Assessment Guide  |   Nov 17, 2020  |   2 minute read

Drug Use | DAST-10

The Drug Abuse Screening Test (DAST-10)

Recommended frequency: Every 4 weeks

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Summary

The Drug Abuse Screening Test 10 (DAST-10) is a brief, 10-item assessment tool designed to measure, evaluate, and identify drug use problems, excluding alcohol or tobacco. While it can be self-administered, the presence of a clinician is recommended to help clarify questions and encourage honest responses. The DAST-10 is a streamlined version of the original 28-item tool (DAST-28), first published in 1982 as a rapid screener for drug-related concerns. The DAST-10 was developed by Dr. Harvey Skinner and published by the Centre for Addiction and Mental Health (CAMH).

We want to thank Dr. Harvey Skinner for sharing his expertise with us in the creation of this Assessment Guide. Dr. Skinner is the author of the DAST-10 and a professor Emeritus of psychology and global health at York University, as well as professor Emeritus at the Dalla Lana School of Public Health, University of Toronto. Dr. Skinner is a registered psychologist in Ontario and a certified trainer in motivational interviewing. Dr. Skinner’s expertise extends to behavior change interventions, eHealth promotion, and global health initiatives, where he has made pioneering contributions.

About the DAST-10

The DAST-10, developed in the late 1980s alongside the DAST-20, gained widespread adoption in the 1990s and early 2000s among clinicians in primary care, substance use treatment centers, and mental health settings. It quickly gained popularity as a valuable tool for detecting issues of drug use and is now widely regarded as a standard screening instrument in both clinical practice and research.

The assessment was developed to address a gap in the field, namely the lack of screening tools that examined drug use in isolation of alcohol and tobacco. In this clip, Dr. Harvey Skinner describes the context and rationale for developing the DAST-10.

The DAST-10 Validity and Research

The original 28-item DAST was modelled after the widely used Michigan Alcoholism Screening Test (Selzer, American Journal of Psychiatry, 1971). The two shortened versions of the DAST successfully retained robust correlations with the 28-item version. A study by Yudko et al. (2007) found the DAST-10 to be quite sensitive and specific in its measurement capabilities, demonstrating moderate to high internal consistency reliability, robust diagnostic validity, and strong concurrent validity, evidenced by significant correlations with other substance use measures.

The DAST-10 is highly recommended for routine screening by institutes such as the National Institute on Drug Abuse (NIDA) and has been integrated into electronic health record systems and national guidelines for substance use screening protocols. It is also included in the Commission on Accreditation of Rehabilitation Services’ (CARF) updated Behavioral Health Standards Manual, listed as an effective and recommended screening tool for substance use disorders. The DAST-10 is also recommended by many national task forces for its ability to identify potential drug-related problems, without placing a heavy time burden on staff or respondents.

As a result of its widespread adoption, the DAST has been adapted into more than 19 different languages internationally since its development.

In the following clip, Dr. Skinner describes why the DAST-10 is widely adopted and used.

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Who is the DAST-10 Assessment For?

Review the list below to determine if this assessment should be used with your client. If you answer YES to all of the following questions, the DAST-10 is likely a good fit to use with your client.

  1. Is your client over the age of 16?
  2. Has your client exhibited signs of drug abuse or misuse?
  3. Are your concerns with the client’s drug use NOT related to alcohol or tobacco use?

The DAST-10 Scale

The DAST-10 can be administered as a self-report questionnaire or in an interview format. The self-report approach allows individuals to complete the questionnaire privately, and may yield to more honest responses. However, if the respondent has any literacy or language barriers, the assessment can be administered in an interview format.

Dr. Skinner shares some tips on the best way to introduce the DAST-10 to maximize client comfort, engagement, and honesty:

The DAST-10 scale asks the respondent about their potential drug use, excluding alcohol and tobacco, in the past 12 months

It is important that clients understand key terms before beginning the assessment.

  • ‘Drug use’ refers to illicit, non-prescribed substances.
  • ‘Drug misuse’ refers to taking prescription medications more frequently or in greater amounts than prescribed.

Dr. Skinner explains why it’s important to define drug use and misuse with the client in order to ensure the context is considered and they can respond as accurately as possible.

General Principles for Administering the DAST-10

Time Frame: The recommended time frame for screening typically asks respondents to consider the past 12 months. For follow-up assessments during or after the course of treatment, shorter time frames, such as the past three months, might be used instead.

Populations: The DAST-10 is generally validated in adult populations. The DAST-10 may be suitable for older teens, depending on clinician’s professional judgement. Language may need to be adapted for adolescents, older adults, and individuals requiring cultural adaptations or those with co-occurring disorders.

Instructions to the respondent: The client should be briefed on the definitions of ‘drug use’ and ‘misuse’ outlined above. Clinicians should also explain that the goal of the DAST-10 is to understand how drug use and misuse may be affecting the client’s life, emphasizing the need for honest and accurate responses.

Watch this clip with Dr. Skinner for further special considerations when administering the DAST-10.

Scoring the DAST-10

Each item in the DAST-10 is scored as 1 point. Items #1, 2, and 4-10 are each worth 1 point if the answer is YES. Item #3 is worth 1 point if the answer is NO.

The result of the DAST-10 is a score ranging from 0 to 10, where a score of 0 means the client reported no drug problems, and a score of 10 equates to severe or multiple drug-related problems.

The table below outlines the degree of problems related to drug abuse and the suggested action for each DAST-10 score.

  • A score of 1-2 indicates a low level problem that may require monitoring and re-assessing drug use at a late date
  • A score of 3-5 signifies a moderate level problem that necessitates further investigation with additional test or resources
  • A score of 6-8 indicates a substantial problem that requires intensive assessment and treatment.
  • A score of 9 or 10 specifies a severe level problem that requires intensive assessment and medical treatment.

 

While the table indicates useful benchmarks and suggested actions, clinicians should use their professional judgement and interpret scores in light of demographic and contextual factors, including frequency and duration of drug use, presences of physical or psychiatric co-morbidities, family and social situations, and any acute safety concerns.

References
Skinner, H. A. (1982). The Drug Abuse Screening Test. Addictive Behavior, 7(4),363–371.
Skinner, Harvey PhD1; Samadi, Shamim BSC1; Khan, Sher Bano BSC1; Crowley, Lisa DNP2. The Drug Abuse Screening Test (DAST): First 40 Years and Future Developments. The Canadian Journal of Addiction 15(4):p 6-13, December 2024. | DOI: 10.1097/CXA.0000000000000222
Yudko, E., Lozhkina, O. & Fouts, A. (2007). A comprehensive review of the psychometric properties of the DAST. Journal of Substance Abuse Treatment, 32(2), 189–198.

Frequently Asked Questions
What is the DAST-10?

The DAST-10 is a brief, 10-item self-report screening tool used to identify drug use problems, excluding alcohol or tobacco use. It consists of 10 YES or NO questions that assess the respondents behaviors related to drug use and misuse over the past 12 months.

How should I introduce the DAST-10 to clients?

Clinicians should explain the purpose of the DAST-10 to clients, which is to better understand how drug use or misuse may be impacting their life. Reassuring clients that their answers will be kept confidential helps foster trust, ensuring that they complete the questionnaire honestly and accurately.

When introducing the DAST-10 to clients, it is important to clearly define key terms. ‘Drug use’ typically refers to illicit or non-prescribed substances, while ‘misuse’ describes the use of prescription medications in ways not intended by a healthcare provider, such as taking higher doses or using them more frequently. Clients should also be reminded that the DAST does not include alcohol or tobacco use, so drinking and tobacco habits should not be considered in their responses.

What are some tips and guidelines for administering the DAST-10?

When implementing the DAST-10 in a clinical setting, it is important to ensure that the client feels respected and supported. Here are some key tips:

  • Create a private, confidential setting (whether in-person or online) to encourage honest and accurate responses.
  • Communicate the purpose of the DAST-10, explaining its value in determining the affect of drug use or misuse on the respondent’s life.
  • Use nonjudgmental, respectful language to reduce stigma and build trust
  • Consider combining the DAST-10 with other tools, like the SADQ for alcohol dependence or PHQ-9 for depression, to get a more complete view of the individual’s needs.
  • Provide timely feedback and referrals based on the results of the assessment. Explain what their score means and discuss recommended next steps with the client.
  • Conduct follow-up assessments at set intervals to track changes over time to guide ongoing treatment plans and evaluate program effectiveness.
How is the DAST-10 scored?

Each item in the DAST-10 is scored as 1 point. Items #1, 2, and 4-10 are each worth 1 point if the answer is YES. Item #3 is worth 1 point if the answer is NO. The result of the DAST-10 is a score ranging from 0 to 10, where a score of 0 means the client reported no drug problems, and a score of 10 equates to severe or multiple drug-related problems.

  • A score of 1-2 indicates a low level problem that may require monitoring and re-assessing drug use at a late date
  • A score within 3-5 signifies a moderate level problem that necessitates further investigation with additional test or resources
  • A score from 6-8 indicates a substantial problem that requires intensive assessment and treatment.
  • A score of 9 or 10 specifies a severe level problem that requires intensive assessment and medical treatment.
What behaviors does the DAST-10 evaluate?

The DAST-10 evaluates behaviors related to drug use and misuse. In the 10-item drug assessment test, respondents are evaluated on:

  1. Use of drugs other than those prescribed by a doctor
  2. Number of drugs used
  3. Ability to refrain from drug use
  4. Negative consequences of drug use
  5. Guilt or remorse about drug use
  6. Family involvement
  7. Affect of drug use on relationships
  8. Illegal activities from drug use
  9. Withdrawal symptoms
  10. Medical problems as a result of drug use
What is the difference between the DAST-10 and the DAST-20?

The DAST-10 and DAST-20 are both shorter versions of the original 28-item DAST. The DAST-10 is a brief, 10-item measure ideal for quick screening, while the DAST-20 is a more in-depth version intended for research and comprehensive assessment. Both the DAST-10 and DAST-20 have strong correlations with the original.

The DAST-10 is recommended by national task forces and other stakeholders for its ability to identify potential drug-related problems without placing a heavy time burden on staff or respondents. The DAST-20 offers broader coverage of different dimensions including withdrawal symptoms, interactions with family, work problems, and physical health concerns, and is commonly used in specialized treatment settings and in research studies.

Why assess drug use?

Substance use disorders are a global public health concern, with the increasing misuse of opioids, methamphetamines, prescription medications, and illicit drugs. This growing crisis underscores the need for effective and accurate screening to detect emerging issues early and ensure individuals receive appropriate care.

A quantitative screening tool can provide insights to guide interventions and inform the required course of treatment. Individuals experiencing milder concerns can benefit from a brief counselling session, while severe cases might require more intensive treatments. Screening tools, such as the DAST, can identify individuals with substance use issues early on and support data-driven treatment plans to provide effective, personalized care.

What prompted the development of the DAST-10?

The original 28-item DAST was developed by Dr. Harvey Skinner with the goal of rapidly screening for drug-related issues. Dr. Skinner recognized the need for a brief, quicker screening assessment, which led to the development of the 10-item DAST.

How is the DAST-10 administered and scored in the Greenspace platform?

The DAST-10 is a self-report questionnaire featuring 10 yes or no questions. Clients can complete the DAST-10 at home via email or SMS, or using our Kiosk function before, after, or during sessions. For remote assessment delivery, providers can customize the frequency and delivery date and time to fit the client’s preferred schedule. The questionnaire takes approximately 2-5 minutes to complete.

Once completed, the results of the questionnaire are automatically scored and visualized to both the provider and client directly in Greenspace, with an overview of the scoring information and its interpretation. Providers can access intelligent insights based on scores and collaboratively discuss results with the client to better understand their symptoms and determine appropriate next steps.

What is the DAST-R and is it different from the DAST-10?

The DAST-10-R is a revised version of the DAST-10, developed by Dr. Skinner and his colleagues to reflect evolving views around stigma and substance use and align with the NIDA’s “Words Matter” recommendations. The DAST-10-R replaces the term ‘abuse’ with ‘use’ or ‘misuse’, in efforts to create a more supportive environment that encourages individuals to be honest about their experiences and access the support they need.

The DAST-R has not been released for community use yet, and is currently undergoing research to confirm its feasibility in clinical settings and psychometric equivalence to the original DAST.

In this clip, Dr. Skinner explains the reasoning behind creating a revised version of the DAST-10.

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