Validity of the self-reported drug use section of the Addiction Severity Index and associated factors used under naturalistic conditions

The study examined the validity of 1848 self-reported uses of drugs determined within an Addiction Severity Index interview in comparison with urinalysis results among drug-dependent subjects undergoing treatment in outpatient clinics (Aquitaine area, southwest France, 1994-2005). Agreement and kappa statistics were calculated for each substance. Factors associated with agreement were defined using a multivariate analysis. The conditional kappa coefficients were excellent for all substances assessed. The accuracy between self-reports and urinalysis results was influenced by factors that only slightly affected conditional kappa coefficients. Clients did not underreport their substance use in naturalistic clinical assessment conditions.     

Validity of self-reports and drug use among young people seeking treatment for substance abuse or dependence

The present study assessed drug use and the validity of self-reports of drug use among young people seeking treatment. On admission the participants (n = 316), 215 males and 101 females, were interviewed about their drug use. Urine samples were collected to screen for alcohol, amphetamine, benzodiazepines, cannabis, cocaine, methylenedioxymethamphetamine (MDMA) and opiate use. Self-reports of substance use were compared with urinalysis results. Seventy-three percent of the participants reported use of two or more substances. Single substance users were primarily alcohol users. Kappa agreement between self-report and urinalysis results was of acceptable concordance (> or = 0.65) except for alcohol (kappa = 0.19). Conditional kappa values were good (> or = 0.85) with exception of opiates (cond. kappa = 0.57). The self-reports were generally reliable among young people seeking treatment. No significant differences (p > or = 0.54) were found in the validity of self-reports between the genders.     

Correlation Between Ancillary Community Services with Adolescent Substance Use Disorders Treatment Outcome

ABSTRACT

Objective: This study explores whether participation in ancillary out-of-program services predicts outcomes of adolescents treated for substance use disorders.

Method: Eighty-eight consenting adolescents, 13–18 years of age recruited at an outpatient program, filled the Teen Treatment Services Review (T-TSR) during eight weekly sessions, and at 3-and 9-Month Post-Treatment. Outcome variables included urinalysis and three subscales of the Teen-Addiction Severity Index (T-ASI) During Treatment (DT) and at follow-ups. The predictor variable was the number of reported Out-of-Program Service Contact Days (OD).

Results: While DT OD did not correlate with DT urinalysis, high DT OD days showed a trend toward predicting negative3-month (3-M) urinalysis. By contrast, high 3-M OD days predicted positive 3-M urinalyses as well as high use on all three T-ASI subscales. Out-of-Program services between 3- and 9-M post-treatment were not correlated with 9-M objective or subjective outcomes.

Conclusion: The more therapeutic services received during treatment, the better the short-term outcome. The more therapeutic services received post-treatment, however, the poorer the short-term outcome. Use of outside services presented a response rather than a cause of substance use.     

Can Assessment Reactivity Predict Treatment Outcome Among Adolescents with Alcohol and Other Substance Use Disorders?

Abstract

The objectives of this paper are two-fold: to examine first, if the change from positive to negative alcohol and any other substance use status from baseline assessment to the onset of the first session (i.e., pre-treatment phase) occurs in adolescents, that is, Assessment Reactivity (AR); second, whether AR predicts treatment outcome. Participants were 177 adolescents with alcohol and other substance use disorders (AOSUD) in a 9-weekly group sessions of cognitive behavioral therapy. Drug urinalysis results at baseline assessment, first and last session and self-report for alcohol use were used as outcome measures. Participants showed a highly significant shift to non-use of both alcohol and of other substances from intake assessment to first session and from first to last session. Alcohol and substance use at first session predicted use at last session. This is the first study in youth asserting Assessment Reactivity as a valid construct during the pretreat-ment phase. AR should be considered in any analysis targeting treatment outcomes.     

Adolescent Alcohol and Marijuana Use: Concordance Among Objective-, Self-, and Collateral-Reports

SUMMARY

The association of and difference between urinalysis, self- and parent collateral-report of alcohol and substance use at baseline, 3- and 9-month follow-up was assessed for 88 male and female adolescents from a treatment study. While urinalyses rates were higher than self and collateral-report, urinalyses and self-report did not differ significantly at follow-up. Associations between urinalyses and self-report were highest (r = .64, .69), followed by youth-/collateral report (.49, .55), and urinalyses/collateral-report (.28, .43). Change in youth subjective substance use was associated with collateral subjective perceptions of use at follow-up. Higher false-negatives render collateral less reliable than self-report but necessary in the assessment process.     

Validity of Adolescent Self-Report of Substance Use

The validity of self-report of substance use was examined in 367 adolescents referred for a substance use assessment between 1996 and 2000. Referrals came from a wide variety of sources, including pediatricians, the courts, and social services, as well as their parents. Average age of the sample was 15, 52% were male, and 82% were Caucasian. Adolescents were first asked about the details of their substance use by a clinician using a structured interview with established reliability and validity (Adolescent Drug and Alcohol Diagnosis). They were subsequently asked to provide a urine sample, a requirement they were unaware of when being interviewed about their substance use. If the urine sample was deemed valid by the laboratory technician, it was analyzed by means of fluorescence polarization immunoassay and paper chromatography. If positive screens were obtained for any substance, the sample was subjected to gas chromatography/mass spectrometry for confirmation and quantification. Biochemical test results were compared to self-report. Overall, 28% (96/338) of the self-reports were not corroborated by urinalysis. In adolescents who reported nonuse of a substance, 26% (56/219) had a positive urinalysis. More surprisingly, 34% (40/119) of adolescents reporting substance use in the urinalysis detection window had a negative urinalysis. The present study found self-report of substance use in adolescents to only have fair validity. It is recommended that biochemical corroboration be routinely used for this population.     

Validity of adolescent self-report of substance use

The validity of self-report of substance use was examined in 367 adolescents referred for a substance use assessment between 1996 and 2000. Referrals came from a wide variety of sources, including pediatricians, the courts, and social services, as well as their parents. Average age of the sample was 15, 52% were male, and 82% were Caucasian. Adolescents were first asked about the details of their substance use by a clinician using a structured interview with established reliability and validity (Adolescent Drug and Alcohol Diagnosis). They were subsequently asked to provide a urine sample, a requirement they were unaware of when being interviewed about their substance use. If the urine sample was deemed valid by the laboratory technician, it was analyzed by means of fluorescence polarization immunoassay and paper chromatography. If positive screens were obtained for any substance, the sample was subjected to gas chromatographyl mass spectrometry for confirmation and quantification. Biochemical test results were compared to self-report. Overall, 28% (96/338) of the self-reports were not corroborated by urinalysis. In adolescents who reported nonuse of a substance, 26% (56/219) had a positive urinalysis. More surprisingly, 34% (40/119) of adolescents reporting substance use in the urinalysis detection window had a negative urinalysis. The present study found self-report of substance use in adolescents to only have fair validity. It is recommended that biochemical corroboration be routinely used for this population.     

Boosting treatment stabilization in patients of amphetamine-type stimulant use disorder

BackgroundTo investigate boosting effects on treatment stabilization in the mandatory treatment modality for patients of amphetamine-type stimulant use disorder.MethodsThis is a retrospective follow-up study over a period from January 2013 to December 2018. We analyzed 425 patients of amphetamine-type stimulant use disorder under mandating treatments. Treatment stabilization for a given patient was defined once 4 negative urinalysis had been observed. We developed a dynamic monitoring model of boosting effects informed by the available data, specifically the number of negative urine samples required to reach stabilization, the sum of urinalyses done at the time when the given number of negative urine samples had been observed and who the patient was. To represent the simulated population, a Monte Carlo method was used to generate p-values from 1000 experiments conducted on a computer.ResultsIn the observed samples, the probability of 4 negative results in urinalysis from 4 outpatient visits was 75.5%. In comparison, the probability for achieving 4th negative results in urinalysis over 4 visits from negative binominal distribution was 57.3%, and from the computer simulation, 49.8%. The observed samples had significantly higher probability of achieving 4 negative results in urinalysis over 4 outpatient visits (p < 0.001).ConclusionsThe mandatory treatment modality boosted treatment stabilization for patients of amphetamine-type stimulant use disorder. The major benefit of using the monitoring model is the ability to monitor boosting effects of stabilization. Results supported the effectiveness of this mandatory treatment modality and can be implemented in deferred-prosecution based treatment modality.     

The Moderating Role of Peer Problems on the Relationship Between Substance Use and Mental Health

ABSTRACT

Understanding the interaction of peer problems with substance use influence on psychiatric symptoms has important clinical implications. We tested the hypothesis that peer problems moderate the relationship between substance use and psychiatric symptoms on a sample of 280 adolescents receiving psychiatric treatment. Age, race, and gender served as covariates. Our model accounted for a significant proportion of the variance in psychiatric symptoms (R² = .379, p < .001). A significant moderating effect of peer problems x substance use on psychiatric symptoms was found (p < .05). Next, we estimated the conditional effect of substance use on psychiatric symptoms as a function of low, moderate, and high levels of peer problems. Significant effects for low-level peer problems emerged, such that as peer problems increase by one unit, the effect of substance use on psychiatric symptoms increases by one half unit. Implications for peer-based interventions are discussed.     

A Group Therapy Program for Opioid-Dependent Adolescents and Their Parents

ABSTRACT. Background: Opioid dependence is a significant problem for adolescents in the United States. Psychosocial treatment for adolescents with opioid use disorders may be effective, although it has not been well studied. Methods: This paper describes a 13-week psychoeducational group therapy program with parallel tracks for adolescents with opioid use disorders and their parents attending an outpatient substance use program in a children's hospital. In addition to group therapy, participating adolescents received medical care, including medication-assisted treatment for opioid dependence, drug testing, medical follow-up, psychopharmacology, individual counseling, and parent guidance. Data were collected as part of a quality improvement project for the program. Forty-two adolescents and 72 parents attended the group program between 2006 and 2009. Frequencies were computed and a weighted kappa was used to assess agreement between adolescent and parent reports of use and driving risk. Results: Of the 42 adolescents participating in the 13-week group program, 36 (86%) completed 3 or more group sessions, and 24 (57%) completed 10 or more sessions. Twenty-two (52%) adolescent participants reported abstinence from all substances on each of their weekly evaluations. Adolescent-parent agreement for substance use was good to very good: weighted kappa (95% confidence interval) .76 (.60, .87), but poor for driving risk, weighted kappa .11 (?.20, .40). Conclusions: Completion rates and self-report of outcomes from this group program indicate promise and warrant further testing.     

Transitions from first substance use to substance use disorders in adolescence: Is early onset associated with a rapid escalation?

BackgroundEarly substance use (SU) in adolescence is known to be associated with an elevated risk of developing substance use disorders (SUD); it remains unclear though whether early SU is associated with more rapid transitions to SUD.ObjectiveTo examine the risk and speed of transition from first SU (alcohol, nicotine, cannabis) to SUD as a function of age of first use.MethodsN = 3021 community subjects aged 14–24 years at baseline were followed-up prospectively over 10-years. SU and SUD were assessed using the DSM-IV/M-CIDI.Results(1) The conditional probability of substance-specific SU-SUD transition was the greatest for nicotine (36.0%) and the least for cannabis (18.3% for abuse, 6.2% for dependence) with alcohol in between (25.3% for abuse; 11.2% for dependence). (2) In addition to confirming early SU as a risk factor for SUD we find: (3) higher age of onset of any SU to be associated with faster transitions to SUD, except for cannabis dependence. (4) Transitions from first cannabis use (CU) to cannabis use disorders (CUD) occurred faster than for alcohol and nicotine. (5) Use of other substances co-occurred with risk and speed of transitions to specific SUDs.ConclusionType of substance and concurrent use of other drugs are of importance for the association between age of first use and the speed of transitions to substance use disorders. Given that further research will identify moderators and mediators affecting these differential associations, these findings may have important implications for designing early and targeted interventions to prevent disorder progression.     

Retrospective use of alcohol and other substances by college students: psychometric properties of a new measure

Using a new retrospective measure, interviews regarding alcohol and other substance use for the 5-year period preceding entry to college were conducted twice (with a 3-week interval) among 111 college students. Test-retest reliability was uniformly high across alcohol and substance use items (mean of Pearson correlations=.85), as were intraclass correlation coefficients (mean=.81) and kappa coefficients. A latent growth model (LGM) was specified and evaluated to test a hypothesized linear trend in alcohol use across the 5-year interval referenced by the retrospective measure. Furthermore, convergent and discriminant validity were provided as the slope (or rate of acceleration) parameter associated with the retrospective assessment predicted current alcohol disorders but not other disorders (e.g., depressive or anxiety disorders). The intercept predicted both current substance disorders (principally marijuana disorders) and anxiety disorders. Findings were discussed with regard to the use of this retrospective interview measure to screen for serious alcohol and other substance use prior to new students entering college, thereby affording opportunity for early interventions.     

Comparison of patient self-reports and urinalysis results obtained under naturalistic methadone treatment conditions

This study examined under naturalistic assessment conditions the validity of self-reported opiate and cocaine use among 175 veterans enrolled in methadone treatment, and factors related to self-report validity, such as stage in treatment and drug of abuse. Veterans were interviewed by clinical staff about past 30-day drug use with the addiction severity index (ASI), and urinalysis results were obtained for the same 30-day interval assessed with the ASI. Analysis revealed that urinalysis generally produced higher rates of substance use than patient self-report, and with the exception of reported opiate use among new patients presenting for treatment, validity of patient self-reported drug use generally was poor with patients under-reporting both opiate and cocaine use. The findings are in marked contrast to those obtained in other studies in which participants are ensured confidentiality regarding their self-reports. Further, the results raise questions about the utility of self-report measures of substance use to assess patient progress or methadone program performance.     

Linguistic adaptation and validation into Spanish of the Diagnostic Interview for Borderline Personality Disorders-Revised (DIB‐R)

ABSTRACT

Objective: This paper describes the linguistic adaptation and psychometric validation into Spanish of the Diagnostic Interview for Borderlines-Revised (DIB‐R) scale for diagnosing borderline personality disorder (BPD).

Methods: A conceptual equivalence approach was undertaken, including forward and backward translations of the scale and patient debriefing in a pilot phase. BPD and control patients were included in the validation study, and all of them were administered the scale by well trained interviewers, blinded to the clinical diagnosis. Reference diagnosis for BPD was done according to DSM‐IV criteria. The interview was independently administered in a subset of patients by different interviewer to test inter-rater reliability. Reliability and validity of the instrument were tested by calculating the Cronbach α and Guttman split-half coefficients and by receiver operating characteristic (ROC) curve analysis, kappa agreement coefficient determination and assessment of sensitivity and specificity of the scale.

Results: A cohort of 111 subjects, 84 BPD patients (33.6 ± 9.3 years) and 27 control subjects (34.9 ± 9.3 years), were included in the study. A cut-off point ≥ 7 showed a kappa agreement coefficient of 0.853 (95% confidence intervals: 0.739–0.967, p < 0.00001). The figures for sensitivity and specificity values were 0.964 (0.899–0.993) and 0.889 (0.708–0.977) respectively. Inter-rater reliability showed a kappa coefficient of 0.783 (?p < 0.0001).

Conclusion: The Spanish version of the DIB‐R showed adequate psychometric properties for diagnosing BPD in Spain.     

Sex differences in the cumulative incidence of substance use by birth cohort

BackgroundMen present higher overall rates of substance use and abuse than women; yet, evidence suggests that an increase of substance use by the younger cohorts of women in recent decades is narrowing this gap in western societies. Moreover, younger cohorts may also be reporting earlier initiation of substance use, representing an increased risk for developing substance-related problems. With this study we intend to identify changes in the patterns of substance use of men and women in Spain for public health policy, planning and intervention.MethodsSex differences in the cumulative incidence of alcohol, tobacco, cannabis and cocaine were examined by birth cohort using a combined sample of individuals aged 15–64 years from eight editions of the Spanish National Survey on Drugs (1995–2009).ResultsInitiation of substance use in Spain is progressively taking place at younger ages, particularly among women. The gender-gap of life-time occurrence of substance use is narrowing (cannabis and cocaine) almost closing (alcohol) and even reversing (tobacco) in the youngest cohort.ConclusionThese results reflect the particular evolution and trends of Spanish society regarding substance use. Women's increased use of substances and the earlier age of initiation of substance use by both sexes present particular challenges for prevention and treatment of future substance-related problems. The trends registered for legal and illegal substances would require re-evaluation of existing prevention policies.     

The Impact on Intravenous Drug Abusers When an Acutely Ill Person with HIV Infection is Hospitalized

Abstract

Past studies have concluded that individuals under criminal justice supervision often underreport their recent use of illicit drugs. To address this underreporting, objective biological measures, such as urine, saliva, and hair testing, have been used to gain better estimates of illegal drug use. While urinalysis is generally recognized as the reference standard, a method recently introduced in nonlaboratory settings for ascertaining drug use—saliva testing—may offer an alternative to urinalysis. To date, however, no studies have compared saliva testing to urinalysis among criminal justice populations. In the current study, urine and saliva specimens were collected from 114 adult arrestees interviewed as part of Maryland's Substance Abuse Need for Treatment among Arrestees (SANTA) project. With urinalysis as the reference standard, analysis of the saliva test results indicated sensitivity of 100% and specificity of 99% for cocaine and sensitivity of 88% and specificity of 100% for heroin. For marijuana, however, the saliva results indicated a sensitivity of only 5%. Anecdotal reports from the field suggest that saliva may have some advantages over urine because of the ease of collection, invulnerability to adulteration, and minimal personal invasiveness. These findings suggest that a more comprehensive study to evaluate the efficacy of saliva testing in field research may be warranted.     

Directions of the relationship between substance use and depressive symptoms from adolescence to young adulthood

PurposeBoth substance use and depression are common in adolescence and often comorbid. Past research has produced conflicting results on whether there is a temporal relationship and if so, in which direction it operates and how it may vary by sex. The purpose of this paper is to explore the longitudinal, potentially bidirectional, relationships between high-frequency substance use and depressive symptoms from adolescence into young adulthood for males and females.MethodsUsing data from the National Longitudinal Study of Adolescent to Adult Health we investigated longitudinal associations between high frequency substance use (alcohol, cigarettes, and marijuana) and depressive symptoms. The linear mixed effects models were stratified by sex and used a lagged measure of the dependent variable to test temporal relationships. A random intercept was used for respondent ID.ResultsIncreases in depressive symptoms were significantly associated with a later increase of about a half day in marijuana use frequency for males and nearly a two day increase in smoking frequency for females. Conversely, increases in smoking frequency were significantly associated with approximately a 0.6-point increase for females and 0.4-point increase for males in depressive symptoms at a later wave.ConclusionsResults indicate a bidirectional relationship between smoking and depressive symptoms for females. For males, there was evidence supporting self-medication with marijuana and for smoking being associated with later increases in depressive symptoms. Results inform how substance use and depression screening, prevention and treatment efforts should be paired and targeted for males and females.     

Acupuncture for addicted patients with chronic histories of arrest. A pilot study of the Consortium Treatment Center

Auricular acupuncture continues to gain popularity as an adjunct to substance abuse treatment. This report describes an outcomes study in a treatment center tailored to the needs of chronic repeat offenders. Thirty-seven patients who received acupuncture (AC) during the early weeks of treatment were followed for 180 days postadmission. Data were collected for four parameters: (1) program retention, (2) new arrests incurred, (3) drug-positive urinalysis results, and (4) number of days needed to progress from entry level to secondary level treatment. These data were compared to archived information from 49 no-acupuncture (NA) patients who had entered the program before acupuncture became available. Chi-square tests determined that AC patients exhibited significantly higher program retention than NA patients at 30 (p < 0.0001), 60 (p <.002), 90 (p <. 001), 120 (p <.007), and 150 (p <.031) days. At 180 days, a higher percentage of AC patients than NA patients remained in treatment, but the difference was not significant. Kaplan-Meier survival analysis determined that AC patients had significantly higher cumulative probability of remaining in treatment than did NA patients (p <.0021). In AC patients, there were decreased numbers of new arrests, drug-positive urinalysis results, and days needed to advance in treatment, but the differences were not significant. Fifty-one percent of all patients named methamphetamine as their primary drug of choice. Regardless of treatment group, methamphetamine-addicted patients exhibited significantly lower program retention than patients addicted to all other drugs (p <. 035). In methamphetamine-addicted patients, acupuncture improved program retention only up to 30 days (p <.021). These findings support addition of acupuncture to substance abuse treatment for criminal justice clients and indicate a need for acupuncture research focusing on withdrawal from methamphetamine.     

Using the Pictorial Representation of Illness and Self Measure (PRISM) to Quantify and Compare Suffering From Trauma and Addiction

Objective: In a sample of people with substance use disorder who had experienced psychological trauma, this study aimed to quantify differences in perceived suffering due to addiction-related problems and to trauma-related problems. Methods: The sample comprised 146 inpatients with substance use disorder: 25% had posttraumatic stress disorder (PTSD), 21% had subthreshold PTSD; and the remainder constituted the trauma-only group. PTSD, substance use disorder, and suffering were assessed using validated instruments. Suffering was measured using the Pictorial Representation of Illness and Self Measure (PRISM). Results: No differences were found among the PTSD, subthreshold PTSD, and trauma-only group in the suffering attributed to addiction-related problems. Those in the PTSD group appraised their suffering due to trauma-related problems as greater than the other groups. In the PTSD group, but not the subthreshold PTSD group, suffering due to trauma-related problems was appraised as greater than that due to addiction-related problems. Conclusions: This is the first study to demonstrate quantitative comparisons between different health problems using the “common currency” of suffering. Our results indicate that even among those in an inpatient substance use disorder treatment program, comorbid PTSD may be more personally salient and cause greater suffering, with implications for therapeutic interventions available on substance use disorder treatment programs.     

The validity of the Substance Use Risk Profile Scale (SURPS) among Australian adolescents

AimsThis study investigated the validity of a brief personality screening measure for substance use in adolescents, the Substance Use Risk Profile Scale (SURPS), among Australian adolescents.Design and participantsA total of 527 adolescents (mean age: 13.38 years, SD = 0.43) from seven Australian schools were assessed at two time points 24 months apart. The concurrent and predictive validity of the SURPS was determined using a series of linear and logistic regressions, and was compared to the results in a United Kingdom (UK) sample. SURPS subscale scores for the Australian population were also reported and compared to those in the UK.FindingsOverall, the SURPS subscale scores for Australian adolescents were similar to those for adolescents from the UK. Tests of concurrent and predictive validity in the Australian sample demonstrated that the all four personality profiles – Hopelessness (H), Anxiety Sensitivity (AS), Impulsivity (IMP), and Sensation Seeking (SS) – were related to measures of substance use and other behavioural and emotional characteristics. In addition, all the predicted specific prospective relationships between the personality profiles and particular substance use and other behavioural problems were confirmed except that H was not associated with illicit drug use. Overall, the results were similar between the Australian and UK samples.ConclusionsThe SURPS is a valid and useful measure for identifying Australian adolescents at high-risk for substance use and other emotional and behavioural problems. Implications for prevention are discussed.