Article

The construct and measurement equivalence of cocaine and opioid dependences: A National Drug Abuse Treatment Clinical Trials Network (CTN) study

Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Duke Clinical Research Institute, Durham, NC 27710, USA.
Drug and alcohol dependence (Impact Factor: 3.42). 06/2009; 103(3):114-23. DOI: 10.1016/j.drugalcdep.2009.01.018
Source: PubMed

ABSTRACT

Although DSM-IV criteria are widely used in making diagnoses of substance use disorders, gaps exist regarding diagnosis classification, use of dependence criteria, and effects of measurement bias on diagnosis assessment. We examined the construct and measurement equivalence of diagnostic criteria for cocaine and opioid dependences, including whether each criterion maps onto the dependence construct, how well each criterion performs, how much information each contributes to a diagnosis, and whether symptom-endorsing is equivalent between demographic groups.
Item response theory (IRT) and multiple indicators-multiple causes (MIMIC) modeling were performed on a sample of stimulant-using methadone maintenance patients enrolled in a multisite study of the National Drug Abuse Treatment Clinical Trials Network (CTN) (N=383). Participants were recruited from six community-based methadone maintenance treatment programs associated with the CTN and major U.S. providers. Cocaine and opioid dependences were assessed by DSM-IV Checklist.
IRT modeling showed that symptoms of cocaine and opioid dependences, respectively, were arrayed along a continuum of severity. All symptoms had moderate to high discrimination in distinguishing drug users between severity levels. "Withdrawal" identified the most severe symptom of the cocaine dependence continuum. MIMIC modeling revealed some support for measurement equivalence.
Study results suggest that self-reported symptoms of cocaine and opioid dependences and their underlying constructs can be measured appropriately among treatment-seeking polysubstance users.

Download full-text

Full-text

Available from: Li-Tzy Wu
  • Source
    • "For example, showed that discontinuous alcohol exposure disrupts zebrafish shoaling behavior, Cachat et al. (2010) observed that withdrawal from alcohol causes stress response in terms of increased cortisol release, and Mathur and Guo (2011) related the alcohol withdrawal to anxiety-like behavior. In mammals, the clinical symptoms of withdrawal are high anxiety, increased heart rate and perspiration, nausea and headache, increased tremors, and hallucinations (Martinotti et al., 2008; Prat, 2009; Wills et al., 2009; Wu et al., 2009). In fish, our results suggest that withdrawal from alcohol can induce inability to properly explore the ambient and difficulty to learn and form memory, behavioral responses associated with the peak of the withdrawal syndrome (Bayard et al., 2004). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Many studies regarding the effects of drugs investigate the acute and chronic use of alcohol, but only a few address the effects of caffeine and alcohol combined to the performance of the zebrafish in cognitive tasks. The zebrafish is an important model for studying the effects of drugs on learning, because it has large genetic similarities to humans and the non-invasive administration of the substances favors translational bias of research. In this study, we observed the effects of alcohol and caffeine on zebrafish cognition through an object discrimination test. We noticed that animals subjected to acute alcohol dose and those under alcohol or caffeine withdrawal did not show discrimination. When fish were treated with associated alcohol and caffeine, those chronically treated with alcohol and subjected to moderate acute dose of caffeine showed learning of the task. Our results reinforce the harmful effects of the alcohol use on cognitive tasks, and suggest that continued use of high doses of caffeine cause cognitive impairment during withdrawal of the substance. However, the acute use of caffeine appears to reverse the harmful effects of alcohol withdrawal, allowing discriminative performance equivalent to control fish. Finally, we reiterate the use of zebrafish as a model for drug effects screening and search for active compounds that modulate the alcohol and caffeine effects.
    Full-text · Article · Feb 2016 · Pharmacology Biochemistry and Behavior
  • Source
    • "ROC-AUC denotes the level of accuracy in classifying cases and noncases of an SUD by taking into account the trade-off between sensitivity and specificity. An IRT approach was included to provide psychometric properties of substance-specific screening questions for ROC-AUC [28] [29]. Both IRT and ROC-AUC results for the five substances demonstrate the potential feasibility of identifying " a core set of substance dependence items " as a simplified screen to facilitate detection of alcohol or drug disorders [14]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: 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.
    Full-text · Article · Jul 2012 · General hospital psychiatry
  • Source
    • "Of note, IICs reveal crucial evidence for selecting " core items " for an assessment tool (Edelen and Reeve, 2007); when such information is overlooked, conclusions can be limited or biased. For example, one IRT analysis has shown that withdrawal was the most severe item among all cocaine dependence criteria, but additional analyses of IICs revealed its very low level of precision, indicating that it is an unreliable item for measuring cocaine dependence; on the other hand, time spent was revealed by IICs as the most reliable, informative item, implying that time spent is a useful screener for identifying cocaine users with cocaine dependence problems (Wu et al., 2009c). Given the scarcity of IIC data to inform item-level reliability or redundancy in assessing MUDs, the first aim addresses item-level redundancy for MUD criteria. "
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · Jun 2012
Show more