Alcohol and drug dependence symptom items as brief screeners for substance use disorders: results from the Clinical Trials Network.
OBJECTIVE
To address an urgent need for screening of substance use problems in medical settings, we examined substance-specific dependence criteria as potential brief screeners for the detection of patients with a substance use disorder (SUD).


METHODS
The sample included 920 opioid-dependent adults who were recruited from outpatient treatment settings at 11 programs in 10 U.S. cities and who completed intake assessments of SUDs for a multisite study of the National Drug Abuse Treatment Clinical Trials Network (CTN003). Data were analyzed by factor analysis, item response theory (IRT), sensitivity, and specificity procedures.


RESULTS
Across all substances (alcohol, amphetamines, cannabis, cocaine, sedatives), withdrawal was among the least prevalent symptoms, while taking large amounts and inability to cut down were among the most prevalent symptoms. Items closely related to the latent trait of a SUD showed good-to-high values of area under the receiver operating characteristic curve in identifying cases of a SUD; IRT-defined severe and less discriminative items exhibited low sensitivity in identifying cases of a SUD (withdrawal for all substances; time using for alcohol and sedatives; giving up activities for sedatives).


CONCLUSIONS
Study results suggest that withdrawal and time using are much less reliable indicators for a SUD than taking larger amounts than intended and inability to cut down and that the latter two items should be studied further for consideration in developing a simplified tool for screening patients for SUDs in medical settings. These findings have implications for the use of common health indicators in electronic health records systems to improve patient care.
Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Box 3419, Durham, NC 27710, USA. litzy.wu@duke.edu
Li-Tzy
LT
Wu
Dan G
DG
Blazer
George E
GE
Woody
Bruce
B
Burchett
Chongming
C
Yang
Jeng-Jong
JJ
Pan
Walter
W
Ling
D000328:Adult; D017004:Codependency, Psychological; D062787:Drug Overdose / Q000175:diagnosis / Q000453:epidemiology; D000431:Ethanol / Q000009:adverse effects*; D005163:Factor Analysis, Statistical; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects*; D013287:Illicit Drugs / Q000009:adverse effects*; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D015995:Prevalence; D012372:ROC Curve; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D013997:Time Factors; D014481:United States / Q000453:epidemiology
D006993:Hypnotics and Sedatives; D013287:Illicit Drugs; D000431:Ethanol