiatric history, their family history and social life, and their alcohol and drug use (McLellan et al., 1985).”
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“Alcohol and drug use were assessed by short versions of indices from the Addiction Severity Index (range 0–1) (McClellan et al., 1985).”
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Self-citationDiscounting of money, health, and freedom in substance abusers and controls
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“The Addiction Severity Index (ASI) has been widely used in drug treatment research and its reliability and validity are well-established (McLellan et al., 1985).”
MethodMcKay, J., Pettinati, H., Morrison, R., Feeley, M., Mulvaney, F., & Gallop, R. (2002) · Psychology of Addictive Behaviors · doi:10.1037/0893-164x.16.3.225 · Cited by 100
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“However, the finding that the CSs were more reliable than SRs is consistent with other reliability and validity studies of the ASI (Alterman et al., 1994; McLellan et al., 1985; Zanis et al., 1994).”
ResultSelf-citationGerstley, L., Mclellan, A., Alterman, A., Woody, G., Luborsky, L., & Prout, M. (1989) · American Journal of Psychiatry · doi:10.1176/ajp.146.4.508 · Cited by 99
Self-citationPrescription OxyContin abuse among patients entering addiction treatment.
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Self-citationCharacteristics of older opioid maintenance patients
Lofwall, M. R., Brooner, R. K., Bigelow, G. E., Kindbom, K., & Strain, E. C. (2005) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2005.01.007 · Cited by 105
“, 1992), Addiction Severity Index, 5th Edition (ASI; Kosten, Rounsaville, & Kleber, 1983; McLellan, Luborsky, Woody, & O’Brien, 1980; McLellan et al., 1985), and the Short Form-36 Version 2 (SF-36v2; McHorney, Ware, & Raczek, 1993; McHorney, Ware, Lu, & Sherbourne, 1994; Ware & Sherbourne, 1992).”
Domestic violence in women with PTSD and substance abuse.
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“The ASI has demonstrated moderate to excellent internal consistency, test–retest reliability, and interrater reliability in different groups of substance abusers (Alterman, Brown, Zaballero, & McKay, 1994; McLellan et al., 1985).”
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“92 or greater; and construct validity has been adequately established through correlations with other relevant, well-validated instruments and predicted criterion measures (McLellan et al., 1985).”
BackgroundImpacts of Perceived Legal Pressure on Retention in Drug Treatment
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The National Institute on Drug Abuse Collaborative Cocaine Treatment Study. Rationale and methods.
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“The ASI has demonstrated excellent reliability and validity across diverse patient populations (Hodgins and El Guebaly 1992; Joyner, Wright, and Devine 1996; McLellan et al. 1985).”
BackgroundKrupitsky, E. M., Zvartau, E. E., Masalov, D. V., Tsoy, M. V., Burakov, A. M., Egorova, V. Y., Didenko, T. Y., Romanova, T. N., Ivanova, E. B., Bespalov, A. Y., et al. (2006) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2006.05.005 · Cited by 93
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“Using a color-coded bar chart comparing the recent ASI and patient-rated severity items per problem area, the DDMI therapist compares and contrasts the ratings, notes rating discrepancies, and promotes the patients’ exploration of their substance use in relationship to other areas, particularly in interaction with the…”
InfluentialKrupitsky, E., Zvartau, E., Blokhina, E., Verbitskaya, E., Wahlgren, V., Tsoy-Podosenin, M., Bushara, N., Burakov, A., Masalov, D., Romanova, T., et al. (2016) · The American Journal of Drug and Alcohol Abuse · doi:10.1080/00952990.2016.1197231 · Cited by 91
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Effect of clinician-veteran racial pairing in the treatment of posttraumatic stress disorder.
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“…of the candidate indices included here, which focus only on drug use, to a single measure indicating relatively unambiguous positive outcome on a number of dimensions, we developed a proxy dichotomous measure for good functioning, based on Addiction Severity Index (ASI; McLellan et al., 1985).”
Telescoping of Drinking-Related Behaviors: Gender, Racial/Ethnic, and Age Comparisons
Johnson, P. B., Richter, L., Kleber, H., Mclellan, A., & Carise, D. (2005) · Substance Use & Misuse · doi:10.1081/ja-200042281 · Cited by 90
“The decision to focus on ASI responses followed more than 20 years of replicated reliability, validity, and utility evaluation of the instrument with a very wide range of substance abusers (McLellan et al., 1980, 1985, 1992).”
BackgroundSelf-citationMarlowe, D., Festinger, D., Lee, P. A., Schepise, M. M., Hazzard, J. E. R., Merrill, J., Mulvaney, F., & Mclellan, A. (2003) · Criminal Justice and Behavior · doi:10.1177/0093854802250997 · Cited by 90
“Multiple examinations of ASI composite scores and lifetime items have indicated adequate test-retest reliability, internal consistency, concurrent validity, and predictive validity across groups of clients characterized by age, race, gender, and primary drug of abuse (e.g., Cacciola, Koppenhaver, McKay, & Alterman, 19…”
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Self-citationA Prospective Study of Integrated Outpatient Treatment for Substance-Abusing Schizophrenic Patients
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Stages of change in treatment-seeking pathological gamblers.
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“Studies demonstrate reliability and validity of this instrument in a variety of substance abusing populations (Kosten, Rounsaville, & Kleber, 1983; McLellan et al., 1985), and the ASI is one of the most commonly used instruments for both clinical and research purposes in addiction populations.”
BackgroundMethodInfluentialStress, craving and mood as predictors of early dropout from opioid agonist therapy
Panlilio, L., Stull, S., Kowalczyk, W., Phillips, K. A., Schroeder, J., Bertz, J., Vahabzadeh, M., Lin, J.-L., Mezghanni, M., Nunes, E., et al. (2019) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2019.05.026 · Cited by 88
“During a screening session, each participant completed the Addiction Severity Index (ASI) (McLellan et al., 1985), a semi-structured interview covering a wide range of psychosocial variables.”
MethodInfluentialRecent Status Scores for Version 6 of the Addiction Severity Index (ASI-6)
Cacciola, J., Alterman, A., Habing, B., & McLellan, A. (2011) · Addiction · doi:10.1111/j.1360-0443.2011.03482.x · Cited by 88
“The stronger relationships were those that also had been identified with previous versions of the ASI [6,8,12].”
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Predicting DSM-IV dependence diagnoses from Addiction Severity Index composite scores.
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“The ASI is a semistructured multidimensional instrument assessing seven life domains (McLellan et al., 1992; McLellan et al., 1985; McLellan, Luborsky, Woody, & O’Brien, 1980).”
BackgroundSelf-citationPhysical and sexual abuse history and addiction treatment outcomes
Rosen, C. S., Ouimette, P. C., Sheikh, J. I., Gregg, J. A., & Moos, R. H. (2002) · Journal of Studies on Alcohol · doi:10.15288/jsa.2002.63.683 · Cited by 86
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VALIDITY OF A GAMBLING SCALE FOR THE ADDICTION SEVERITY INDEX
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“The ASI (McLellan et al., 1985) was administered by trained interviewers; they received didactic instruction, reviewed manuals about the instrument, and practiced administration of at least 5 supervised interviews prior to study initiation.”
BackgroundMethodInfluentialExacerbated craving in the presence of stress and drug cues in drug-dependent patients
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“The majority of neurocognitive studies of drug addiction employ the SCID-Substance Abuse Module (First et al. 1996), the well-established Addictions Severity Index (McLellan et al. 1985) or the newer KreekMcHugh-Schluger-Kellogg Scale (Kellogg et al. 2003).”
Reinforcing compliance with non-drug-related activities.
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“66) (McLellan et al., 1985; Zanis et al., 1994).”
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“Thus, questions from several of the leading health services instruments (40,41,42,43) were reviewed and selected.”
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Community reinforcement approach in the treatment of opiate addicts.
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A randomized trial of contingency management delivered by community therapists
Petry, N., Alessi, S. M., & Ledgerwood, D. M. (2012) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0026826 · Cited by 82
Courbasson, C. M. A., Nishikawa, Y., & Shapira, L. B. (2010) · Eating Disorders · doi:10.1080/10640266.2011.533603 · Cited by 79
McKay, J. R., Horn, D. H. A. V., Oslin, D. W., Lynch, K. G., Ivey, M. A., Ward, K., Drapkin, M. L., Kraut-Becher, J. R., & Coviello, D. M. (2010) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0020700 · Cited by 83
“The ASI has demonstrated adequate to good internal consistency, test–retest, and interrater reliabilities in different groups of substance abusers (McLellan et al., 1985).”
Contingency Management among Homeless, Out-of-Treatment Men who have Sex with Men
Reback, C., Peck, J., Dierst-Davies, R., Nuno, M., Kamien, J. B., & Amass, L. (2010) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2010.06.007 · Cited by 82
Marlowe, D., Festinger, D., Dugosh, K. L., Lee, P. A., & Benasutti, K. M. (2007) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2006.10.001 · Cited by 82
“…impressive evidence of reliability, concurrent validity, predictive validity, and discriminative utility across groups of clients characterized by age, race, gender, and primary drug of abuse (e.g., Alterman et al., 1998;Cacciola et al., 1999;McDermott et al., 1996;McLellan et al., 1980,1985,1992).”
BackgroundBrown, S. A., Glasner-Edwards, S., Tate, S. R., McQuaid, J. R., Chalekian, J. S., & Granholm, E. (2006) · Journal of Psychoactive Drugs · doi:10.1080/02791072.2006.10400584 · Cited by 82
Methadone maintenance improves cognitive performance after two months of treatment.
Gruber, S. A., Tzilos, G. K., Silveri, M. M., Pollack, M. H., Renshaw, P. F., Kaufman, M. J., & Yurgelun-Todd, D. A. (2006) · Experimental and Clinical Psychopharmacology · doi:10.1037/1064-1297.14.2.157 · Cited by 79
Cox, G., Walker, R., Freng, S. A., Short, B. A., Meijer, L., & Gilchrist, L. (1998) · Journal of Studies on Alcohol · doi:10.15288/jsa.1998.59.523 · Cited by 82
Alterman, A., Kampman, K., Boardman, C., Cacciola, J., Rutherford, M., McKay, J. R., & Maany, I. (1997) · Drug and Alcohol Dependence · doi:10.1016/s0376-8716(97)00049-5 · Cited by 82
Self-citationSingle versus multiple drug focus in substance abuse clinical trials research.
Rounsaville, B., Petry, N., & Carroll, K. (2003) · Drug and Alcohol Dependence · doi:10.1016/s0376-8716(03)00033-4 · Cited by 81
“Many instruments with established reliability and validity permit assessment of quantity, frequency, or severity of multiple classes of substance use including the Timeline Followback Method (Sobell and Sobell, 1992), the Addiction Severity Index (Alterman et al., 2000; McLellan et al., 1985), the Substance Dependence…”
BackgroundMethodPsychiatric symptoms in problem gambling and non-problem gambling substance abusers.
Petry, N. M. (2000) · American Journal on Addictions · doi:10.1080/10550490050173235 · Cited by 81
Denis, C. M., Cacciola, J., & Alterman, A. (2013) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2013.06.003 · Cited by 80
Self-citationLifetime history of traumatic brain injury among persons with substance use disorders
Corrigan, J. D., Bogner, J. A., & Holloman, C. H. (2012) · Brain Injury · doi:10.3109/02699052.2011.648705 · Cited by 89
Parole Revocation Among Prison Inmates With Psychiatric and Substance Use Disorders
Baillargeon, J., Williams, B. A., Mellow, J., Harzke, A. J., Hoge, S., Baillargeon, G., & Greifinger, R. (2009) · Psychiatric Services · doi:10.1176/appi.ps.60.11.1516 · Cited by 80
“Both instruments are reported to have high positive predictive values and high sensitivity, indicating a high degree of accuracy in excluding nondependent participants and an ability to identify a substantial proportion of substance-dependent participants (35).”
BackgroundA comparison of pathological gamblers with and without substance abuse treatment histories.
Ladd, G. T., & Petry, N. (2003) · Experimental and clinical psychopharmacology · doi:10.1037/1064-1297.11.3.202 · Cited by 80
The Use of the Personality Assessment Inventory (PAI) in Assessing Offenders
Morey, L., & Quigley, B. (2002) · International journal of offender therapy and comparative criminology · doi:10.1177/0306624x02463007 · Cited by 80
“Follow-up studies comparing ALC and DRG scores to the interview-based Addiction Severity Index (McLellan et al., 1985) have found relatively good convergence for alcohol-related problems, although results for the drug-related problems have been more mixed (Alterman et al.”
BackgroundResultInfluential
Metadata
- Authors
- McLELLAN, A. T., LUBORSKY, L., CACCIOLA, J., GRIFFITH, J., EVANS, F., BARR, H. L., & OʼBRIEN, C. P.
- Affiliations
- Philadelphia VA Medical Center (US)
- Venue
- The Journal of Nervous and Mental Disease
- Published
- 1985-07
- Volume
- 173
- Issue
- 7
- Pages
- 412-423
- ISSN
- 0022-3018 (ISSN-L)
- OpenAlex
- W2144736441
- Cited by
- 1,503
- References
- 0
- Citations by year
- 2026: 8 · 2025: 5 · 2024: 14 · 2023: 11 · 2022: 15 · 2021: 24 · 2020: 63 · 2019: 21 · 2018: 32 · 2017: 25 · 2016: 32 · 2015: 43 · 2014: 52 · 2013: 54 · 2012: 49
- FWCI
- 3.27
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Nervous and Mental Disease (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Drug Abuse (DAO2554)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- Addiction Severity Index, alcohol abuse, drug abuse, treatment challenges, reliability statistics, validity, concurrent validity, discriminant validity, test-retest reliability, inter-rater concordance, veterans, addiction treatment, treatment outcome prediction, patient-treatment matching
- MeSH terms
- Adult, Alcoholism, Mental Disorders, Divorce, Employment, Evaluation Studies as Topic, Female, Hospitalization, Humans, Male, Marriage, Psychiatric Status Rating Scales, Psychological Tests, Psychometrics, Social Adjustment, Social Control, Formal, Substance-Related Disorders
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