Addiction Severity Index (ASI) | How Professionals Use The ASI Assessment

Like many other diseases, drug addiction (also called substance use disorder) is treatable. However, different people need different types of addiction treatment. 

To identify a person’s treatment needs, most health care providers use the Addiction Severity Index (ASI). 

What Is The Addiction Severity Index (ASI)?

The ASI is an assessment instrument used to determine how substance abuse affects a person’s life and what treatments they need. 

It was developed in 1980 by A. Thomas McLellan and fellow researchers at the University of Pennsylvania’s Center for the Studies of Addiction. Over the years, it’s become the most popular addiction assessment tool. 

The assessment typically lasts 50 minutes to 1 hour. During that time, a clinician interviews a patient about seven key problem areas:

Medical Status

This area includes questions such as:

• How many times in your life have you been hospitalized for medical problems? 
• How many times have you experienced medical problems in the past 30 days? 

Employment/Support Status

This area includes questions such as:

• How long was your longest full-time job? 
• How many days were you paid for working in the past 30 days?

Alcohol Use

This area includes questions such as:

• How many times in your life have you been treated for alcohol abuse?
• How many times have you had delirium tremens (a severe form of alcohol withdrawal)?

Drug Use

This area includes questions such as:

• How much money would you say you spent during the past 30 days on drugs?
• How many days in the past 30 have you experienced drug problems?

Legal Status

This area includes questions such as:

• How many days in the past 30 have you engaged in illegal activities for profit? 
• How serious do you feel your present legal problems are?

Family/Social Status

This area includes questions such as:

• Have any of your blood-related relatives had what you would call a significant drinking, drug use, or psychiatric problem?
• How troubled or bothered have you been in the past 30 days by family problems or social problems?

Psychiatric Status

This area includes questions such as:

• How many times have you been treated for any psychological or emotional problems in a hospital or inpatient setting or as an outpatient/private patient?
• Do you receive a pension for a psychiatric disability?

How Is The ASI Scored?

The ASI features two different kinds of scores: composite scores and interviewer severity ratings.

Composite Scores

Most ASI questions are scored on a 0-1 scale. For instance, for yes-no questions, the answer “yes” equals 1 point, while the answer “no” equals 0 points. 

Once the assessment ends, the clinician adds up these scores, which are called “composite scores.” In general, higher scores signal a greater need for treatment. 

As the patient progresses through addiction treatment, the clinician can readminister the ASI and see whether the composite scores have changed. The changes (or lack of changes) will help the clinician determine whether the treatment is working. 

Interviewer Severity Ratings

Interviewer severity ratings are estimates of a patient’s problem severity in each of the ASI key problem areas. The interviewer assigns the ratings using this scale:

• 0–1: No imminent problem, treatment not indicated
• 2–3: Slight problem, treatment may not be necessary
• 4–5: Moderate problem, a treatment plan should be considered
• 6–7: Considerable difficulty, begin a treatment plan
• 8–9: Extreme problem, treatment is vital

What Is The ASI-Lite?

The Addiction Severity Index Lite version (ASI-Lite) is a shortened version of the ASI. It features 22 fewer questions. 

In addition, it doesn’t include interviewer severity ratings. It also omits the family history grid found in the family/social status area of the original assessment. 

Why Is The ASI Important?

The ASI considers multiple aspects of a patient’s life. Thus, it helps health care providers design substance abuse treatment plans that address not only substance abuse but also other needs.

Identifying Mental Health Concerns

Many substance abuse patients also struggle with co-occurring mental health conditions like depression or bipolar disorder. 

If these individuals only receive treatment for substance abuse problems, they face a much higher risk of relapse. The ASI can identify underlying mental health concerns so patients can receive treatment for all of their conditions at the same time. 

Choosing Inpatient Or Outpatient Care

The ASI can help providers determine whether a patient needs inpatient or outpatient care. 

In general, inpatient care is recommended for people with moderate to severe addictions or co-occurring mental health conditions. Outpatient care may work for people with milder addictions and strong support systems. 

Developing Effective Aftercare Plans

The ASI can also help doctors create more effective aftercare plans. An aftercare plan includes interventions meant to reduce a person’s risk of relapse, such as:

• follow-up therapy appointments
• support groups
• referrals to housing assistance programs

To learn more about drug abuse treatment options, please contact an Ark Behavioral Health specialist. We offer personalized, recovery-focused services for people struggling with drug or alcohol problems.