Network analysis of Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) 3.1 items for non-medical use of alcohol, tobacco, cannabis, prescription sedatives, prescription stimulants, and prescription opioids
Front Psychiatry. 2025 May 16;16:1541628. doi: 10.3389/fpsyt.2025.1541628. eCollection 2025.
ABSTRACT
BACKGROUND: At-risk substance use is a leading cause of preventable morbidity and mortality worldwide. The Alcohol, Smoking and Substance Involvement Screening Test 3.1 (ASSIST) is widely used to screen for such use.
OBJECTIVES: Using network analysis to reframe risky substance use as a web of interacting ASSIST symptoms to provide important suggestions about potential mechanisms underlying risky use.
METHODS: Cross-sectional data on the ASSIST was collected via an online survey from a general population sample of Jewish adults in Israel (N=4,002; 50.4% women). Network analysis was carried out for ASSIST symptoms for non-medical use of alcohol, tobacco, cannabis, prescription sedatives, prescription stimulants, and prescription opioids. First, networks were modeled for each substance, to explore the following research questions: which symptoms were most strongly related? and what are the key symptoms that compose the networks? Second, networks were compared to determine if symptom relationships differed between substances.
RESULTS: Basic similarities were observed across substances, e.g., strongest direct associations between frequency of use and craving, and frequency of substance related problems and role interference. Role interference and craving appeared to play important roles in the networks. Differences were observed between substances in strength of associations between symptoms.
CONCLUSION: Network structures were similar across substances, suggesting that similar intervention approaches may be appropriate, with substance-specific strategies as warranted. Among those who use substances, addressing the effects of role interference and craving in risky substance use may help reduce substance-related harms and limit progression to full blown disorder.
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