THE ADDICTION SEVERITY INDEX AS A SCREEN FOR TRAUMA AND POSTTRAUMATIC-STRESS-DISORDER

Objective: The Addiction Severity Index (ASI) includes items to assess patients' history of trauma (physical or sexual). The goal of this st udy was to assess the sensitivity and specificity of those questions i n relation to the Trauma History Questionnaire (THQ), a more thorough measure of lifetime trauma and, in addition, to an actual posttraumati c stress disorder (PTSD) diagnosis. Method: At the start of treatment cocaine dependent outpatients (N = 110, 65.5% male) were assessed on t he ASI, the THQ and a PTSD symptom checklist as part of a multisite cl inical trial. Results: Specificity of the ASI questions was higher tha n sensitivity for both sexual trauma (specificity = .96, sensitivity = .46) and physical trauma (specificity = .71, sensitivity = .50), whil e for PTSD the sensitivity of the ASI (.91) was higher than its specif icity (.43). Other findings indicated that patients were more likely t o report trauma on the THQ than on the ASI (which may be due to the se lf-report format of the THQ); that the ASI was better at assessing sex ual than assessing physical trauma; and that the higher the number of ASI trauma items endorsed, the more likely was the PTSD diagnosis. Fin ally, PTSD patients had greater severity than non-PTSD patients on oth er ASI items (e.g., psychological severity, need for treatment). Concl usions: The ASI trauma questions show stronger utility as a screen for PTSD than for trauma. Results of the study are discussed in light of ways to modify the ASI to screen more accurately for trauma, clinical implications, and limitations of the study method.