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Can patients screen themselves? Pilot study of an audio-guided computer-assisted self-interview (ACASI) approach to screening for substance use in primary care

Lack of a brief, validated screening and assessment tool to identify problematic drug use is a significant barrier to integrating screening, brief intervention and referral to treatment (SBIRT) services into primary care settings. Because patient self-administered screening is potentially more efficient than the traditional face-to-face approach, we undertook a pilot study examining the feasibility and acceptability of an audio-guided computer-assisted self-interview (ACASI) to identify substance use. We adapted the World Health Organization’s Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) to ACASI format and administered it on touch-screen tablet computers. English- and Spanish-speaking patients were recruited from a large urban primary care clinic. Participants completed the ACASI ASSIST in the waiting area and received a $4.50 transit card. Of 47 eligible patients approached, 35 (74%) agreed to participate. Participants were 57% male with a mean age of 49 years (range 28–72 years, SD = 11). The majority (54%) were foreign born, 50% were Hispanic, and 29% were African American. Twenty-five subjects completed the ASSIST in English, and 10 in Spanish. Thirty participants (86%) screened positive for lifetime use of alcohol, and 18 (51%) for other drugs (excluding tobacco). Twenty-two (63%) had used alcohol and/or other drugs in the past three months, and 13 (37%) had moderate- or high-risk use (6 alcohol; 11 other drugs; 4 both). Mean time to complete the ACASI ASSIST was 5.6 minutes (range, 1.5–17.2 minutes, SD = 3.2). Responses were 100% complete. All but one participant felt comfortable answering these questions on a computer. Most either preferred the computer to an interviewer (50%) or had no preference (38%). These results indicate that computer-assisted substance use screening may be feasible and acceptable among a culturally diverse primary care patient population. Our next step will be to evaluate the validity of the ACASI-administered ASSIST.

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Correspondence to Jennifer McNeely.

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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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McNeely, J., Gilberti, B., Khan, R. et al. Can patients screen themselves? Pilot study of an audio-guided computer-assisted self-interview (ACASI) approach to screening for substance use in primary care. Addict Sci Clin Pract 7, A7 (2012).

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  • Primary Care
  • Primary Care Clinic
  • Primary Care Patient
  • Tablet Computer
  • Substance Involvement