Psychometric properties of DSM assessments of illicit drug abuse and dependence: Results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)

Washington University School of Medicine, Department of Psychiatry, St Louis, MO 63110, USA.
Psychological Medicine (Impact Factor: 5.94). 10/2007; 37(9):1345-55. DOI: 10.1017/S0033291707000396
Source: PubMed


DSM-IV criteria for illicit drug abuse and dependence are largely based on criteria developed for alcohol use disorders and there is a lack of research evidence on the psychometric properties of these symptoms when applied to illicit drugs.
This study utilizes data on abuse/dependence criteria for cannabis, cocaine, stimulants, sedatives, tranquilizers, opiates, hallucinogens and inhalants from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC, n=43 093). Analyses included factor analysis to explore the dimensionality of illicit drug abuse and dependence criteria, calculation of item difficulty and discrimination within an item response framework and a descriptive analysis of 'diagnostic orphans': individuals meeting criteria for 1-2 dependence symptoms but not abuse. Rates of psychiatric disorders were compared across groups.
Results favor a uni-dimensional construct for abuse/dependence on each of the eight drug classes. Factor loadings, item difficulty and discrimination were remarkably consistent across drug categories. For each drug category, between 29% and 51% of all individuals meeting criteria for at least one symptom did not receive a formal diagnosis of either abuse or dependence and were therefore classified as 'orphans'. Mean rates of disorder in these individuals suggested that illicit drug use disorders may be more adequately described along a spectrum of severity.
While there were remarkable similarities across categories of illicit drugs, consideration of item difficulty suggested that some alterations to DSM regarding the relevant severity of specific abuse and dependence criteria may be warranted.

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    • "On the basis of this evidence, the Work Group eliminated the distinction between abuse and dependence in favor of a single category—substance use disorder—operationalized with 11 criteria (Hasin et al., 2013). The diagnostic criteria are sufficiently unidimensional for calibration with IRT models, but they are high-threshold items most relevant at the severe end of the continuum of substance use (Hartman et al., 2008; Langenbucher et al., 2004; Lynskey and Agrawal, 2007). Our goal was to identify not only items consistent with the diagnostic criteria but also items that were more normally distributed in a sample that included drug users in the community as well as drug users seeking treatment. "
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    ABSTRACT: Background: Two item banks for substance use were developed as part of the Patient-Reported Outcomes Measurement Information System (PROMIS(®)): severity of substance use and positive appeal of substance use. Methods: Qualitative item analysis (including focus groups, cognitive interviewing, expert review, and item revision) reduced an initial pool of more than 5300 items for substance use to 119 items included in field testing. Items were written in a first-person, past-tense format, with 5 response options reflecting frequency or severity. Both 30-day and 3-month time frames were tested. The calibration sample of 1336 respondents included 875 individuals from the general population (ascertained through an internet panel) and 461 patients from addiction treatment centers participating in the National Drug Abuse Treatment Clinical Trials Network. Results: Final banks of 37 and 18 items were calibrated for severity of substance use and positive appeal of substance use, respectively, using the two-parameter graded response model from item response theory (IRT). Initial calibrations were similar for the 30-day and 3-month time frames, and final calibrations used data combined across the time frames, making the items applicable with either interval. Seven-item static short forms were also developed from each item bank. Conclusions: Test information curves showed that the PROMIS item banks provided substantial information in a broad range of severity, making them suitable for treatment, observational, and epidemiological research in both clinical and community settings.
    Drug and alcohol dependence 10/2015; 156. DOI:10.1016/j.drugalcdep.2015.09.008 · 3.42 Impact Factor
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    • "SUDAAN (Research Triangle Institute, 2006) was used to examine distributions of study variables (chi-square test). Consistent with IRT studies on SUDs (Gillespie et al., 2007; Lynskey & Agrawal, 2007; Wu et al., 2009a), discrete factor, IRT, and MIMIC analyses were based on past-year marijuana users (N=6,917). Mplus (V.5.1) with complex survey procedures was used for these analyses (Muthén & Muthén, 2007). "
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    ABSTRACT: While item response theory (IRT) research shows a latent severity trait underlying response patterns of substance abuse and dependence symptoms, little is known about IRT-based severity estimates in relation to clinically relevant measures. In response to increased prevalences of marijuana-related treatment admissions, an elevated level of marijuana potency, and the debate on medical marijuana use, we applied dimensional approaches to understand IRT-based severity estimates for marijuana use disorders (MUDs) and their correlates while simultaneously considering gender- and race/ethnicity-related differential item functioning (DIF). Using adult data from the 2008 National Survey on Drug Use and Health (N = 37,897), Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for MUDs among past-year marijuana users were examined by IRT, logistic regression, and multiple indicators-multiple causes (MIMIC) approaches. Among 6917 marijuana users, 15% met criteria for a MUD; another 24% exhibited subthreshold dependence. Abuse criteria were highly correlated with dependence criteria (correlation = 0.90), indicating unidimensionality; item information curves revealed redundancy in multiple criteria. MIMIC analyses showed that MUD criteria were positively associated with weekly marijuana use, early marijuana use, other substance use disorders, substance abuse treatment, and serious psychological distress. African Americans and Hispanics showed higher levels of MUDs than Whites, even after adjusting for race/ethnicity-related DIF. The redundancy in multiple criteria suggests an opportunity to improve efficiency in measuring symptom-level manifestations by removing low-informative criteria. Elevated rates of MUDs among African Americans and Hispanics require research to elucidate risk factors and improve assessments of MUDs for different racial/ethnic groups.
    06/2012; 21(2):117-33. DOI:10.1002/mpr.1354
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    • "" suggests that this infrequently endorsed item is a poor discriminator. Indeed, based on results from a number of reports, some including formal tests of DIF (N.A. Gillespie, et al., 2007; Hartman, et al., 2008; Hasin, Paykin, Meydan, & Grant, 2000; Langenbucher, et al., 2004; Lynskey & Agrawal, 2007; Schuckit et al., 1999; Teesson, et al., 2002) the same conclusion can be made thereby empirically justifying the removal of legal consequences from the proposed DSM-V. "
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    ABSTRACT: Despite the consensus that criteria for cannabis abuse and dependence and symptoms of withdrawal are best explained by a single latent liability, it remains unknown whether alternative models provide a better explanation of these criteria. A series of latent factor, latent class, and hybrid factor mixture models were fitted to data from 872 recent cannabis users from the Minnesota Twin Family Study who completed Diagnostic and Statistical Manual of Mental Disorders (3rd ed., revised, and 4th ed.) diagnostic criteria for cannabis abuse, dependence, and symptoms of withdrawal. Despite theoretical appeal, results did not support latent class or factor mixture modeling. Instead, symptoms of abuse, dependence, and withdrawal were better summarized by a single latent factor Cannabis Use Disorder (CUD) for male and female young adults. An almost 2-fold sex difference in item endorsement was best explained by a single mean difference on the CUD factor, indicating that young men have a greater latent liability toward expressing CUD.
    Psychology of Addictive Behaviors 11/2011; 26(1):68-77. DOI:10.1037/a0026230 · 2.09 Impact Factor
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