Nearly one in five people have used illegal drugs or misused prescription drugs in the past year, according to the National Center for Drug Abuse Statistics, and this figure may be growing larger and more deadly due to the ongoing opioid epidemic (Rudd et al., 2016). The societal costs of substance use disorders may exceed $740 billion in the United States alone, according to the National Institute on Drug Abuse (NIDA), and clinicians are often well aware of the personal toll of drugs on patients and their loved ones. The healthcare providers who frequently encounter drug abuse may be in a position to measure the presence and severity of substance abuse issues, then offer help before it is too late.
The Drug Abuse Screening Test (DAST) is a short questionnaire created to screen for drug abuse. It is available within CBS Health to include in any protocol alongside measures of cognitive performance and other questionnaires, allowing a clinician to easily measure and track substance abuse as part of any healthcare practice.
What is the DAST?
The DAST is an instrument for systematic assessment of drug use and abuse. It was developed by Harvey Skinner at York University in 1982 as a way to provide valuable information to practitioners for identifying problems as early as possible, tailoring interventions to a patient, and measuring the effectiveness of treatments.
With only 10 items, the DAST-10 can be self-administered in about 2 minutes, making it suitable for routine screening and other clinical usage, resulting in a quantitative index of the consequences of drug abuse for a particular patient. The DAST-10 is a shorter version of the 20-item DAST-20, but correlates almost perfectly with the longer scale despite taking less time.
Each item on the DAST-10 asks about involvement with drugs other than alcohol, such as non-medical use of drugs and use of prescribed drugs in excess of directions. Each question refers to the past 12 months, and the patient responds with “yes” or “no.” In Creyos Health, the DAST-10 can be administered in-clinic or sent remotely for patients to take on their own device. Written instructions define the terms involved, so every patient is on the same page and can provide consistent information.
The DAST-10 is scored by assigning one point to each response that indicates problematic drug use, forming a total score out of 10. Higher scores indicate a greater degree of problems or consequences related to drug abuse. Tentative guidelines, ranging from brief counseling to intensive interventions, are recommended based on this score. In Creyos Health, the DAST is automatically scored, and guidelines to aid in interpretation are presented on the patient’s report. If a patient has taken the DAST more than once, scores are tracked over time and a graph is generated.
DAST-10 scores have proven to be reliable and valid in several studies, ensuring the scale can be confidently used in research and clinical settings across a variety of populations. See the paper by Yudko, Lozhkina, and Fouts (2007) for a review of the DAST’s psychometric properties, and for more information on scoring and administration, review the guide for using the DAST.
Important note: the purpose of the DAST-10 is to assess drug abuse. However, it is not a standalone diagnostic tool. Any conclusions drawn from the DAST-10 should be paired with clinical interviews and observations, other health examinations or assessments administered, other evaluations of the patient, and/or the patient’s family history.
How are problems with substance abuse related to cognition?
Cognitive capacity is linked with several aspects of drug abuse, such as direct effects of drugs, withdrawal effects, and the probability of relapse after treatment. Thus, cognition is central to drug addiction. One recent review (Melugin, Nolan, & Sicilliano, 2021) notes that there is growing evidence that the link between cognition and drug abuse is bidirectional—that is, deficits across multiple domains of cognition are a risk factor for substance abuse, but substance abuse can also directly cause further deficits. Reductions in cognitive function are seen in both behavioural data and in brain imaging, with different drugs associated with different patterns of brain deficits (Lundqvist, 2009).
Because the nature of the link between brain health and substance abuse depends on the specific drug or drugs in question, as well as characteristics of the individual and the stage of treatment, it is important to measure both cognitive performance and the severity of drug abuse problems when dealing with patients in a clinical context. Some experts (e.g., Rezapour et al., 2015, Verdejo-Garcia et al., 2019) recommend that treatments for addiction include neurocognitive rehabilitation and testing in addition to the standard management of withdrawal symptoms and reduction of craving that directly address addictive behaviours.
Creyos Health’s neuropsychological tasks are validated measures of cognitive function, which complement the results from the DAST-10 to identify risks, measure the severity of problems, track recovery as treatment progresses, and monitor for signs of relapse. Read more about how addiction and rehab centers use Creyos Health here.
Which healthcare disciplines should screen for drug abuse with the DAST?
Addiction clinics have an obvious use case for the DAST, but many other disciplines may find a need to measure the severity of problems with drug abuse as well. Substance abuse is comorbid with a wide variety of health conditions, and rarely occurs in isolation. For example, according to the National Survey on Drug Use and Health, 11.9% of people with a substance use disorder also have alcohol use disorder, and 45.6% of those with a substance use disorder also have a mental illness. Most clinicians will encounter substance use problems in the course of their practice.
NIDA lists resources for professional disciplines such as family physicians, nurse practitioners, and pain medicine specialists. Some psychologists have also pushed for greater involvement in addressing the public health crisis of addiction (Dimoff, Sayette, & Norcross, 2017). Psychiatrists and neurologists may be positioned to help as well, addressing the neurological consequences of addiction, and taking advantage of the availability of digital tools to better monitor for potential problems with prescription medications, such as opioids (Goadsby et al., 2018).
The DAST may present a rare opportunity to screen for problems with substance abuse before the most devastating consequences occur. The questionnaire, along with a cognitive function baseline, can provide information that assists a variety of clinicians in doing early screening, diagnosis, intervention, and/or referral to specialists. Creyos Health provides an easy way to have the DAST close at hand and integrate the instrument into any practice.
How to administer a computerized DAST in Creyos Health
Before administering the DAST in Creyos Health, ensure it is appropriate for the patient. Because the content of the questionnaire directly asks about drug use, which can be a sensitive topic, patients may provide inaccurate information due to embarrassment, social repercussions, or even legal issues. Every effort should be taken to make sure the patient is comfortable providing accurate information in a healthcare context, and results should be combined with other pieces of information about the patient to ensure a complete picture emerges. Skinner also recommended the following tips for best use of the DAST:
- The assessment should be self-administered when the patient is defensive or high in social anxiety—though the Internet did not exist when the scale was developed, remote administration in the patient’s own home may further help with confidentiality and accurate responding
- Do not administer the DAST to patients who are currently under the influence of drugs
- Do not administer the DAST to patients who are undergoing withdrawal
Once proper prerequisites have been established, administering the DAST in Creyos Health is easy. It can be given to a patient in isolation, or included as part of any protocol that mixes questionnaires and cognitive assessments. When creating a protocol within Creyos Health, click the Questionnaires section, then check off the DAST. You can then choose and rearrange other questionnaires and tasks from the Cognitive Assessments section for an integrated flow.
For detailed instructions on administering questionnaires within Creyos Health, please see our previous blog post on administering a digital PHQ-9.
The Creyos Health version of the DAST-10 is computerized and web-based, so the test can be administered to a patient in-clinic or at home, and requires no special training. The DAST can also be added to a Creyos Health schedule, allowing you to automatically send it via email on a regular cadence. The results are scored instantly, and if a patient completes the questionnaire more than once, results are added to the patient’s report to track changes in response to treatments, or to monitor for variations over time. No registration or login are required, and the DAST-10 takes about 2 minutes to complete. With minimal effort, healthcare providers, patients, and caregivers can all benefit from the valuable information provided by a standardized screening for problems with drug abuse.
Need more computerized health questionnaires and screeners?
If there are additional questionnaires you would like integrated in Creyos Health, such as instruments you currently administer in pen-and-paper form, please do not hesitate to let us know by commenting on this blog post or contacting us directly by email at email@example.com. We always welcome your feedback.
Thank you, as always,
— The Creyos Team