The eleven-item Alcohol, Smoking and Substance Involvement Screening Test (ASSIST-11): Cross-cultural psychometric evaluation across 42 countries

Lee CT 1 , Lin CY 2 , Koós M 3 , Nagy L 3 , Kraus SW 4 , Demetrovics Z 5 Show all authors , Potenza MN 6 , Ballester-Arnal R 7 , Batthyány D 8 , Bergeron S 9 , Billieux J 10 , Burkauskas J 11 , Cárdenas-López G 12 , Carvalho J 13 , Castro-Calvo J 14 , Chen L 15 , Ciocca G 16 , Corazza O 17 , Csako RI 18 , Fernandez DP 19 , Fernandez EF 20 , Fujiwara H 21 , Fuss J 22 , Gabrhelík R 23 , Gewirtz-Meydan A 24 , Gjoneska B 25 , Gola M 26 , Grubbs JB 27 , Hashim HT 28 , Islam MS 29 , Ismail M 28 , Jiménez-Martínez M 30 , Jurin T 31 , Kalina O 32 , Klein V 33 , Költő A 34 , Lee SK 35 , Lewczuk K 36 , Lochner C 37 , López-Alvarado S 38 , Lukavská K 39 , Mayta-Tristán P 40 , Milea I 41 , Miller DJ 42 , Orosová O 43 , Orosz G 44 , Sungkyunkwan University's Research Team(,) 45 , Ponce FP 46 , Quintana GR 47 , Garzola GCQ 48 , Ramos-Diaz J 49 , Rigaud K 44 , Rousseau A 50 , Scanavino MT 51 , Schulmeyer MK 52 , Sharan P 53 , Shibata M 54 , Shoib S 55 , Sigre-Leirós V 56 , Sniewski L 57 , Spasovski O 58 , Steibliene V 11 , Stein DJ 59 , Strizek J 60 , Ünsal BC 3 , Vaillancourt-Morel MP 61 , Van Hout MC 62 , Bőthe B 9

Affiliations 

  • 1 Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
  • 2 Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan. Electronic address: cylin36933@gmail.com
  • 3 Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
  • 4 Department of Psychology, University of Nevada, Las Vegas, Las Vegas, NV, USA
  • 5 Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; Centre of Excellence in Responsible Gaming, University of Gibraltar, Gibraltar, Gibraltar
  • 6 Yale University School of Medicine, New Haven, CT, USA; Connecticut Council on Problem Gambling, Wethersfield, CT, USA
  • 7 Departmento de Psicología Básica, Clínica y Psicobiología, University Jaume I of Castellón, Spain
  • 8 Institute for Behavioural Addictions, Sigmund Freud University Vienna, Austria
  • 9 Département de Psychologie, Université de Montréal, Montréal, Canada
  • 10 Institute of Psychology, University of Lausanne, Lausanne, Switzerland; Center for Excessive Gambling, Addiction Medicine, Lausanne University Hospitals (CHUV), Lausanne, Switzerland
  • 11 Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, Lithuania
  • 12 Virtual Teaching and Cyberpsychology Laboratory, School of Psychology, National Autonomous University of Mexico, Mexico
  • 13 William James Center for Research, Departamento de Educação e Psicologia, Universidade de Aveiro, Aveiro, Portugal; CPUP: Center for Psychology at Porto University
  • 14 Department of Personality, Assessment, and Psychological Treatments, University of Valencia, Spain
  • 15 Department of Psychology, College of Humanity and Social Science, Fuzhou University, China
  • 16 Section of Sexual Psychopathology, Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
  • 17 Department of Clinical, Pharmaceutical and Biological Sciences, University of Hertfordshire, United Kingdom; Department of Psychology and Cognitive Science, University of Trento, Italy
  • 18 Department of Psychology and Neuroscience, Auckland University of Technology, Auckland, New Zealand
  • 19 Nottingham Trent University, United Kingdom
  • 20 HELP University, Malaysia
  • 21 Department of Neuropsychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Decentralized Big Data Team, RIKEN Center for Advanced Intelligence Project, Tokyo, Japan
  • 22 Institute of Forensic Psychiatry and Sex Research, Center for Translational Neuro- and Behavioral Sciences, University of Duisburg-Essen, Essen, Germany
  • 23 Charles University, Department of Addictology, Prague, Czech Republic; General University Hospital in Prague, Department of Addictology, Czech Republic
  • 24 School of Social Work, University of Haifa, Israel
  • 25 Macedonian Academy of Sciences and Arts, Macedonia
  • 26 Institute of Psychology, Polish Academy of Sciences, Poland; Institute for Neural Computations, University of California San Diego, USA
  • 27 Bowling Green State University, United States
  • 28 University of Baghdad, College of Medicine, Iraq
  • 29 Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh; Centre for Advanced Research Excellence in Public Health, Savar, Dhaka, 1342, Bangladesh
  • 30 Universidad Pedagógca y Tecnológica de Colombia, Colombia; Grupo de Investigación Biomédica y de Patología, Colombia
  • 31 Department of Psychology, Humanities and Social Sciences, University of Zagreb, Croatia
  • 32 Department of Educational Psychology and Psychology of Health, Pavol Jozef Safarik University in Kosice, Slovakia
  • 33 School of Psychology, University of Southampton, United Kingdom
  • 34 Health Promotion Research Centre, University of Galway, Ireland
  • 35 Department of Psychiatry, Hallym University Chuncheon Sacred Heart Hospital, South Korea; Chuncheon Addiction Management Center, South Korea
  • 36 Institute of Psychology, Cardinal Stefan Wyszynski University, Warsaw, Poland
  • 37 SAMRC Unit on Risk & Resilience in Mental Disorders, Stellenbosch University, South Africa
  • 38 University of Cuenca, Ecuador
  • 39 Charles University, Department of Addictology, Prague, Czech Republic; Charles University, Department of Psychology, Prague, Czech Republic
  • 40 Universidad Científica Del Sur, Lima, Peru
  • 41 Babeș-Bolyai University, Romania
  • 42 James Cook University, Australia
  • 43 Pavol Jozef Safarik University in Kosice, Department of Educational Psychology and Psychology of Health, Slovakia
  • 44 Artois University, France
  • 45 Department of Psychology, Sungkyunkwan University, South Korea
  • 46 Facultad de Psicología, Universidad de Talca, Chile
  • 47 Departamento de Psicología y Filosofía, Universidad de Tarapacá, Arica, Arica y Parinacota, Chile
  • 48 Florida State University, Panama; Sistema Nacional de Investigación (SNI), SENACYT, Panama
  • 49 Universidad Privada Del Norte, Lima, Peru
  • 50 Leuven School for Mass Communication, KU Leuven, Leuven, Belgium
  • 51 Department of Psychiatry, Universidade de São Paulo, Brazil; Experimental Pathophisiology Post Graduation Program, Universidade de São Paulo, Brazil
  • 52 Universidad Privada de Santa Cruz de la Sierra, Bolivia
  • 53 Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, 110029, India
  • 54 Department of Neuropsychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
  • 55 Department of Psychology, Shardha University, India
  • 56 Institute of Psychology, University of Lausanne, Lausanne, Switzerland; Institute of Legal Psychiatry, Lausanne University Hospitals (CHUV), Lausanne, Switzerland
  • 57 Auckland University of Technology, New Zealand
  • 58 University of Ss. Cyril and Methodius in Trnava, Slovakia
  • 59 SAMRC Unit on Risk & Resilience in Mental Disorders, Dept of Psychiatry & Neuroscience Institute, University of Cape Town, South Africa
  • 60 Austrian Public Health Institute, Austria
  • 61 Département de Psychologie, Université Du Québec à Trois-Rivières, Trois-Rivières, Canada
  • 62 Public Health Institute, Liverpool John Moores University, United Kingdom
J Psychiatr Res, 2023 Sep;165:16-27.
PMID: 37453212 DOI: 10.1016/j.jpsychires.2023.06.033

Abstract

The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) is an instrument to screen substance-use-related health risks. However, little is known whether the ASSIST could be further shortened while remaining psychometrically sound across different countries, languages, gender identities, and sexual-orientation-based groups. The study aimed to validate a shortened 11-item ASSIST (ASSIST-11). Using the International Sex Survey data, 82,243 participants (M age = 32.39 years) across 42 countries and 26 languages completed questions from the ASSIST-11 regarding gender identity, sexual orientation, and other information. Confirmatory factor analysis (CFA) and multigroup CFA (MGCFA) evaluated the ASSIST-11's structure and tested measurement invariance across groups. Cronbach's α and McDonald's ω were used to examine the internal consistency. Cohen's d and independent t-tests were used to examine known-group validity. The ASSIST-11 was unidimensional across countries, languages, age groups, gender identities (i.e., men, women, and gender-diverse individuals), and sexual orientations (i.e., heterosexual and sexual minority individuals). Cronbach's α was 0.63 and McDonald's ω was 0.68 for the ASSIST-11. Known-group validity was supported by Cohen's d (range between 0.23 and 0.40) with significant differences (p-values<0.001). The ASSIST-11 is a modified instrument with a unidimensional factor structure across different languages, age groups, countries, gender identities, and sexual orientations. The low internal consistency of the ASSIST-11 might be acceptable as it assesses a broad concept (i.e., use of several different substances). Healthcare providers and researchers may use the ASSIST-11 to quickly assess substance-use information from general populations and evaluate the need to follow up with more detailed questions about substance use.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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