Skip to main content
SpringerLink
Log in

The Alcohol Smoking and Substance Involvement Screening Test (ASSIST) in an Acute Mental Health Setting

  • Published:
International Journal of Mental Health and Addiction Aims and scope Submit manuscript

Abstract

Up to sixty percent of people admitted to acute mental health services in Australia present with a clinically significant co-occurring drug and/or alcohol problem. These individuals experience poorer health outcomes when compared to the general population and to those people who have a mental illness but have no co-morbid alcohol and drug problems. Anecdotal evidence also suggests that many nurses working in the area do not have the knowledge and skills and confidence to work effectively with this patient population. Drug and alcohol assessment tools, considered the gold standard, generally assess only one substance at a time or provide little specific information on the particular substance of use or abuse. An amended version of the World Health Organisation, (WHO) Alcohol Smoking and Substance Involvement Screening Test Version 3 (ASSIST V3.0) and associated brief interventions was implemented following an in-vivo education program at an acute mental health inpatient unit in Western Australia. This before and after intervention’ study utilised a self-rating questionnaire and a knowledge quiz to assess nurses’ knowledge of drug and alcohol issues as well as their level of confidence to work with people who have a mental illness and co-occurring drug and alcohol problems. Translation of acquired knowledge into patient care was also evaluated through a review of patient medical records. Significant improvement in nurses’ knowledge was reported along with increased clinical confidence and skills to identify, assess, and manage this group of patients and to provide them with information and referral to appropriate agencies in the community.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Adams, M. W. (2008). Comorbidity of mental health and substance misuse problems: a review of workers’ reported attitudes and perceptions. Journal of Psychiatric and Mental Health Nursing, 15(2), 101–108. doi:10.1111/j.1365-2850.2007.01210.x.

    Article  PubMed  CAS  Google Scholar 

  • Allen, J., Hamilton, A., Nunn, R., Crock, L., Frecker, J., & Burk, N. (2009). Evaluation of a community-based mental health drug and alcohol nurse in the care of people living with HIV/AIDS. Journal of Psychiatric and Mental Health Nursing, 16(2), 129–136. doi:10.1111/j.1365-2850.2008.01340.x.

    Article  PubMed  CAS  Google Scholar 

  • Australian Bureau of Statistics. (2007). National Survey of Mental Health and Wellbeing: Summary of Results, 2007.

  • Baker, A., Lewin, T., Reichler, H., Clancy, R., Carr, V., Garrett, R., et al. (2002). Evaluation of a motivational interview for substance use within psychiatric in-patient services. Addiction, 97(10), 1329–1337.

    Article  PubMed  Google Scholar 

  • Baker, A., Thornton, L., Hiles, S., Hides, L., & Lubman, D. (2012). Psychological interventions for alcohol misuse among people with co-occurring depression or anxiety disorders: a systematic review. Journal of Affective Disorders, 139(3), 217–229.

    Article  PubMed  Google Scholar 

  • Blanchard, J. J., Brown, S. A., Horan, W. P., & Sherwood, A. R. (2000). Substance use disorders in schizophrenia: review, integration, and a proposed model. Clinical Psychology Review, 20(2), 207–234.

    Article  PubMed  CAS  Google Scholar 

  • Brown, C., Pirmohamed, M., & Park, B. K. (1997). Nurses’ confidence in caring for patients with alcohol-related problems. Professional Nurse, 13(2), 83–86.

    CAS  Google Scholar 

  • Burgess, P., Trauer, T., Coombs, T., McKay, R., & Pirkis, J. (2009). What does ‘clinical significance’ mean in the context of the Health of the Nation Outcome Scales? Australasian Psychiatry, 17(2), 141–148.

    Article  PubMed  Google Scholar 

  • Carra, G., & Johnson, S. (2009). Variations in rates of comorbid substance use in psychosis between mental health settings and geographical areas in the UK. A systematic review. Social Psychiatry and Psychiatric Epidemiology, 44(6), 429–447. doi:10.1007/s00127-008-0458-2.

    Article  PubMed  Google Scholar 

  • Colton, D. (2000). Quality improvement in health care :conceptual and historical foundations. Evaluation & the Health Professions, 23(1), 7–42.

    Article  CAS  Google Scholar 

  • Degenhardt, L., & Hall, W. (2012). Extent of illicit drug use and dependence, and their contribution to the global burden of disease. Lancet, 379(9810), 55–70. doi:10.1016/s0140-6736(11)61138-0.

    Article  PubMed  Google Scholar 

  • Gavin, D. R., Ross, H. E., & Skinner, H. A. (1989). Diagnostic validity of the drug abuse screening test in the assessment of DSM-III drug disorders. British Journal of Addiction, 84(3), 301–307.

    Article  PubMed  CAS  Google Scholar 

  • Gerace, L. M., Hughes, T. L., & Spunt, J. (1995). Improving nurses’ responses toward substance-misusing patients: a clinical evaluation project. Archives of Psychiatric Nursing, 9(5), 286–294.

    Article  PubMed  CAS  Google Scholar 

  • Groth-Marnat, G. (2009). Handbook of psychological assessment (Vol. 5). New Jersey, USA: John Wiley & Sons.

    Google Scholar 

  • Happell, B., Carta, B., & Pinikahana, J. (2002). Nurses’ knowledge, attitudes and beliefs regarding substance use: a questionnaire survey. Nursing & Health Sciences, 4(4), 193–200.

    Article  Google Scholar 

  • Hides, L., Cotton, S., Berger, G., Gleeson, J., O'Donnell, C., Proffitt, T., et al. (2009). The reliability and validity of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in first-episode psychosis. Addictive Behaviors, 34(10), 821–825.

    Article  PubMed  Google Scholar 

  • Hoolahan, B., Kelly, B., Stain, H. J., & Killen, D. (2006). Co-morbid drug and alcohol and mental health issues in a rural New South Wales Area Health Service. Australian Journal of Rural Health, 14(4), 148–153. doi:10.1111/j.1440-1584.2006.00792.x.

    Article  PubMed  Google Scholar 

  • Humeniuk, R., Ali, R., Babor, T. F., Farrell, M., Formigoni, M. L., Jittiwutikarn, J., et al. (2008). Validation of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Addiction, 103(6), 1039–1047. doi:10.1111/j.1360-0443.2007.02114.x.

    Article  PubMed  Google Scholar 

  • Kavanagh, D. J., Waghorn, G., Jenner, L., Chant, D. C., Carr, V., Evans, M., et al. (2004). Demographic and clinical correlates of comorbid substance use disorders in psychosis: multivariate analyses from an epidemiological sample. Schizophrenia Research, 66(2–3), 115–124.

    Article  PubMed  Google Scholar 

  • Kelleher, S. (2007). Health care professionals’ knowledge and attitudes regarding substance use and substance users. Accident and Emergency Nursing, 15(3), 161–165. doi:10.1016/j.aaen.2007.05.005.

    Article  PubMed  Google Scholar 

  • Koola, M. M., McMahon, R. P., Wehring, H. J., Liu, F., Mackowick, K. M., Warren, K. R., et al. (2012). Alcohol and cannabis use and mortality in people with schizophrenia and related psychotic disorders. Journal of Psychiatric Research. doi:10.1016/j.jpsychires.2012.04.019.

  • Kring, D. L. (2008). Research and quality improvement: different processes, different evidence. (CNE SERIES). Medsurg Nursing, 17(3), 162–169.

    PubMed  Google Scholar 

  • Lacey, J. (2009). Alcohol brief interventions: exploring perceptions and training needs. Community Practitioner, 82(6), 30–33.

    PubMed  Google Scholar 

  • Marshall, B. D. L., & Werb, D. (2010). Health outcomes associated with methamphetamine use among young people: a systematic review. Addiction, 105(6), 991–1002.

    Article  PubMed  Google Scholar 

  • McQueen, J., Howe, T. E., Allan, L., Mains, D., Hardy, V. (2011). Brief interventions for heavy alcohol users admitted to general hospital wards. [Review]. Cochrane Database of Systematic Reviews: Reviews 2011 Issue 8 John Wiley & Sons, Ltd Chichester, UK. doi:10.1002/14651858.CD005191.pub3.

  • Mills, K. L., Deady, M., Proudfoot, H., Sannibale, C., Teesson, M., Mattick, R., Burns, L. (2009). Guidelines on the management of co-occurring alcohol and other drug and mental health conditions in alcohol and other drug treatment settings. Sydney: Australian Government Department of Health and Ageing.

  • Moore, E., Mancuso, S. G., Slade, T., Galletly, C. A., & Castle, D. J. (2012). The impact of alcohol and illicit drugs on people with psychosis: the second Australian national survey of psychosis. The Australian and New Zealand Journal of Psychiatry. doi:10.1177/0004867412443900.

  • National Mental Health Education, & Training Advisory Group. (2002). National practice standards for the mental health workforce. Canberra: Publications Production Unit (Public Affairs, Parliamentary and Access Branch), Commonwealth Department of Health and Ageing, Canberra.

    Google Scholar 

  • 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 and Alcohol Review, 24(3), 217–226. doi:10.1080/09595230500170266.

    Article  PubMed  Google Scholar 

  • Newhouse, R., Pettit, J., Poe, S., & Rocco, L. (2006). The slippery slope: differentiating between quality improvement and research. The Journal of Nursing Administration, 36(4), 211–219.

    Article  PubMed  Google Scholar 

  • Pinikahana, J., Happell, B., & Carta, B. (2002). Mental health professionals’ attitudes to drugs and substance abuse. Nursing & Health Sciences, 4(3), 57–62.

    Article  Google Scholar 

  • Randall, D., Degenhardt, L., Vajdic, C., Burns, L., Hall, W., Law, M., et al. (2011). Increasing cancer mortality among opioid-dependent persons in Australia: a new public health challenge for a disadvantaged population. Australian and New Zealand Journal of Public Health, 35(3), 220–225.

    Article  PubMed  Google Scholar 

  • Rassool, G. H., & Rawaf, S. (2008). Predictors of educational outcomes of undergraduate nursing students in alcohol and drug education. Nurse Education Today, 28(6), 691–701.

    Article  PubMed  Google Scholar 

  • Ratschen, E., Britton, J., Doody, G. A., Leonardi-Bee, J., & McNeill, A. (2009). Tobacco dependence, treatment and smoke-free policies: a survey of mental health professionals’ knowledge and attitudes. General Hospital Psychiatry, 31(6), 576–582. doi:10.1016/j.genhosppsych.2009.08.003.

    Article  PubMed  Google Scholar 

  • Saunders, J. B., Aasland, O. G., Babor, T. F., de la Fuente, J. R., & Grant, M. (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption-II. Addiction, 88(6), 791–804.

    Article  PubMed  CAS  Google Scholar 

  • Thornton, L., Baker, A., Johnson, M., & Lewin, T. (2012). Attitudes and perceptions towards substances among people with mental disorders: a systematic review. Acta Psychiatrica Scandinavica, 126(2), 87–105.

    Article  PubMed  CAS  Google Scholar 

  • Thornton, L., Baker, A., Lewin, T., Kay Lambkin, F., Kavanagh, D., Richmond, R., et al. (2012). Reasons for substance use among people with mental disorders. Addictive Behaviors, 37(4), 427–434.

    Article  PubMed  Google Scholar 

  • Tran, D., Stone, A., Fernandez, R., Griffiths, R., & Johnson, M. (2009). Does implementation of clinical practice guidelines change nurses’ screening for alcohol and other substance use? Contemporary Nurse: a Journal for the Australian Nursing Profession, 33(1), 13–19.

    Article  Google Scholar 

  • Willaing, I., & Ladelund, S. (2005). Nurse counseling of patients with an overconsumption of alcohol. Journal of Nursing Scholarship, 37(1), 30–35.

    Article  PubMed  Google Scholar 

  • Winstock, A. R., & Mitcheson, L. (2012). New recreational drugs and the primary care approach to patients who use them. British Medical Journal, 344, e288. doi:10.1136/bmj.e288.

    Article  PubMed  Google Scholar 

  • World Health Organisation (2010). Management of substance abuse Retrieved 31 May 2010, 2010, from http://www.who.int/substance_abuse/activities/assist/en/index.html.

Download references

Conflict of Interest

The authors have no conflict of interest and have full control of all primary data.

Author information

Authors and Affiliations

  1. Curtin Health Innovation Research Institute/ School of Nursing and Midwifery, Curtin University, GPO Box U 1987, Perth, WA, 6845, Australia

    Karen Heslop & Dianne Wynaden

  2. Department of Psychiatry, Royal Perth Hospital Perth, Perth, WA, Australia

    Karen Heslop, Calum Ross & Bernadette Osmond

Authors
  1. Karen Heslop
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Calum Ross
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bernadette Osmond
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Dianne Wynaden
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Karen Heslop.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Heslop, K., Ross, C., Osmond, B. et al. The Alcohol Smoking and Substance Involvement Screening Test (ASSIST) in an Acute Mental Health Setting. Int J Ment Health Addiction 11, 583–600 (2013). https://doi.org/10.1007/s11469-013-9428-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11469-013-9428-3

Keywords

Search

Navigation