Examining the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) Moderate Risk Cannabis Use Threshold Among a Sample of U.S. Military Veterans with Chronic Pain Who Report Medical Cannabis Use

Abstract

BACKGROUND: The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) is widely used for substance use screening. However, its established risk cutoffs may not be appropriate for people who use cannabis for medical reasons. This study sought to determine an optimal moderate-risk cannabis use cutoff for this population. METHODS: A sample of 501 U.S. military veterans who reported using cannabis for medical reasons and were prescribed long-term opioid therapy were administered the ASSIST and Cannabis Use Disorder Identification Test - Revised (CUDIT-R). Receiver operating characteristic (ROC) curves compared the performance of the ASSIST to the CUDIT-R. RESULTS: The currently recommended cutoff of 4 demonstrated poor performance (Area Under the Curve [AUC] = 52.8). A cutoff of 7 maximized AUC (66.2). However, this cutoff resulted in low sensitivity (59.9). A cutoff of 6 improved sensitivity (94.7), with a reduced AUC of 59.8. CONCLUSIONS: Among this population, raising the ASSIST cutoff to 7 to detect moderate cannabis risk may be appropriate for ongoing patient monitoring, while a cutoff of 6 may be preferable for screening. However, there remain significant problems with the ASSIST as a measure for detecting risk for cannabis-related harms among this population. Development of population-specific screening tools is needed.