Rachel Humeniuk

Validation of the alcohol, smoking and substance involvement screening test (ASSIST)

AIM The concurrent, construct and discriminative validity of the World Health Organizations Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) were examined in a multi-site international study. PARTICIPANTS One thousand and 47 participants, recruited from drug treatment (n = 350) and primary health care (PHC) settings (n = 697), were administered a battery of instruments. MEASUREMENTS Measures included the ASSIST; the Addiction Severity Index-Lite (ASI-Lite); the Severity of Dependence Scale (SDS); the MINI International Neuropsychiatric Interview (MINI-Plus); the Rating of Injection Site Condition (RISC); the Drug Abuse Screening Test (DAST); the Alcohol Use Disorders Identification Test (AUDIT); the Revised Fagerstrom Tolerance Questionnaire (RTQ); and the Maudsley Addiction Profile (MAP). FINDINGS Concurrent validity was demonstrated by significant correlations between ASSIST scores and scores from the ASI-Lite (r = 0.76-0.88), SDS (r = 0.59), AUDIT (r = 0.82) and RTQ (r = 0.78); and significantly greater ASSIST scores for those with MINI-Plus diagnoses of abuse or dependence (P < 0.001). Construct validity was established by significant correlations between ASSIST scores and measures of risk factors for the development of drug and alcohol problems (r = 0.48-0.76). Discriminative validity was established by the capacity of the ASSIST to discriminate between substance use, abuse and dependence. Receiver operating characteristic (ROC) analysis was used to establish cut-off scores with suitable specificities (50-96%) and sensitivities (54-97%) for most substances. CONCLUSIONS The findings demonstrated that the ASSIST is a valid screening test for identifying psychoactive substance use in individuals who use a number of substances and have varying degrees of substance use.

Validation of the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): report of results from the Australian site

The concurrent, construct, discriminative and predictive validity of the World Health Organizations Alcohol Substance Involvement Screening Test (ASSIST) were examined in an Australian sample. One hundred and fifty participants, recruited from drug treatment (n = 50) and primary health care (PHC) settings (n = 100), were administered a battery of instruments at baseline and a modified battery at 3 months. Measures included the ASSIST; the Addiction Severity Index-Lite (ASI-Lite); the Severity of Dependence Scale (SDS); the MINI International Neuropsychiatric Interview (MINI-Plus); the Rating of Injection Site Condition (RISC); the Drug Abuse Screening Test (DAST); the Alcohol Use Disorders Identification Test (AUDIT); the Revised Fagerstrom Tolerance Questionnaire (RTQ); and the Maudsely Addiction Profile (MAP). Concurrent validity was demonstrated by significant correlations between ASSIST scores and scores from the ASI-lite, SDS, AUDIT and DAST; and significantly greater ASSIST scores for those with diagnoses of abuse or dependence. Construct validity was established by significant correlations between ASSIST scores and measures of risk factors for the development of drug and alcohol problems. Participants diagnosed with attention deficit/hyperactivity disorder or antisocial personality disorder had significantly higher ASSIST scores than those not diagnosed as such. Discriminative validity was established by the capacity of the ASSIST to discriminate between substance use, abuse and dependence. ROC analysis was able to establish cut-off scores for an Australian sample, with suitable specificities and sensitivities for most substances. Predictive validity was demonstrated by similarity in ASSIST scores obtained at baseline and at follow-up. The findings demonstrated that the ASSIST is a valid screening test for psychoactive substance use in individuals who use a number of substances and have varying degrees of substance use.

A Randomized Controlled Trial of a Brief Intervention for Illicit Drugs Linked to the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in clients recruited from primary health care settings in four countries

AIMS This study evaluated the effectiveness of a brief intervention (BI) for illicit drugs (cannabis, cocaine, amphetamine-type stimulants and opioids) linked to the World Health Organization (WHO) Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). The ASSIST screens for problem or risky use of 10 psychoactive substances, producing a score for each substance that falls into either a low-, moderate- or high-risk category. DESIGN Prospective, randomized controlled trial in which participants were either assigned to a 3-month waiting-list control condition or received brief motivational counselling lasting an average of 13.8 minutes for the drug receiving the highest ASSIST score. SETTING Primary health-care settings in four countries: Australia, Brazil, India and the United States. PARTICIPANTS A total of 731 males and females scoring within the moderate-risk range of the ASSIST for cannabis, cocaine, amphetamine-type stimulants or opioids. MEASUREMENTS ASSIST-specific substance involvement scores for cannabis, stimulants or opioids and ASSIST total illicit substance involvement score at baseline and 3 months post-randomization. FINDINGS Omnibus analyses indicated that those receiving the BI had significantly reduced scores for all measures, compared with control participants. Country-specific analyses showed that, with the exception of the site in the United States, BI participants had significantly lower ASSIST total illicit substance involvement scores at follow-up compared with the control participants. The sites in India and Brazil demonstrated a very strong brief intervention effect for cannabis scores (P < 0.005 for both sites), as did the sites in Australia (P < 0.005) and Brazil (P < 0.01) for stimulant scores and the Indian site for opioid scores (P < 0.01). CONCLUSIONS The Alcohol, Smoking and Substance Involvement Screening Test-linked brief intervention aimed at reducing illicit substance use and related risks is effective, at least in the short term, and the effect generalizes across countries.

The role of GABAB receptors in mediating the stimulatory effects of ethanol in mice

Recently, the GABAB receptor antagonist phaclofen has been shown to attenuate the stimulation of locomotor activity induced by ethanol (Allan and Harris 1989). In the present study, the effects of a range of recently developed GABAB receptor antagonists (phaclofen, 2-hydroxysaclofen, beta-phenyl-beta-alanine, CGP 35348) and the GABAB receptor agonist baclofen, were studied for their ability to block the locomotor stimulation induced by a low dose of ethanol administered IP to mice (1.75 g/kg). Results showed that phaclofen, 2-hydroxysaclofen, BPBA and baclofen all dose-dependently decreased ethanol-induced locomotor activity, and, of these, baclofen and BPBA did so at doses which did not attenuate locomotor activity when administered alone. CGP 35348 had no effect on the activity produced by ethanol. The action of baclofen on ethanol-induced activity appeared to be GABAB receptor mediated, as the effects were stereospecific and were reversed by the antagonist, CGP 35348. However phaclofen, 2-hydroxysaclofen and BPBA failed to reverse the effects of baclofen. These results suggest that the GABAB receptor may modulate locomotor stimulation induced by low doses of ethanol, and furthermore, that agonist, rather than antagonist activity at the GABAB receptor is responsible for this reduction. The GABAB receptor subtype responsible for modulating the effects of ethanol may have properties different from those GABAB receptors characterised to date.

The effects of GABAB ligands on alcohol withdrawal in mice

Recent research suggests that the GABAB receptor may mediate some of the acute effects of alcohol, but little is known of its involvement in alcohol withdrawal. Mice made dependent on alcohol exhibited tremor and tail arch when consumption ceased. Diazepam dose-dependently attenuated both tremor and tail arch, whereas baclofen had no effect on either of these two withdrawal symptoms. However, baclofen dose-dependently induced convulsant behaviour in the withdrawing mice, and this was significantly attenuated by the GABAB antagonists phaclofen (50 mg/kg) and CGP 35348 (300 mg/kg), but not BPBA (50 mg/kg). Phaclofen, BPBA, and CGP 35348, when administered alone and in combination with a single dose of baclofen, did have an effect on tremor, although the magnitude was small in comparison to that seen with diazepam. It appears that the GABAB receptor may play a role in mediating convulsions during alcohol withdrawal, and that in this system baclofen is proconvulsant.

Substance use patterns in newly admitted male and female South Australian prisoners using the WHOASSIST (Alcohol, Smoking and Substance Involvement Screening Test)

OBJECTIVE To report on the patterns of substance use in newly admitted male and female South Australian prisoners using the WHO-ASSIST screening tool (Alcohol, Smoking and Substance Involvement Screening Test) and observe the feasibility of using the ASSIST and associated Brief Intervention in this population. DATA SOURCES Results of the first 518 prisoners screened using ASSIST in South Australian reception prisons. RESULTS In the first 10 months of the implementation of the WHO ASSIST, 518 clients were assessed in the 3 metropolitan intake prisons in Adelaide, Australia. This represents 31% of all male and 35% of all female prisoners admitted over this period. Injecting drug use was reported in the previous 3 months by 55% of men and 51% of women. The six most common substances used at high and moderate risk levels, in order of prevalence (from high to low) in males were tobacco, cannabis, amphetamines, opiates, alcohol, and sedatives. In women the order was tobacco, amphetamines, cannabis, opiates and sedatives equal, and alcohol. Fifty percent of men and 33% of women were using four or more substances. Overall rates of substance use related risk amongst men coming into prison are slightly greater than for women. Accessing prisoners for screening within the first few days is difficult with 55% already being released or at court or other external appointments.

Characterization of GABAB ligands in vivo

1. While GABAB antagonists have been examined in vitro, very few have been tested in vivo. A range of GABAB antagonists were tested against baclofen-induced muscle relaxation and hypothermia. 2. The GABAB antagonists exhibited a range of in vivo activity profiles. 3. CGP 35348 showed clear antagonist effects, while BPBA and 4-ABPA appeared to have agonist properties. 4. Phaclofen, 2-hydroxysaclofen, 3-APPA and 9G seemed to have little effect in this system at the doses tested. 5. Differences between in vivo and in vitro activity could be explained by differences in blood-brain barrier permeability, or possible differences in affinities for the sub-classes of GABAB receptors.

The first methadone clinic in Beijing

In December 2004 one of the authors (R.H.) had the opportunity to spend a day with Professor Zhao Chengzheng from the National Institute of Drug Dependence and her colleagues at the Ankang Hospital methadone clinic in Beijing—the first methadone clinic to be approved in the area. The visit was part of a review of their site, which is part of the WHO study on Substitution Treatment of Opioid Dependence and HIV/AIDS being co-ordinated by the WHO Collaborating Centre in Adelaide, in conjunction with the Zurich team led by Ambros Uchtenhagen. The study is being conducted in China, Indonesia and Thailand as well as Eastern Europe (Lithuania, Ukraine, the Czech Republic and Iran). Ankang Hospital had received approval from the Chinese government to dispense methadone for therapeutic maintenance purposes only a few weeks prior to the visit. In the 2 or so years prior to this time, methadone had been approved for research purposes only to investigate its long-term maintenance properties. However, methadone has been available in China since the early 1990s and approved by the government for short-term detoxification from opioids such as opium and heroin. In these instances, methadone is administered in tapered doses for up to 3 weeks and has been shown to be effective for detoxification [1]. Initially methadone was approved for use only in the southern provinces of China where opioid use was a greater problem, due to the closer proximity to south east Asia where opioids are more freely available. As opioid use spread to other regions of China, so did the approval to use methadone as a detoxification medication. The modern opium trade has historical roots dating back approximately 200 years to the Qing dynasty (1636 – 1909) when western colonialists brought opium into the country. The impact of colonialism on China, which involved Portugal and Britain among other countries, resulted in two major Opium Wars arising from Chinese opposition to the trade. At the end of the second Opium War in 1858 the Chinese legalized the opium trade while regulating domestic trade and maintaining control of the customs duty. This resulted in considerable growth in opium production in China itself, with southern areas of China becoming the provinces where production was highest. The southern provinces exported opium to south-east Asia and the rest of China, resulting in high rates of dependence in the general population of China. Following the founding of the Peoples Republic of China by Mao Zedong in October 1949, a nation-wide anti-drugs campaign was executed along with the many other anticampaigns initiated by the new communist government. During the 3-year campaign, people involved with production or trafficking of opioids were punished according to the new laws. Accordingly, opium availability decreased rapidly and it was reported that 20 million opioid-dependent people became drug free again [2]. The next 30 years of the history of China were reported to be relatively drug-free until the 1980s, when the political tide of China slowly began to change with new market reforms and increased openness and trade with the rest of the world. Slowly drugs, particularly opium, were reintroduced to China, initially near the borders of south-west China and rural areas in the north-west, but spread quickly throughout other parts of the country. Opioid use has increased markedly from 1990 until the current time. The re-

γ-Guanidinobaclofen is a peripheral GABAB receptor agonist

Abstract In the guinea-pig isolated ileum, both baclofen and γ-guanidinobaclofen elicited dose-dependent depression of cholinergic twitch contractions, sensitive to the GABAB receptor antagonists phaclofen and 2-hydroxysaclofen. γ-Guanidinobaclofen was 5 times less potent than R,S-(±)-baclofen in depressing the contractions. The corresponding GABA analogs, guanidinoacetic acid, β-guanidinopropionic acid and γ-guanidinobutanoic acid were inactive. In rat neocortical slices maintained in Mg2+-free medium, baclofen (1–50 μM) reduced the amplitude and rate, whilst γ-guanidinobaclofen (1 mM) has a very weak GABAB receptor agonist action, 100 times weaker than baclofen. γ-Guanidinobaclofen is therefore a GABAB receptor agonist, more potent at peripheral than central GABAB receptors.

ASSIST-Y V1.0: First-Stage Development of the WHO Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) and Linked Brief Intervention for Young People

ABSTRACT While the World Health Organization (WHO) Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) is a useful screening and brief intervention tool for use with adults, the risk cut-offs are not appropriate for people under 18 years of age. Drawing on the literature available and expert clinical consultation and consensus, two distinct ASSIST-Youth (ASSIST-Y) questionnaires and Feedback Report cards with different score weightings were proposed, reflecting the dynamic nature of substance use-related risk in developing adolescents ages 10 to 14 years and ages 15 to 17 years old. Appropriate interventions also were recommended, with a strong emphasis on referral for assessment and management of broader psychosocial issues. This revised ASSIST for young people was developed with the intention that this “first-pass” set of cut-off scores and associated materials might form the basis for further psychometric validation of the youth ASSIST in the future, while still providing practitioners with a screening brief intervention option for using with young people in the interim.