Screening for drug use disorders in the emergency department: performance of the rapid drug problems screen (RDPS)

Little research is available on brief screening instruments for identify those meeting diagnostic criteria for drug dependence or abuse. A brief, four-item screening instrument, called the rapid drug problems screen (RDPS), was developed from a similar instrument for alcohol use disorders, the rapid alcohol problems screen (RAPS). Performance of the RDPS was evaluated against DSM-IV and ICD-10 criteria for drug dependence and for dependence or abuse in a sample of 703 emergency department patients in Mexico City. Among males, sensitivity and specificity were 91 and 96%, respectively, for dependence and 93 and 96%, respectively, for dependence or abuse. Neither of the two females meeting diagnostic criteria for dependence or abuse were identified by the RDPS. Area under the receiver-operating characteristic curve indicates an optimum cut point of 1. The data suggest that the RDPS may hold promise as a brief screening instrument for substance use among males, but should be tested in larger populations of females meeting diagnostic criteria for drug use disorders, and across ethnic subgroups in other geographic locales.     

Are drunk-driving offenders referred for screening accurately reporting their drug use?

Several studies report that a substantial percentage of offenders arrested for impaired driving test positive for drugs of abuse besides alcohol. Current guidelines recommend screening offenders for both alcohol and other drug use, yet little is known about the accuracy of self-reports of drug use in this population. We compared drug abuse and dependence DSM-III-R diagnoses from an initial, court-ordered screening evaluation of 583 female and 495 male convicted drunk-driving offenders with diagnoses obtained via a voluntary, non-coerced interview 5 years later. At initial screening, fewer than 6% of offenders were diagnosed with drug abuse or dependence. Among offenders who did not receive an initial drug diagnosis, 28% subsequently reported having experienced drug use problems consistent with a retrospective diagnosis of drug abuse or dependence by the age at which they were screened. Half of those with a retrospective diagnosis of drug dependence reported their initial screening responses were "very accurate". We conclude that, although many drunk-driving offenders undergoing screening have diagnosable drug problems, a high proportion under-report their drug use. We suggest that certain modifications to screening procedures, such as urine drug screening, reducing barriers to treatment, and training counselors in motivational interviewing techniques, may increase accurate identification of drug use problems in this population.     

The 12-month prevalence and trends in DSM-IV alcohol abuse and dependence: United States, 1991-1992 and 2001-2002

BACKGROUND: Alcohol abuse and dependence can be disabling disorders, but accurate information is lacking on the prevalence of current DSM-IV alcohol abuse and dependence and how this has changed over the past decade. The purpose of this study was to present nationally representative data on the prevalence of 12-month DSM-IV alcohol abuse and dependence in 2001-2002 and, for the first time, to examine trends in alcohol abuse and dependence between 1991-1992 and 2001-2002. METHODS: Prevalences and trends of alcohol abuse and dependence in the United States were derived from face-to-face interviews in the National Institute on Alcohol Abuse and Alcoholism's (NIAAA) 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC: n = 43, 093 ) and NIAAA's 1991-1992 National Longitudinal Alcohol Epidemiologic Survey (NLAES: n= 42, 862 ). RESULTS: Prevalences of DSM-IV alcohol abuse and dependence in 2001-2002 were 4.65 and 3.81%. Abuse and dependence were more common among males and among younger respondents. The prevalence of abuse was greater among Whites than among Blacks, Asians, and Hispanics. The prevalence of dependence was higher in Whites, Native Americans, and Hispanics than Asians. Between 1991-1992 and 2001-2002, abuse increased while dependence declined. Increases in alcohol abuse were observed among males, females, and young Black and Hispanic minorities, while the rates of dependence rose among males, young Black females and Asian males. CONCLUSIONS: This study underscores the need to continue monitoring prevalence and trends and to design culturally sensitive prevention and intervention programs.     

Drinking patterns among individuals with and without DSM-IV alcohol use disorders

OBJECTIVE: The purpose of this study was to compare alcohol consumption patterns among individuals with and without alcohol use disorders, using a representative sample of the general population that would not exaggerate differences as a result of selection biases associated with treatment for alcohol problems. METHOD: Based on data from 18,352 past-year drinkers selected from a nationally representative sample of U.S. households, 11 measures of past-year alcohol consumption were compared for three diagnostic groups: (1) individuals who did not meet the criteria for either alcohol abuse or dependence, i.e., those without a DSM-IV alcohol use disorder (AUD); (2) those classified with abuse only; and (3) those classified with alcohol dependence, with or without abuse. RESULTS: For all measures reflecting frequency and quantity of drinking, frequency of heavy drinking and intoxication, and frequency of atypical temporal drinking patterns, the values for abusers lay midway between those for individuals without an AUD and those with dependence. Individuals with alcohol use disorders drank a greater proportion of their ethanol intake in the form of beer and a lower proportion in the form of wine than did those without an AUD. Of all the consumption measures considered, frequency of intoxication showed the strongest association with the probability of having an AUD, followed by frequency of drinking 5 + drinks, prevalence of morning drinking and total volume of intake. The ratios of consumption measures for individuals with disorders relative to those without an AUD showed relatively little significant variation across demographic subgroups of the population. CONCLUSIONS: The findings supported the distinction between the disorders of alcohol abuse and dependence, and implicated loss of control as an important element of this distinction. They also indicated that even among individuals with alcohol use disorders, demographic differentials reflecting cultural, physiological and normative forces were maintained and should be considered in approaches to treatment.     

医疗机构药物滥用监测模式下药物成瘾性特征分析

目的： 了解医疗机构就诊患者麻醉、精神药品滥用/依赖情况和特征，为加强麻醉、精神药品管理提供依据。方法： 利用Excel表统计分析2018-2019年某院确诊为药物滥用或药物依赖患者的麻醉、精神药品使用情况，对确诊为麻醉、精神药品滥用/依赖者的人口学特征、药物使用情况进行描述性分析。结果： 该院就诊患者确诊药物依赖237例，未发现药物滥用患者。237例药物依赖者中，男性84例，占35.44%，女性153例，占64.56%；>60岁的药物依赖者161例，占67.93%；平均年龄（66.83±13.97）岁；依赖年限分布集中在1~3年，占56.119%，平均年限为（4.75±6.96）年；初中及以下文化程度者190例，占79.76%；已婚158例，占66.67%；离/退休人员140例，占59.07%。依赖的药物主要为苯二氮类，145例，占61.19%；药物获得渠道来自医疗机构占99.58%；使用药物原因为控制疾患的患者216例，占91.14%；监测上报人群中以医师、药师为主，占85.23%。结论： 在医疗机构药物滥用监测模式下能关注老年人麻醉、精神药品的合理使用，挖掘潜在的用药风险信号，提前预警与干预，降低药物成瘾性损害事件的发生。     

Drug use among two American Indian populations: prevalence of lifetime use and DSM-IV substance use disorders

American Indians (AIs) have often reported higher rates of drug use than have other racial/ethnic groups. However, the majority of these studies have focused on drug use among high school adolescents, with little attention to pathological use such as drug abuse or dependence. This study is among the first to report lifetime drug use and disorder (abuse/dependence) information from community samples of two culture groups of AI people-one in the Southwest (SW), one in the Northern Plains (NP)-ranging in age from 15 to 57 years old. Analyses were conducted within four groups: SW men, SW women, NP men, and NP women. Across the four groups, lifetime use rates for marijuana (36.9-57.5%), cocaine (4.3-21.5%), and inhalants (3.6-17.0%) were the highest drug use rates; heroin (0.5-2.1%), the lowest. Lifetime drug disorder rates were highest for marijuana (4.5-14.1%), cocaine (1.1-2.3%), and stimulants (0.7-1.7%). Lifetime polydrug use disorder rates from 1.2 to 4.5%. Women generally had lower prevalence rates than did men in their culture group. The SW women generally had the lowest rates of use and disorder. Lifetime use and disorder rates among the youngest group were often not different from rates of the older groups. Overall, 40-60% had never used any drugs; 85-95% had not developed any drug disorder. Despite widespread concern and rhetoric about drug problems among AIs, many who had used various drugs either were using them without serious consequences or had quit use altogether.     

Theoretical and observed subtypes of DSM-IV alcohol abuse and dependence in a general population sample

The purpose of this study was to quantify the degree of heterogeneity of the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) alcohol abuse and dependence categories by comparing the number of theoretically predicted subtypes of each category with those observed in a nationally representative sample of the US general population. Among respondents classified with a past year diagnosis of abuse, only 11 (47.8%) of the 23 theoretically predicted subtypes of abuse were observed, while 53 (53.5%) of the 99 theoretically predicted subtypes of dependence were observed in this general population sample. Approximately 90% of the respondents classified with abuse could be represented by three subtypes of abuse and 70% of the respondents with current diagnoses of dependence could be characterized by six subtypes of dependence, indicating the relative homogeneity of both diagnostic categories. Sociodemographic differentials were also observed including the reduction in the number of observed subtypes of abuse and dependence with age as well as the larger numbers of subtypes associated with males and whites relative to females and blacks, respectively. Implications of these results are discussed in terms of increased physical morbidity and disruption of family life as persons with alcohol use disorders age, the potential role of physiological and impaired control over drinking indicators of dependence as critical features of the disorder, and the future need to examine the conceptual basis of the abuse category and to conduct longitudinal epidemiological research.     

Nationwide survey of alcohol drinking and alcoholism among Japanese adults]

PURPOSE: To investigate the characteristics of alcohol use among Japanese adults and prevalence of alcohol dependence in Japan, we conducted a nationwide survey on alcohol drinking behavior and alcohol dependence among Japanese adults using a representative sampling method. METHODS: We sampled 3500 adults from throughout the entire country using a stratified random sampling method with two-step stratification, and carried out a home visit interview survey. A total of 2547 people (72.8%) responded to the survey. The survey period was June, 2003. The questionnaire contained questions about the frequency and quantity of alcohol use, 'hazardous use of alcohol' and 'alcohol dependence' according to the ICD-10 definition, several screening scales on problem use of alcohol (CAGE, KAST, AUDIT), life-time prevalence of 24 alcohol related diseases, smoking status, dysgryphia, and nightcap drinking. RESULTS: The number of respondents was, 1184 males, and 1363 females. Lifetime alcohol drinking, and weekly drinking, and daily drinking rates were 95.1%, 64.4%, and 36.2% for males, 79.0%, 27.5%, and 7.5% for females, respectively. Average daily alcohol consumption was 3.7 units for males, and 2.0 units for females (1 unit = 10 g pure alcohol). The proportion of drinkers who drank alcohol 4 units or more daily was 28.9% for males, and 7.6% for females, and that for 6 units or more was 12.7% for males, and 3.4% for females. The proportion of flasher was 41.2% for males, and 35.0% for females. Among screening questions, problem drinking was most frequently identified using AUDIT (score 12 points or more, 150 persons), followed by KAST (2 points or more, 100 persons) and CAGE (2 points or more, 98 persons). The number of subjects who met the ICD-10 criteria for alcohol dependence was 24, while the number who engaged in hazardous alcohol use was 64. CONCLUSIONS: This study revealed that problem drinking and alcohol dependence are a serious problem in Japanese general population. The problem of females drinking may be growing. The government should emphasize the prevention of alcohol drinking problems in adults and continue the conduct of nationwide prevalence surveys to monitor the problem.     

Measures of Substance Consumption Among Substance Users, DSM-IV Abusers, and Those With DSM-IV Dependence Disorders in a Nationally Representative Sample

ABSTRACT. Objective: Neither the Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R), nor the DSM-IV uses measures of substance consumption as part of the diagnostic criteria for substance use disorders. Therefore, this report examined the extent to which frequency and/or quantity of consumption across a broad spectrum of substances are associated with DSM-IV diagnoses of specific substance use disorders and whether there are informative hierarchical levels of consumption among users, abusers, and those who are substance dependent in the U.S. general population. Method: The analyses focused on consumption data from respondents of the 2001-2002 National Epidemiologic Survey of Alcohol and Related Disorders. Multinomial logistic regression was used to predict DSM-IV diagnoses of dependence or abuse based on the continuous consumption measures. Results: Among individuals who used substances, the substances with the greatest liability for dependence were nicotine first and cocaine second. For nearly all substances investigated, users without specific substance use disorders demonstrated lower levels of quantity and frequency of consumption relative to those with DSM-IV abuse and dependence disorders. Dose-response curves for the log odds of abuse and dependence suggested unidimensionality of abuse and dependence for frequency of alcohol drinking; frequency of cannabis use; frequency of opioid use; frequency of hallucinogen use; and, to a lesser extent, frequency of amphetamine use. However, the dose-response curves for the quantity of alcohol consumed demonstrated differential patterns for abuse and dependence such that alcohol dependence has a distinctly greater "quantity of use" relationship than that found among alcohol-abusing individuals. Conclusions: These results confirm the findings of others concerning the unidimensionality of abuse and dependence diagnoses when consumption variables alone are examined and suggest that consumption measures may be useful metrics gauging severity. (J. Stud. Alcohol Drugs, 73, 820-828, 2012).     

Personality profile and drug of choice; a multivariate analysis using Cloninger's TCI on heroin addicts, alcoholics, and a random population group

As personality may predispose, precipitate or perpetuate substance abuse and/or dependence, and as it is considered to remain stable across the years in a given subject, potential links with the drug of choice may help screen future patients before drug consumption. The present study compared three groups: 42 patients with heroin dependence (mean age: 31.2; standard deviation (SD): 5.5; 10 females), 37 patients with alcohol dependence (mean age 44.2; SD: 9.1; 9 females) and 83 subjects from a random population sample (mean age: 38.8; SD: 6.9; 20 females). Personality was measured by Cloninger's Temperament and Character Inventory (TCI). Pillai's MANCOVA with age as a covariate and gender as a cofactor was highly significant. Univariate ANOVA analyses using TCI dimensions as dependent variable showed most variables to vary in parallel for the two patient groups in comparison with controls. Post-hoc tests showed heroin patients to score higher in Novelty-Seeking and Self-Directedness than alcohol patients. Sub-dimensions Exploratory Excitability, Fear of the Uncertain, Responsibility, Congruent Second Nature and Transpersonal Identification were also significantly different in the two patient samples. Logistic regression showed Exploratory Excitability to segregate up to 76% of heroin patients from alcohol patients. In conclusion, personality profiles were linked to some preferential choice of drug and personality screening might be tested in preventive strategies.     

The DSM-IV criteria for adolescent alcohol and cannabis use disorders.

OBJECTIVE: The aims of this study are to compare DSM-IV criteria for alcohol and cannabis use disorders with its predecessor, DSM-III-R, and to examine the validity of the new criteria in an adolescent drug clinic sample. METHOD: During evaluation, a sample of 772 adolescents (63% boys, 77% white) were administered a structured interview of diagnostic symptoms and additional problem severity measures. Independent staff ratings of problem severity and treatment referral were collected as well. RESULTS: Compared to its predecessor, DSM-III-R, application of the DSM-IV criteria for alcohol and cannabis users resulted in more abuse assignments and fewer dependence assignments. The shift in assignments appeared to be largely due to a lowering of the abuse threshold, rather than to a tightening of the dependence criteria. The external validity data generally supported the DSM-IV abuse and dependence distinction in adolescents, and the newer criteria were as valid as the older criteria. CONCLUSIONS: In contrast to DSM-III-R, the DSM-IV system yields more abuse cases and fewer dependence cases among adolescent alcohol and cannabis abusers. Validity evidence for the new criteria are defensible, yet the findings are seen as a starting point for discussing the need for tailoring substance use disorder criteria for adolescents.     

Alcohol abuse and dependence in an urban primary care clinic in Nigeria.

A two-stage epidemiological survey was conducted in an urban walk-in clinic in Nigeria to detect, among other disorders, the prevalence of alcohol abuse and dependence using DMS-IIIR criteria. At the first stage, respondents were administered the 12-item General Health Questionnaire and the Alcohol Use Disorders Identification Test (AUDIT). A proportion of the respondents were selected for detailed interview at the second stage using the Composite International Diagnostic Interview (CIDI). An estimated 1.7% of this sample met the criteria for alcohol abuse or dependence. All the identified cases were males, thus giving an estimated prevalence of 5.2% in males. In this setting, the AUDIT performed poorly as a screening instrument. It has a sensitivity of 32% but a specificity of 93%. Apart from reasons relating to the low base rates of the disorders under investigation, cultural factors influencing the ways alcohol use are perceived may explain this poor performance.     

西藏察隅县城区中小学生的弱视患病率及其治疗情况调查

目的　调查我国西藏自治区林芝市察隅县城区中小学生的弱视患病率及其相关因素。方法　横断面研究。2018年5月对察隅县城区的中小学生开展视力普查及基本的眼科检查包括视力及屈光、眼前段检查、眼底检查、眼位检查等，对视力低于6/12的进行睫状肌麻痹验光，对确诊为弱视的学生进行问卷调查并分析发病原因。计量资料行配对t检验；用logistic回归分析分析年龄和性别与弱视患病率的关系。结果　察隅县城区小学和初中共1 795名学生参与调查，其中男888人，女907人。其中弱视患病人数为77人，患病率为4.3%。患病率在不同年龄和性别间差异均无统计学意义（均P>0.05）。在受检中小学生中引起弱视的主要发病原因如下：屈光参差19.5%（15/77），屈光不正77.9%（60/77），斜视2.6%（2/77）。结论　屈光不正性弱视和屈光参差性弱视是察隅县城区中小学生弱视的主要类型，及时配戴合适的眼镜有助于降低弱视的患病率。     

Assessment of cocaine and other drug dependence in the general population: "gated" versus "ungated" approaches

BACKGROUND: There is a need for large-scale epidemiological surveys to be (a) faithful to diagnostic specifications and (b) constrain time and participant burden associated with each section of a possibly lengthy interview. OBJECTIVE: To examine whether one "gating" approach devised for recent large-scale international psychiatric surveys results in a reduced number of identified cases of drug dependence and/or biases in estimated associations with background characteristics. DESIGN AND SETTING: Data from a recently released cross-sectional, nationally representative household survey, the United States National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) were analysed. PARTICIPANTS: Forty-three thousand ninety-three English speaking adults aged 18 years and over. MAIN OUTCOME MEASURES: Dependence upon cocaine and other illegal drug dependence, defined in two ways: "ungated" and "gated". "Ungated" dependence included all persons meeting criteria for DSM-IV dependence, without regard for DSM-IV drug abuse clinical features. "Gated" dependence required at least one feature of DSM-IV drug abuse. RESULTS: There was no statistically robust decrement in the estimated prevalence of cocaine or other drug dependence using a "gated" assessment. Patterns of association of cocaine dependence with background characteristics were not appreciably different when the gated and ungated approaches were applied. CONCLUSIONS: In panoramic mental health surveys, the inefficiency of an ungated approach must be balanced against the anticipated number of cases of dependence without associated social role impairments or harm. In this study, the reduction in the number of identified cocaine dependence cases appeared to be so small that even in a sample of over 40,000 participants, attenuation in population prevalence would prove difficult to detect.     

Substance Abuse Disorders Among Homeless and Runaway Adolescents

This paper presents lifetime and 12-month prevalence rates and comorbidity data for substance abuse disorders among homeless and runaway adolescents. Data are from baseline interviews of a longitudinal diagnostic study of 428 (187 males and 241 females) homeless and runaway adolescents aged 16 to 19 years (mean age = 17.4 year, SD = 1.05). The data were collected by full-time interviewers on the streets and in shelters in eight Midwestern cities of various populations. About two thirds (60.5%) of the runaways met lifetime criteria for at least one of three substance disorders (alcohol abuse, alcohol dependence, drug abuse), and nearly one half (48.1%) met 12-month criteria for at least one of the disorders. Nearly all of the adolescents (93%) who met criteria for a substance disorder met criteria for at least one other mental disorder. Those factors most predictive of meeting lifetime criteria Include parenting practices, experience of abuse, and association with deviant peers.     

Drug use among prisoners: by any definition, it's a big problem

According to several studies, the prevalence of drug use (1) among prisoners is manyfold compared to general population. However, comparisons across studies are hampered by the use of a variety of mutually noncomparable methodologies. We report substance use among Finnish prisoners using three methods and analyze these differences. The material consisted of 610 Finnish prisoners in 2006 and represents all Finnish prisoners. The subjects participated in a comprehensive field study including a standardized psychiatric interview (SCID-I). Alcohol abuse/dependence was diagnosed in 68% (SCID-I) and 72% (ICD-10) among men and 70% (both SCID-I and ICD-10) among women. Drug abuse/dependence was diagnosed in 62% (SCID-I) and 69% (ICD-10) among men and 64% (SCID-I) and 70% (ICD-10) among women prisoners. Interview data revealed that the majority had at least tried most substances. Both alcohol and drug abuse/dependence were vastly more common among Finnish prisoners than reported elsewhere. The DSM-IV-based SCID-I produced slightly lower prevalence estimates than an ICD-10 clinical examination, but overall SCID/ICD agreement was very good. It seems that physicians use information other than that captured by standardized structured clinical interview when placing a diagnosis. Nonclinical interview-based prevalence figures may overestimate harmful use of drugs unless known risk patterns of use (e.g., intravenous use) are specifically addressed.     

Concordance of DSM-IV alcohol and drug use disorder criteria and diagnoses as measured by AUDADIS-ADR,CIDI and SCAN

This study was designed to examine the agreement of DSM-IV alcohol and drug use disorder diagnoses generated by three WHO/NIH diagnostic instruments, the AUDADIS-ADR, the CIDI, and the SCAN. This substudy, conducted in three countries, Greece, Luxembourg, and the United States, was part of the larger joint project on diagnosis and classification of mental disorders and alcohol and drug-related problems, which was initiated to evaluate the cross-cultural applicability of the instruments and the criteria. Overall, concordance among the three assessments was good for alcohol and opiate dependence, fair to good for cocaine and sedative dependence, and low for amphetamine dependence. Cannabis dependence concordance was significantly more discrepant than any other substance. Agreement on abuse was low for all substances examined. In addition, the concordance of DSM-IV criteria for each substance was examined. Finally, reasons for discrepancies in responses among assessments were examined, based on discrepancy interview protocol methodology. Further investigation will help to refine these instruments in order to provide a more thorough understanding of alcohol and drug abuse diagnoses.     

Comparative performance of the AUDIT-C in screening for DSM-IV and DSM-5 alcohol use disorders

Objective

Under the proposed DSM-5 revision to the criteria for alcohol use disorder (AUD), a substantial proportion of DSM-IV AUD cases will be lost or shifted in terms of severity, with some new cases added. Accordingly, the performance of the AUDIT-C in screening for DSM-IV AUD cannot be assumed to extend to DSM-5 AUD. The objective of this paper is to compare the AUDIT-C in screening for DSM-IV and DSM-5 AUD.

Methods

Using a broad range of performance metrics, the AUDIT-C was tested and contrasted as a screener for DSM-IV AUD (any AUD, abuse and dependence) and DSM-5 AUD (any AUD, moderate AUD and severe AUD) in a representative sample of U.S. adults aged 21 and older and among past-year drinkers.

Results

Optimal AUDIT-C cutpoints were identical for DSM-IV and DSM-5 AUD: ≥4 for any AUD, ≥3 or ≥4 for abuse/moderate AUD and ≥4 or ≥5 for dependence/severe AUD. Screening performance was slightly better for DSM-5 severe AUD than DSM-IV dependence but did not differ for other diagnoses. At optimal screening cutpoints, positive predictive values were slightly higher for DSM-5 overall AUD and moderate AUD than for their DSM-IV counterparts. Sensitivities were slightly higher for DSM-5 severe AUD than DSM-IV dependence. Optimal screening cutpoints shifted upwards for past-year drinkers but continued to be identical for DSM-IV and DSM-5 disorders.

Conclusions

Clinicians should not face any major overhaul of their current screening procedures as a result of the DSM-5 revision and should benefit from fewer false positive screening results.