- 作者：Li-Tzy Wu ; Sc.D.a ; litzy.wu@duke.edu ; Marvin S. Swartz ; M.D.a ; Jeng-Jong Pan ; Ph.D.b ; Bruce Burchett ; Ph.D.a ; Paolo Mannelli ; M.D.a ; Chongming Yang ; Ph.D.c ; Dan G. Blazer ; M.D. ; Ph.D.a
- 关键词：Clinical Trials Network ; Item response theory ; Receiver operating characteristic curve ; Brief screening ; Substance use disorders
- 刊名：General Hospital Psychiatry
- 出版年：2013
- 出版时间：January-February, 2013
- 年：2013
- 卷：35
- 期：1
- 页码：74-82
- 全文大小：1224 K
Objective
The objective was to identify a potential core set of brief screeners for the detection of individuals with a substance use disorder (SUD) in medical settings.Method
Data were from two multisite studies that evaluated stimulant use outcomes of an abstinence-based contingency management intervention as an addition to usual care (National Drug Abuse Treatment Clinical Trials Network trials 006-007). The sample comprised 847 substance-using adults who were recruited from 12 outpatient substance abuse treatment settings across the United States. Alcohol and drug use disorders were assessed by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Checklist. Data were analyzed by factor analysis, item response theory (IRT), sensitivity and specificity procedures.
Results
Comparatively prevalent symptoms of dependence, especially inability to cut down for all substances, showed high sensitivity for detecting an SUD (low rate of false negative). IRT-defined severe (infrequent) and low discriminative items, especially withdrawal for alcohol, cannabis and cocaine, had low sensitivity in identifying cases of an SUD. IRT-defined less severe (frequent) and high discriminative items, including inability to cut down or taking larger amounts than intended for all substances and withdrawal for amphetamines and opioids, showed good-to-high values of area under the receiver operating characteristic curve in classifying cases and noncases of an SUD.
Conclusion
Findings suggest the feasibility of identifying psychometrically reliable substance dependence symptoms to develop a two-item screen for alcohol and drug disorders.