Centre of Research Excellence on Meaningful Outcomes in Substance Use Treatments

Research

Outcome measure repository

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We aim to provide evidence-based recommendations to assist in the implementation of routine outcome measures and feedback (ROMF) for alcohol and other drug (AOD) services.

As part of this initiative, we have compiled a list of outcome measure instruments that we recommend services routinely implement with clients to monitor treatment outcomes and efficacy. These instruments have been tested for reliability and validity with AOD populations.

World Health Organization Alcohol, Smoking and Substance Involvement Screening Test (ASSIST)

The World Health Organization Alcohol, Smoking and Substance Involvement Screening Test (ASSIST)1 is a culturally validated screening measure of substance use and related problems2. The WHO-ASSIST is sensitive to risk levels of substance use (low, moderate, high)3 for multiple substances, with set scoring guidelines that have been validated in populations worldwide2. The ASSIST adopts a broader conceptualisation of severity (encompassing occupational, financial, and psychological) and enables clinicians to identify secondary substances of concern1. It is the recommended screening tool for the detection and management of a range of substance use disorders and related problems by the National Institute on Drug Abuse (NIDA)4.

  1. The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): development, reliability, and feasibility. (2002). Addiction, 97(9), 1183-1194. https://doi.org/10.1046/j.1360-0443.2002.00185.x
  2. Humeniuk, R., Ali, R., Babor, T. F., Farrell, M., Formigoni, M. L., Jittiwutikarn, J., de Lacerda, R. B., Ling, W., Marsden, J., Monteiro, M., Nhiwatiwa, S., Pal, H., Poznyak, V., & Simon, S. (2008). Validation of the Alcohol, Smoking And Substance Involvement Screening Test (ASSIST). Addiction, 103(6), 1039-1047. https://doi.org/10.1111/j.1360-0443.2007.02114.x
  3. Newcombe, D. A., Humeniuk, R. E., & Ali, R. (2005). Validation of the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): report of results from the Australian site. Drug Alcohol Rev, 24(3), 217-226. https://doi.org/10.1080/09595230500170266
  4. McCauley, J. L., Killeen, T., Gros, D. F., Brady, K. T., & Back, S. E. (2012). Posttraumatic Stress Disorder and Co-Occurring Substance Use Disorders: Advances in Assessment and Treatment. Clin Psychol (New York), 19(3). https://doi.org/10.1111/cpsp.12006
  5. Carlyle, M., Walter, Z. C., Theroux, B., Leung, J., & Hides, L. (2023). Reliability of online self-report versions of the Australian Treatment Outcome Profile (ATOP) and Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) among people in residential treatment for substance use problems. Addictive Behaviors, 144, 107756. https://doi.org/10.1016/j.addbeh.2023.107756

Severity of Dependence Scale (SDS)

The Severity of Dependence Scale (SDS) is a screening tool that determines the presence of substance use dependency for the client’s primary substance of concern1. The 5-item measure focuses on psychological dependency2, and cut-offs are determined by the prevalence of substance-specific dependency within the population3.

  1. Gossop, M., Darke, S., Griffiths, P., Hando, J., Powis, B., Hall, W., & Strang, J. (1995). The Severity of Dependence Scale (SDS): psychometric properties of the SDS in English and Australian samples of heroin, cocaine and amphetamine users. Addiction, 90(5), 607-614. https://doi.org/10.1046/j.1360-0443.1995.9056072.x
  2. González-Sáiz, F., Domingo-Salvany, A., Barrio, G., Sánchez-Niubó, A., Brugal, M. T., de la Fuente, L., & Alonso, J. (2009). Severity of dependence scale as a diagnostic tool for heroin and cocaine dependence. Eur Addict Res, 15(2), 87-93. https://doi.org/10.1159/000189787
  3. Kaye, S., & Darke, S. (2002). Determining a diagnostic cut-off on the Severity of Dependence Scale (SDS) for cocaine dependence. Addiction, 97(6), 727-731. https://doi.org/10.1046/j.1360-0443.2002.00121.x

Patient Health Questionnaire (PHQ-9)

The Patient Health Questionnaire (PHQ-9)1 is a valid and reliable self-report measure for assessing symptoms of depression in adults2. The PHQ-9 has been validated among substance users2-4 and has demonstrated good convergent validity with other measures of depression including the Beck Depression Inventory3,4. A cut-off score of ≥ 10 on the PHQ-9 has been suggested to identify those with a depressive disorder with acceptable sensitivity and specificity1.

  1. Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ‐9: validity of a brief depression severity measure. Journal of general internal medicine, 16(9), 606-613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
  2. Bentley, K. H., Sakurai, H., Lowman, K. L., Rines-Toth, L., McKowen, J., Pedrelli, P., Evins, A. E., & Yule, A. M. (2021). Validation of brief screening measures for depression and anxiety in young people with substance use disorders. J Affect Disord, 282, 1021-1029. https://doi.org/10.1016/j.jad.2021.01.005
  3. Dum, M., Pickren, J., Sobell, L. C., & Sobell, M. B. (2008). Comparing the BDI-II and the PHQ-9 with outpatient substance abusers. Addictive Behaviors, 33(2), 381-387. https://doi.org/https://doi.org/10.1016/j.addbeh.2007.09.017
  4. Hepner, K. A., Hunter, S. B., Edelen, M. O., Zhou, A. J., & Watkins, K. (2009). A comparison of two depressive symptomatology measures in residential substance abuse treatment clients. Journal of Substance Abuse Treatment, 37(3), 318-325. https://doi.org/10.1016/j.jsat.2009.03.005

Generalised Anxiety Disorder (GAD-7)

The Generalised Anxiety Disorder (GAD-7)1 questionnaire is a self-report measure for assessing symptoms of anxiety in adults2. The GAD-7 has demonstrated acceptable reliability and validity among substance using populations, and ability to detect the presence of an anxiety disorder2-4. Cut-off scores of 5, 10, and 15 have been suggested to represent mild, moderate, and severe anxiety symptoms1.

  1. Spitzer RL, Kroenke K, Williams JB, Lowe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092-1097. https://doi.org/10.1001/archinte.166.10.1092
  2. Bentley, K. H., Sakurai, H., Lowman, K. L., Rines-Toth, L., McKowen, J., Pedrelli, P., Evins, A. E., & Yule, A. M. (2021). Validation of brief screening measures for depression and anxiety in young people with substance use disorders. J Affect Disord, 282, 1021-1029. https://doi.org/10.1016/j.jad.2021.01.005
  3. Delgadillo, J., Payne, S., Gilbody, S., Godfrey, C., Gore, S., Jessop, D., & Dale, V. (2012). Brief case finding tools for anxiety disorders: Validation of GAD-7 and GAD-2 in addictions treatment. Drug Alcohol Depend, 125(1), 37-42. https://doi.org/10.1016/j.drugalcdep.2012.03.011
  4. Levitt, E. E., Syan, S. K., Sousa, S., Costello, M. J., Rush, B., Samokhvalov, A. V., McCabe, R. E., Kelly, J., & MacKillop, J. (2021). Optimizing screening for depression, anxiety disorders, and post-traumatic stress disorder in inpatient addiction treatment: A preliminary investigation. Addictive Behaviors, 112, 106649. https://doi.org/10.1016/j.addbeh.2020.106649