February 28, 2025
Education News Canada

YORK UNIVERSITY
York University's Harvey Skinner a pioneer in global health and addiction care

January 29, 2025

A questionnaire developed 40 years ago by York University's Harvey Skinner has revolutionized how public health and health-care providers across the globe identify and address substance use disorders.

The Drug Abuse Screening Test (DAST) was created by Skinner during his early career at the Addiction Research Foundation, a founding organization of the Centre for Addiction and Mental Health (CAMH)), has evolved from a modest clinical tool into an internationally recognized gold standard for substance use screening.


Harvey Skinner

"When I developed the DAST in the early 1980s, I never imagined it would become a global standard," says Skinner, professor of psychology and global health and senior fellow at the Dahdaleh Institute, York University. "It's inspiring to see it help so many people, advance research and remain a topic of interest for colleagues and students worldwide."  

Skinner is the founding dean of York's Faculty of Health, and during his time in that role from 2006-16, he helped shape a vision for rethinking health education, research and practice. And his research has had a global impact. He was ranked among the top 2 per cent of scientists worldwide by Stanford University's 2022 research impact analysis, and in addition to DAST, he has developed other widely used tools like the eHealth Literacy Scale (eHEALS) and Family Assessment Measure (FAM).  

To mark 40 years of the DAST's success, Skinner and collaborators released updated versions of the DAST (DAST-10-R and DAST-20-R) that aim to shift the perspectives on global addiction screening and care through inclusive and empathetic language. This latest innovation transforms the DAST tool to reflect an updated understanding of addictions that supports equity, diversity and inclusion.  

"We've removed stigmatizing language, replacing 'abuse' with 'use' or 'misuse' to make it more inclusive and neutral, following the U.S. National Institute on Drug Abuse's 'Words Matter' guidelines," says Skinner.  

His team recognizes these developments come at a crucial time, as substance use has shifted dramatically since the emergence of the DAST.  

"The ongoing opioid crisis, new policies decriminalizing certain drugs (like cannabis in Canada) and the rising popularity of psychedelics - both recreationally and therapeutically - mean we need tools that can adapt to these changing landscapes," says Skinner. 

Over the last four decades, Skinner and his team have continued to update and refine the DAST, and looking forward they are exploring ways to integrate the newest version through:  

  • clinical feasibility research, such as hospitals, primary care clinics and community health programs;  
  • calibration and psychometric studies to compare scores from the original and most up-to-date DAST;  
  • cultural adaptions, including tailoring the test for different legal and cultural environments; and  
  • digital integration for adding DAST to eHealth services and digital health tools. 

The DAST was recently featured in the Canadian Journal of Addiction to mark its 40th anniversary and explore how the tool continues to stay relevant despite shifting substance use trends.  

"The DAST has proven flexible enough to keep pace," says Skinner, "helping track prescription drug misuse and co-occurring polysubstance use and sparking valuable conversations about emerging substances."  

Since its original introduction in 1982, the DAST was praised for being short, accurate and easy to use. It has become a standardized tool in addiction clinics, but also in hospitals and schools, correctional facilities and community health centers. Skinner further notes it has been cited nearly 4,000 times by researchers and has been translated into 19 languages including French, Spanish, Mandarin, Urdu and Arabic.  

"It's one of the most influential self-report instruments in the field of addiction studies," says Matthew Keough, associate professor of psychology at York University. "When it comes to understanding and treating addictive behaviors, we need gold-standard, well-validated instruments that respect the dignity of those seeking help."  

Sanjeev Sockalingam, senior vice-president and chief medical officer at CAMH, says: "The DAST's unique blend of scientific rigour and real-world sensitivity is why this made-in-Canada innovation has become a cornerstone of substance use screening, assessment and research."  

But, behind all the academic citations and global adoption, there are real people whose lives have been changed for the better, says Skinner. Public health workers use the DAST to track substance use trends and allocate resources where they're needed most. Clinicians rely on it to start open, empathetic conversations with their clients, often leading to timely referrals and more appropriate care.  

"Each time someone contacts me to translate the DAST or asks how to use it in their community, I'm reminded that this tool thrives because of our shared commitment to preventing and reducing substance use harms," says Skinner. "It's deeply rewarding to see it."

This story was originally featured in YFile, York University's community newsletter.

For more information

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www.yorku.ca


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