Validation of the Alcohol Smoking and Substance Involvement Screening Test (ASSIST) in acute psychiatric inpatients

The aims of this study were to examine the psychometric properties of The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in psychiatric inpatients, due to the scarcity of screening instruments validated in this population. Patients from Hospital Clínic's psychiatric ward (n = 202) completed: ASSIST, Addiction Severity Index (ASI), MINI-International Neuropsychiatric Interview (MINI), Alcohol Use Disorders Identification Test (AUDIT), Fagerström Test for Nicotine Dependence (FTND), Severity of Dependence Scale (SDS), and Drug Abuse Screening Test (DAST). Reliability and validity evidences based on internal structure (Exploratory and Confirmatory Factor Analyses) and on the relation to other variables were obtained. Excellent internal consistency was found for Total Substance Involvement (TSI) (α = .92 and ω = .93) and for Specific Substance Involvement (SSI) scores (α = .88 - .96 and ω = .89 - .95). Analysis of internal structure for tobacco, alcohol and cannabis subscales resulted in unidimensional models with adequate goodness-of-fit indices. ASSIST scores were significantly correlated with those of ASI (r = .795 to r = .953), AUDIT (r = .864), FTND (r = .808), DAST (r = .831), SDS (r = .519) and with "number of diagnoses of abuse/dependence" in MINI-Plus (TSI: r = .857 to r = .862; SSI: r = .646 to r = .834). Receiver operating characteristic analysis (ROC) and Mann-Whitney's U test found good discriminative validity evidences. ASSIST scores showed good reliability and there were validity evidences that support its use for identifying risk levels of tobacco, alcohol and other substance use in psychiatric patients.

Active Smoking Before Liver Transplantation in Patients with Alcohol Use Disorder: Risk Factors and Outcomes

Tobacco use is more prevalent among alcohol liver disease (ALD) transplant patients and exerts harmful effects to the patient and to the graft. The aims of this study were to examine the impact of smoking status (nonsmoker, ex-smoker, active smoker) on patient survival and clinical outcomes, and to assess risk factors for active smoking before and after liver transplant (LT). An observational retrospective cohort study with 314 ALD patients undergoing LT from January 2004 to April 2016. Recipients were followed until April 2017 or death. Kaplan-Meier and Cox proportional hazards regression analyses were used to assess risk of mortality according to smoking status before LT. Smokers had a 79% higher risk of dying than those who had never smoked or quit smoking before LT. Ex-smokers had a greater survival probability (96.2%, 93.8%, 86.9%, and 83.1% at 1, 3, 5, and 10 years after LT) than active smokers until LT (96.0%, 85.6%, 80.0%, and 70.4%). Active smokers before LT with poor toxicity awareness had more than a twofold higher risk of mortality (Cox HR = 2.20, 95% CI: 1.05-4.58, p = 0.04) than ex-smokers. Younger age (OR = 94), higher Model for End-Stage Liver Disease (MELD) (OR = 1.06), and comorbid substance use disorder (OR = 2.35) were predictors of smoking until LT. Six months or less of alcohol abstinence (OR = 3.23), and comorbid substance use disorder (OR = 4.87) were predictors of active smoking after LT. Quitting smoking before transplantation improved survival. Evidence based smoking cessation interventions should be offered before and after LT.