阿片成瘾严重程度量表的初步编制与信息测试

目的：编制阿片成瘾严重程度评定量表，并对量表进行信度检验。方法：参考相关文献自行设计“28项阿片成瘾严重程度量表”(28Items Opioid Addiction Severity Inventory,OASI-28)，对北京市某戒毒治疗机构收治的60例海洛因成瘾者进行结构性访谈。通过小样本预试验，采用同质性信度与重测信度对量表进行信度评价。结果：同质性信度：除家庭后果一项外，其余各因子及量表总的Cronbach‘‘‘‘‘‘‘‘s α。系数在0．5244—0.8140之间。各症状项目分与总分的相关性除第1题(从第一次吸毒时间到成瘾的时间)、第15题(体重变化)和第21题(吸毒后工作情况)外，余者的P值均＜0．05。重测信度：总量表及各因子的重测相关系数介于0.476—0.895之间(P＜0．01)。结论：本量表有较好的同质性信度和重测信度。     

中文版成瘾严重性指数量表在参加美沙酮维持治疗的海洛因成瘾者中的信度和效度评价

背景:为遏制艾滋病病毒在海洛因成瘾者中的传播,我国于2004年开始选用美沙酮口服液作为海洛因的替代药物,对海洛因成瘾者进行长期维持治疗。为更好地评价美沙酮维持治疗(methadone maintenance treatment,MMT)的效果,研究者引进和翻译了在国外广泛用于评价药物成瘾的一种工具《成瘾严重性指数量表》(Addiction Severity Index,ASI)第5版。目的:评价中文版ASI(ASI-C)在接受MMT的海洛因成瘾者中应用的信度和效度。方法:对1005名(男744名,女261名)MMT受治者用ASI-C进行面对面访谈,其中35名受治者接受了间隔7d的重复测量,分析ASI的信度和效度。结果:ASI-C与原量表具有相近的结构,通过因子分析,有7个因子的特征值大于1,ASI-C萃取出7个维度;通过与相关效度条目的检验,ASI-C具有较好的区分效度,各效度检验条目与维度评分间相关系数在0.09-0.80。内部一致性信度测量显示平均Cronbach’α为0.68(0.52-0.88),有5个维度Cronbach’α大于0.60。相隔7d的重测信度达到可接受的水平。结论:ASI-C在参加美沙酮维持治疗的海洛因成瘾者中应用,具有较好的结构效度和区分效度,5个维度的内部一致性信度Cronbach’α达到可接受的水平,2维度上还有待提高。初步测量的重测信度达到可接受水平。     

阿片成瘾严重程度量表的初步编制与信度测试

目的 :编制阿片成瘾严重程度评定量表 ,并对量表进行信度检验。方法 :参考相关文献自行设计“2 8项阿片成瘾严重程度量表”( 2 8ItemsOpioidAddictionSeverityInventory ,OASI - 2 8) ,对北京市某戒毒治疗机构收治的 6 0例海洛因成瘾者进行结构性访谈。通过小样本预试验 ,采用同质性信度与重测信度对量表进行信度评价。结果 :同质性信度 :除家庭后果一项外 ,其余各因子及量表总的Cronbach’sα系数在 0 .5 2 44～ 0 .8140之间。各症状项目分与总分的相关性除第 1题 (从第一次吸毒时间到成瘾的时间 )、第 15题 (体重变化 )和第 2 1题 (吸毒后工作情况 )外 ,余者的P值均 <0 .0 5。重测信度 :总量表及各因子的重测相关系数介于 0 .476～ 0 .895之间 (P <0 .0 1)。结论 :本量表有较好的同质性信度和重测信度。     

应用因子分析法分析中文版成瘾严重程度指数量表的结构效度

目的:在社区吸毒者中评估中文版成瘾严重程度指数量表(ASI-C)的结构效度。方法:使用因子分析的方法分析ASI-C量表的结构效度。结果:经因子分析共提取出11个公因子,与量表中原有7个分量表数目不符,但发现"毒品使用情况"分量表包括了3个公因子的变量;"精神状况"分量表包括了2个公因子的变量;"家庭社会关系"分量表包括了2个公因子的变量,其余4个分量表的变量分别由1个公因子的变量代表。结论:ASI-C具有可接受的结构效度。     

成瘾严重程度指数量表第五版的汉化和评价及其在成瘾状况调查中的应用

目的:评价《成瘾严重程度指数量表》第五版汉化版的信度和效度,并用该量表评价美沙酮维持治疗门诊病人的成瘾问题。方法:将英文版Addiction Severity Index(ASI)翻译成中文,并根据国情修订;使用ASI中文版量表在陕西省西安市五家美沙酮维持治疗门诊中选取526名治疗时间超过3个月的病人进行访谈,一周后随机抽取50名再次访谈;并对五家门诊中治疗时间不足1个月的317名病人进行访谈,评估其成瘾情况。结果:ASI中文版量表的克朗巴赫α系数为0.44-0.79,重测信度为0.68-0.84,评分者信度为0.87-0.98;"精神状况"子量表的CSs与"症状自评量表"的相关系数为0.50;"家庭社会关系"子量表与"家庭亲密度和适应性量表中文版"的相关系数为0.45。治疗时间不足1个月病人中除了"医疗状况"和"酒精滥用情况"子量表外,其余5个子量表均有较大比例的病人存在着不同程度的问题或需要咨询/治疗。结论:《成瘾严重程度指数量表》第五版汉化版具有良好的信度和效度;参加维持治疗的病人中很多具有较大的成瘾问题,需要门诊医生采取针对性的治疗措施。     

30例海洛因依赖者与30例氯胺酮依赖者的BDI-13量表、社会支持量表、VAS量表的比较与分析

目的:比较海洛因依赖者与氯胺酮依赖者在抑郁程度、社会支持以及药物渴求之间的区别,为制定相应的干预措施提供相应的依据。方法:对珠海市某自愿戒毒中心的64例(海洛因依赖者32例,氯胺酮依赖者32例)戒毒人员,采取自愿的方式,随机抽样,使用BDI-13量表、社会支持量表、VAS量表进行调查并作出比较与分析。结果:共60名调查对象的问卷有效,在医院进行脱毒期间,海洛因依赖者与氯胺酮依赖者在抑郁程度、社会支持、药物渴求方面存在一定的差异。结论:海洛因依赖者的抑郁程度明显高于氯胺酮依赖者,在社会支持方面,氯胺酮依赖者获得的社会支持(主要是家庭支持)比海洛因依赖者较多,海洛因依赖者社会支持较差,具有较强的消极应对倾向,这种消极应对倾向与其心理健康状况密切相关,住院期间,海洛因依赖者对药物的渴求度普遍高于氯胺酮依赖者。     

Fischer和Lewis两种品系的大鼠可作为研究药物成瘾易感性的遗传背景实验材料

药物滥用的流行病学资料显示,大约70%阿片类依赖者亲属产生药物依赖性的危险性比对照人群(非依赖者亲属)高8倍。酒精成瘾者的亲属产生酒依赖的危险性比一般人群高。研究遗传因素在药物成瘾易感性中的作用正成为研究药物成瘾的神经生物学的内容之一。Fischer大鼠和Lewis大鼠是遗     

毒品依赖者的成瘾行为与心理、社会因素的相关性

有资料表明，95％以上的吸毒成瘾人员在戒毒后一段时间内，如再次接触毒品，又会复吸。成瘾性的形成是一个综合性的过程，受多种因素调控，既有心理性、社会性因素，也有人格特征、基因遗传等因素，社会因素也是导致复吸的重要原因之一。本文从社会人口学特征、心理因素和社会支持几个方面分析、阐述这些因素与成瘾行为的相关性。     

生理脱毒者药物渴求的理论维度构建和量表编制

目的：生理脱毒者药物渴求的理论维度构建和量表编制。方法：参考国内外文献,采用了访谈法和初始问卷调查法,提出了生理脱毒者药物渴求的维度结构理论假设,编制出了34个项目的预测问卷,选择符合生理脱毒标准的戒毒机构内的432人为调查对象,进行了信效度考察。结果：使用主成分分析法进行探索性因素分析,提取出五个因子,分别是奖赏性药物渴求、消极性药物渴求、反射性药物渴求、社会性药物渴求和消除性药物渴求,解释了项目总方差的56．490％,未去掉一个题项,符合理论假设;量表的α系数为0．96,折半信度为0．85,各因子的α系数为0．75-0．90,均在P〈0．01的条件下显著;验证性因素分析表明指标拟合度良好。结论：该量表理论构建合理,具有良好的信、效度,进一步完善后能成为生理脱毒者药物渴求良好的评鉴工具。     

新型毒品依赖患者社会适应评估量表的初步编制

目的:编制适用于新型毒品依赖患者的社会适应量表,并检验其信效度。方法:从个体、家庭、社会三个层面进行量表构念设计。以武汉市强制隔离戒毒机构中的新型毒品依赖患者作为量表施测对象,分别进行量表初测(n=82)和正式施测(n=288)。采用初测样本数据进行条目分析,采用正式施测样本数据进行探索性因子分析、验证性因子分析、相关分析和信度分析。结果:修订形成的新型毒品依赖患者社会适应评估量表共有17个条目,包括"个体心理适应"、"对家庭环境的适应"、"对社会环境的适应"3个因子,累计解释总方差的57.59%。量表的三因子结构模型拟合良好(χ^2/df=1.331,CFI=0.962,NNFI=0.952,SRMR=0.078,RMSEA=0.048)。量表及各因子得分与成功戒毒信心量表得分、心理韧性量表得分之间均呈正相关,相关系数均有统计学意义(P<0.05)。总量表的Cronbach α系数为0.848,重测信度系数为0.841;各因子的Cronbach α系数为0.644~0.856,重测信度系数为0.702~0.784。结论:新型毒品依赖患者社会适应评估量表具有良好的信效度,可用于测量新型毒品依赖患者的社会适应水平。     

The longitudinal stability of the addiction severity index

The Addiction Severity Index (ASI) is a structured interview widely used by substance abuse clinicians and researchers for client screening, determining treatment needs, and assessing treatment outcomes. Previous researchers have evaluated inter-rater agreement, test-retest reliability, and concurrent validity. The present report describes the stability of ASI scores in longitudinal work. In the context of an ongoing treatment outcome evaluation study involving seven assessors, inter-rater agreement, inter-rater reliability, as well as intra- and inter-rater accuracy were assessed repeatedly during a 2-year period. The results show the scores derived from the ASI to be stable across assessors and over time. The relationship between stable scores and resources required for training are discussed.     

Use of the addiction severity index with homeless substance abusers

The Addiction Severity Index (ASI) is a widely adopted assessment instrument that provides severity ratings of the multiple problems exhibited by alcohol and drug dependent persons and allows for quantitative assessment (composite scores) of client status in these problems areas over time. ASI change scores of homeless and near homeless substance abusers, generated by contrasting ASI composite scores at two points in time, show a high level of agreement to objective relapse data from the Massachusetts Bureau of Substance Abuse Services Management Information System. Clients readmitted to a publicly funded detoxification facility exhibited significantly lower mean change scores on five of the seven problems areas measured by the ASI. These data illustrate the applicability of the ASI to homeless men and women and the utility of the ASI in measuring client improvement.     

Reliability and validity of the addiction severity index with a homeless sample

The Addiction Severity Index (ASI) is an instrument widely used to assess the treatment problems of substance users. Its psychometric properties have been tested and found satisfactory for many types of substance abusers entering treatment. However, there are many other subgroups of substance users not in formal treatment, such as homeless substance users. While the ASI has been used with this subgroup, its psychometric properties remain questionable. This study examined the reliability and validity of the ASI in a sample of 98 homeless substance users awaiting temporary housing placement. Test-retest reliability found the ASI to have moderate to high reliability coefficients in each of the seven domains assessed. Both composite score and severity rating measures were found to be quite independent with low intercorrelations. Three of the seven ASI composite scores were tested for and found to have moderate concurrent validity: alcohol (r = .31 to .36), drug (r = .46), and psychiatric (r = .53 to .66). Composite score interitem correlations were .70 or greater in each of the domains except for employment (.50) and family (.52). These data suggest that, although there are some limitations in using the ASI with homeless substance users, it demonstrated acceptable reliability and validity.     

Using the addiction severity index to predict mental and medical health service utilization

This study assessed the utility of adding the Addiction Severity Index (ASI) to demographic and clinical diagnostic information for the purpose of predicting subsequent substance use disorder service use, and use of other healthcare services by 260 veterans admitted for outpatient substance use disorder treatment. Data collected included demographics, clinical diagnoses, assessment data from the ASI, as well as measures of six-month health service utilization (e.g., substance use disorder services, other mental health services, outpatient medical visits, urgent care visits, inpatient psychiatric and medical). Multivariate analysis using Tobit regression models showed six out of seven ASI scales were significant predictors, and that combining ASI data with demographics and clinical data significantly improved prediction of health care services. It also was found that certain psychiatric and medical diagnoses were related to service use measures, and that a diagnosis of depression was related to overall healthcare utilization.     

Assessment of addiction severity among ritual users of ayahuasca

Ayahuasca is a psychoactive beverage used for magico-religious purposes in the Amazon. Recently, Brazilian syncretic churches have helped spread the ritual use of ayahuasca abroad. This trend has raised concerns that regular use of this N,N-dimethyltryptamine-containing tea may lead to the medical and psychosocial problems typically associated with drugs of abuse. Here we assess potential drug abuse-related problems in regular ayahuasca users. Addiction severity was assessed using the Addiction Severity Index (ASI), and history of alcohol and illicit drug use was recorded. In Study 1, jungle-based ayahuasca users (n = 56) were compared vs. rural controls (n = 56). In Study 2, urban-based ayahuasca users (n = 71) were compared vs. urban controls (n = 59). Follow-up studies were conducted 1 year later. In both studies, ayahuasca users showed significantly lower scores than controls on the ASI Alcohol Use, and Psychiatric Status subscales. The jungle-based ayahuasca users showed a significantly higher frequency of previous illicit drug use but this had ceased at the time of examination, except for cannabis. At follow-up, abstinence from illicit drug use was maintained in both groups except for cannabis in Study 1. However, differences on ASI scores were still significant in the jungle-based group but not in the urban group. Despite continuing ayahuasca use, a time-dependent worsening was only observed in one subscale (Family/Social relationships) in Study 2. Overall, the ritual use of ayahuasca, as assessed with the ASI in currently active users, does not appear to be associated with the deleterious psychosocial effects typically caused by other drugs of abuse.     

The role of family history in addiction severity and treatment response

This study examined the relationship between familial history of substance use and addiction severity and treatment outcomes of opiate-dependent patients. The sample was comprised of 281 methadone maintenance patients at a VA or community-based clinic. Using the family history section of the Renard Diagnostic Interview, three familial risk groups were identified based on patients' self-report of their relatives' substance use. The three groups considered both the number and type (e.g., first vs. second degree) of biological relatives with a substance use problem. These three risk groups included: (1) high risk (HR, n = 111), (2) medium risk (MR, n = 80), and (3) low risk (LR, n = 90). HR patients reported a history of more severe asocial behavior at baseline and they reported more medical problems and a greater degree of concurrent alcohol use both prior to and after 6 months of treatment compared to LR patients. In addition, the HR group reported more family/social problems at baseline compared to the MR and LR group and both HR and MR patients reported more psychological problems than LR patients after 6 months of treatment. However, when accounting for baseline differences, the regression analyses demonstrated that familial risk was not predictive of drug treatment outcomes after 6 months of methadone maintenance treatment.     

The development of the comprehensive addiction severity index for adolescents (CASI-A): An interview for assessing multiple problems of adolescents

The Comprehensive Addiction Severity Index for Adolescents (CASI-A) is a 45 to 90-minute comprehensive, semi-structured clinical interview for evaluating adolescents who present for treatment at various provider agencies. CASI-A modules and their individual items were selected and revised based on theory, clinical wisdom, and adolescent experiences obtained during pilot interviews and focus groups. The CASI-A assesses known risk factors, concomitant symptomatology, and consequences of adolescent alcohol/drug use within seven primary areas of functioning: education status, alcohol/drug use, family relationships, peer relationships, legal status, psychiatric distress, and use of free time. The CASI-A is not a diagnostic or screening instrument, but rather a clinical assessment tool that obtains clinically pertinent information designed to guide treatment planning and to evaluate treatment outcome. The CASI-A's design makes it suitable for administration in a variety of settings, for repeat administration at posttreatment follow-up evaluations, and for assessment of virtually all adolescents in treatment regardless of their admission problem. Overall, the CASI-A has encouraging but preliminary evidence of validity and internal consistency. Information collected soon after admission during administration of the CASI-A by nonclinical interviewers corresponded quite well with that obtained over the course of the adolescent's treatment stay by the entire treatment team. Revisions to the instrument are being made in those areas where correspondence between information on the CASI-A and that extracted from clinical records dropped below 75 %, or in those early subscales, where alpha coefficients dropped below .6. As a result of the encouraging results reported in this paper, we are beginning additional psychometric testing, refining the proposed scoring system, and developing a computerized data entry, scoring, and report system.     

Delay discounting, impulsiveness, and addiction severity in opioid-dependent patients

Individuals who abuse drugs show higher delay discounting (DD) rate and impulsiveness scores compared with controls; however, it is unclear if DD rate covaries with severity of the addiction or if an individual's discounting rate can be changed by effective substance abuse treatment. This study compared methadone maintenance treatment (MMT) patients (n = 30) who had not used illegal drugs for 2 years with drug-using MMT patients (n = 30) and controls (n = 25) in terms of addiction severity, DD rate, and impulsiveness. Methadone patients abstinent from illegal drugs scored significantly lower on a number of addiction severity measures than the drug-using methadone patients. In addition, both groups of MMT patients showed significantly higher rates of DD and impulsiveness than the control group; however, no differences in DD rate or impulsiveness were found between the groups of patients. Results suggest that DD rate and impulsiveness may not covary with indicators of addiction severity in MMT patients.     

The relationship between lifetime stress and addiction severity in cocaine-dependent participants

ObjectiveThe primary focus of the current report was to determine if there was an association between LSC-R and ASI-Lite scores in cocaine-dependent individuals. The secondary focus was to determine if any demographic/drug use variables or comorbid psychiatric diagnoses (e.g. alcohol-dependence, mood disorders) were associated with higher LSC-R or ASI-Lite scores. We hypothesized that scores on the LSC-R would be positively correlated with ASI-Lite scores.MethodThe sample included 239 cocaine-dependent individuals. The primary assessments administered were the LSC-R, the ASI-Lite, and the demographic/drug use questionnaire.ResultsSimple linear regression revealed that total lifetime stress was positively and significantly correlated with total ASI-Lite scores; however, the r² value was very low indicating that this relationship is more likely explained by other factors. It was also determined that participants with a diagnosis of alcohol dependence versus those that did not had significantly higher ASI-Lite scores (even when the alcohol composite score was included as a covariate). Participants with a diagnosis of a mood disorder versus those who did not had significantly higher LSC-R scores and females had significantly higher LSC-R scores when compared to males. After performing a median split, those cocaine users with High LSC scores had significantly higher Beck Depression Inventory-II scores, total ASI-Lite scores, and Fagerström Test of Nicotine Dependence scores when compared to those individuals with Low LSC scores. Further analysis of the ASI-Lite demonstrated that composite scores in the domains of Medical, Drug, Legal, Family and Social Status, and Psychiatric were all significantly elevated in the High LSC group.ConclusionsOverall, those with higher lifetime stress demonstrated higher addiction severity and depressive symptoms versus those that endorsed lower lifetime stress. Thus, additional research should be conducted investigating the impact stressful life events has on drug use patterns and characteristics.