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Instrument Summary for Substance Abuse

Please note that this section is an archive and is no longer being updated.



1. CAGE Questionnaire
Additional Resources

As an example of best practices (the ideal way to evaluate an instrument for your specific use), we have written full critiques of these instruments:

Development: The CAGE Questionnaire was developed in 1970; it was tested in a group of psychiatric inpatients within 1-7 days upon admission. The patients were identified as either being alcoholic or non-alcoholic. The CAGE Questionnaire was found to be more useful as a screening instrument rather than a detector of alcoholism based upon a total instrument positive score of 2 or 3.

Purpose: The purpose of the CAGE, a brief and easy to use questionnaire, is to detect alcoholism in adults and adolescents over 16 years of age. It is generally administered within a medical, primary care setting population.

Useful Facts: The CAGE Questionnaire consists of four assessment items: Cutting down, Annoyance by criticism, Guilty feeling, and Eye-openers. It can be self-administered or a clinician-administered interview. The items are scored based upon dichotomous responses (yes/no), a score of "1 or more" suggests a positive screening test and further investigation into the subject's drinking behavior. The CAGE was modified to detect alcohol abuse in undergraduate drinkers. Translations are available in German, French, Japanese, Malaysian, Portuguese, Russian, and Spanish. The CAGE has been tested in cohorts such as the general medical population, American Indian population, HIV-infected patients, homosexually active men, college students, and the elderly.

VA Relevance: This instrument has been used among veteran populations.4

Availability: An online version of the Cage questionnaire can be found at the University of North Carolina Medical School, Bowles Center for Alcohol Studies website.

References:

  1. Mayfield D, McLeod G, Hall P. The CAGE Questionnaire: validation of a new alcoholism-screening instrument. Am J Psychiatry 1974 Oct; 131(10):1121-3. [Abstract ]
  2. Ewing JA. Detecting alcoholism. The CAGE Questionnaire. JAMA 1984 Oct; 252(14):1905-7. [Abstract ]
  3. Boyd CJ, McCabe SE, d'Arcy H. A modified version of the CAGE as an indicator of alcohol abuse and its consequences among undergraduate drinkers. Subst Abuse 2003 Dec; 24(4):221-32. [Abstract ]
  4. Morton JL, Jones TV, Manganaro MA. Performance of alcoholism screening questionnaires in elderly veterans. Am J Med. 1996 Aug;101(2):153-9. [Abstract ]




2. Short Michigan Alcoholism Screening Test (SMAST)

Development: The Short Michigan Alcoholism Screening Test, or SMAST, was developed to detect alcoholism in individuals. It has 13 items compared with the original MAST that has 25 items.

Purpose: The purpose of the SMAST is to assess past and present drinking habits. It examines the negative effects of an individual's attitude and socio-behavioral consequences.

Useful Facts: The SMAST was found to be just as valid and reliable in detecting alcoholism as the original MAST. The SMAST scale format consists of dichotomous responses (yes/no) and it is scored by the recommended Selzer method; the number of points allowed for each question are contingent upon a 'yes' or 'no' respons

VA Relevance: This instrument has had limited use among a veteran population.4 The original MAST has had somewhat more extensive use among veteran populations [Pubmed Search Results].

Availability: This instrument may be found online on the SAHMSA CSAP Prevention Pathways website.

References:

  1. Selzer ML, Vinokur A, van Rooijen L. The self-administered Short Michigan Alcoholism Screening Test (SMAST). J Stud Alcohol 1975 Jan; 36(1):117-26. [Abstract ]
  2. Fleming MF, Barry KL. A study examining the psychometric properties of the SMAST 13. J Subst Abuse 1988-9; 1(2):173-82. [Abstract ]
  3. Barry KL, Fleming MF. Computerized administration of alcoholism screening tests in a primary care setting. J Am Board Fam Pract 1990 Apr-Jun;3(2):93-8 [Abstract ]




3. Alcohol Use Disorders Identification Test (AUDIT)

Development: The AUDIT is a 10-item screening instrument, developed by the World Health Organization (WHO). It contains 3 subscales: dependence symptoms (3 items), problems caused by alcohol or harmful alcohol use (4 items), and hazardous alcohol use or alcohol consumption (3 items).

Purpose: The purpose of the AUDIT is to assess hazardous and excessive drinking in adults.

Useful Facts: The AUDIT is available in both paper and pencil and computerized versions. The minimum score for non-drinkers is 0 and the maximum possible score is 40. A score of 8 or more suggests a strong possibility of alcohol abuse. Additional language translations include: Turkish, Hindi, Greek, German, Dutch, Polish, French, Japanese, Portuguese, Spanish, Danish, Chinese, and Italian.

VA Relevance: This instrument has been used among veteran populations.4

Availability: The AUDIT is available from the World Health Organization website, and includes both the interview and self-report versions. [PDF]

References:

  1. Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M. Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption--II. Addiction. 1993 Jun;88(6):791-804 [Abstract ]
  2. Chan-Pensley E. Alcohol Use-Disorders Identification Test: a comparison between paper and pencil and computerized versions. Alcohol Alcohol 1999 Nov-Dec;34(6):882-5. [Abstract ]
  3. Maisto SA, Conigliaro J, McNeil M, Kraemer K, Kelley ME. An empirical investigation of the factor structure of the AUDIT. Psychol Assess. 2000 Sep;12(3):346-53 [Abstract ]
  4. Conigliaro J, Lofgren RP, Hanusa BH. Screening for problem drinking: impact on physician behavior and patient drinking habits. J Gen Intern Med. 1998 Apr;13(4):251-6. [Abstract ]




4. Composite International Diagnostic Interview- Substance Abuse Module (CIDI-SAM)

Development: The CIDI-SAM was developed by Dr. Linda Cottler at the request of the World Health Organization (WHO)/ADAMHA Task Force on Psychiatric Assessment. It is the expanded version of the Composite International Diagnostic Interview (CIDI). The SAM can be used as a substitute for CIDI sections (alcohol, tobacco, and drugs) or it can be alone in an interview.

Purpose: The purpose of the CIDI-SAM is to assess and attempt to make a clinical diagnosis of psychoactive substance abuse and dependence disorders

Useful Facts: The CIDI-SAM can be administered by a non-clinician or a trained clinician interviewer (after about 1 week of training). It is combined with Likert-type responses, dichotomous (yes/no) responses, and open and close-ended questions; a computer calculates the score. A Spanish version of the CIDI-SAM is available.

VA Relevance: No information has been found regarding the use of this instrument among veteran populations.

Availability: This instrument is available for purchase from Washington University, Department of Psychiatry online.

References:

  1. Cottler LB, Robins LN, Helzer JE. The reliability of the CIDI-SAM: a comprehensive substance abuse interview. Br J Addict. 1989 Jul;84(7):801-14. [Abstract ]
  2. Compton WM, Cottler LB, Dorsey KB, Spitznagel EL, Mager DE. Comparing assessments of DSM-IV substance dependence disorders using CIDI-SAM and SCAN. Drug Alcohol Depend 1996 Nov;42(3):217-9. [Abstract ]
  3. Clements R. A critical evaluation of several alcohol screening instruments using the CIDI-SAM as a criterion measure. Alcohol Clin Exp Res. 1998 Aug;22(5):985-93. [Abstract ]




5. Obsessive Compulsive Drinking Scale (OCDS)

Development: The OCDS was developed as an adapted, revised version of the Yale-Brown Obsessive Compulsive Scale-HD. It is a 14-item self-report measure, but was later shortened to 10 items, that assesses alcohol-related obsessions and compulsions.

Purpose: The purpose of the OCDS is to assess urges/cravings to use both alcohol and drugs, in addition to examining obsessive and compulsive characteristics.

Useful Facts: The OCDS might be useful in screening for other addictive (cocaine, tobacco) or compulsive disorders (eating, gambling) besides alcohol. An adolescent version of the OCDS is the A-OCDS, which is helpful in screening for the presence of alcohol abuse and dependence.

VA Relevance: This measure has been used on veteran populations.4

Availability: This instrument may be obtained from Raymond F. Anton, M.D.:
Center for Drug and Alcohol Programs
Medical University of South Carolina
67 President Street
PO Box 250861
Charleston, SC 29425

References:

  1. Bohn MJ, Barton BA, Barron KE. Psychometric properties and validity of the obsessive-compulsive drinking scale. Alcohol Clin Exp Res. 1996 Aug;20(5):817-23. [Abstract ]
  2. Roberts JS, Anton RF, Latham PK, Moak DH. Factor structure and predictive validity of the Obsessive Compulsive Drinking Scale. Alcohol Clin Exp Res. 1999 Sep;23(9):1484-91. [Abstract ]
  3. Morgan TJ, Morgenstern J, Blanchard KA, Labouvie E, Bux DA. Development of the OCDS--revised: a measure of alcohol and drug urges with outpatient substance abuse clients. Psychol Addict Behav. 2004 Dec;18(4):316-21. [Abstract ]
  4. Freeman T, Kimbrell T. Relationship of alcohol craving to symptoms of posttraumatic stress disorder in combat veterans. J Nerv Ment Dis. 2004 May;192(5):389-90. [Abstract ]


[created 11 May 2005]