Addiction Severity Index (ASI)

The full ASI (7 domains, 45–60 min) provides comprehensive assessment across all life areas and is preferred for admission to treatment, research, and detailed treatment planning. The ASI-Lite (6 core items, 5–10 min) is a brief screening version suitable for busy primary care settings, emergency departments, or when time is limited. ASI-Lite is less comprehensive and has lower predictive validity than the full ASI. Use full ASI for treatment admission and major assessment; use Lite for rapid screening or follow-ups.

A Medical Composite Score ≥0.50 indicates significant medical problems (untreated infections, chronic disease, medication non-adherence, etc.). This warrants: (1) primary care referral for medical evaluation, (2) coordination between addiction treatment and primary care, (3) treatment of pain or medical comorbidities that may be driving substance use, and (4) monitoring of medical treatment adherence as part of addiction recovery. Medical problems often improve as substance use decreases, but active medical care is essential.

Discrepancy between interviewer observation (e.g., visible depression, anxiety, paranoia) and patient denial may indicate: (1) lack of insight (common in psychosis or active intoxication), (2) stigma preventing disclosure, or (3) substance-induced psychiatric symptoms (e.g., stimulant-induced paranoia) that the patient attributes to the drug, not a disorder. Clarify with follow-up questions: 'Have others told you that your mood/thinking seems different? Do these symptoms occur when you're not using?' Refer for psychiatric evaluation regardless of patient agreement; psychiatric comorbidity is critical to address in treatment.

No. ASI measures severity of substance use and related problems but does not diagnose substance use disorder. Diagnosis requires structured diagnostic interview (SCID, MINI) assessing DSM-5 or ICD-10 criteria (11 items for SUD: tolerance, withdrawal, loss of control, persistence, continued use despite harm, etc.). High ASI Drug and Alcohol Composite Scores suggest SUD is likely, but clinical diagnostic assessment is necessary for formal diagnosis and severity classification (mild, moderate, severe).

Standard practice: full ASI at treatment admission, then every 6–12 months or at major treatment transitions (end of intensive phase, discharge from inpatient, transition to aftercare). Monthly administration is excessive and impractical. Use briefer screening tools (AUDIT, DAST-10, urine drug screens) between comprehensive ASI assessments. At end of treatment (3–12 months depending on program length), final ASI documents treatment outcomes and discharge status.

Meaningful change on ASI Composite Scores: a reduction of 0.15–0.20 points per domain over 3–6 months indicates treatment progress. For example, a patient with Drug Composite = 0.80 at admission improving to 0.60–0.65 at 6-month follow-up shows substantial improvement. Expect greatest improvements in Drug and Alcohol domains if abstinence is achieved; Family/Social and Employment improvements lag and may take 12+ months of stable recovery.