title: Development of the Addiction Dimensions for Assessment and Personalised Treatment (ADAPT).
abstract: BACKGROUND
  Convergent research reveals heterogeneity in substance use disorders (SUD). The Addiction Dimensions for Assessment and Personalised Treatment (ADAPT) is designed to help clinicians tailor therapies.
  
  
  METHODS
  Multicentre study in 21 SUD clinics in London, Birmingham (England) and Adelaide (Australia). 132 clinicians rated their caseload on a beta version with 16 ordinal indicators of addiction severity, health and social problem complexity, and recovery strengths constructs. In Birmingham, two in-treatment outcomes were recorded after 15-months: 28-day drug use (Treatment Outcome Profile; n=703) and Global Assessment of Functioning (GAF; DSM-IV Axis V; n=695). Following item-level screening (inter-rater reliability [IRR]; n=388), exploratory structural equation models (ESEM), latent profile analysis (LPA), and mixed-effects regression evaluated construct, concurrent and predictive validity characteristics, respectively.
  
  
  RESULTS
  2467 patients rated (majority opioid or stimulant dependent, enrolled in opioid medication assisted or psychological treatment). IRR-screening removed two items and ESEM models identified and recalibrated remaining indicators (root mean square error of approximation 0.066 [90% confidence interval 0.055-0.064]). Following minor re-specification and satisfactory measurement invariance evaluation, ADAPT factor scores discriminated patients by sample, addiction therapy and drug use. LPA identified three patient sub-types: Class 1 (moderate severity, moderate complexity, high strengths profile; 46.9%); Class 2 (low severity, low complexity, high strengths; 25.4%) and Class 3 (high severity, high complexity, low strengths; 27.7%). Class 2 had higher GAF (z=4.30). Class 3 predicted follow-up drug use (z=2.02) and lower GAF (z=3.51).
  
  
  CONCLUSIONS
  The ADAPT is a valid instrument for SUD treatment planning, clinical review and outcome evaluation. Scoring and application are discussed.
authors.affiliation: Addictions Department, Institute of Psychiatry, King's College London, United Kingdom; South London and Maudsley NHS Mental Health Foundation Trust, United Kingdom; Alcohol, Drug and Tobacco Division, Health and Wellbeing Directorate, Public Health England, United Kingdom. Electronic address: john.marsden@kcl.ac.uk.
authors.forename: John
authors.initials: J
authors.lastname: Marsden
authors.affiliation: Addictions Department, Institute of Psychiatry, King's College London, United Kingdom; Alcohol, Drug and Tobacco Division, Health and Wellbeing Directorate, Public Health England, United Kingdom.
authors.forename: Brian
authors.initials: B
authors.lastname: Eastwood
authors.affiliation: Drug and Alcohol Services South Australia and Discipline of Pharmacology, School of Medical Sciences, University of Adelaide, Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: Ali
authors.affiliation: Alcohol, Drug and Tobacco Division, Health and Wellbeing Directorate, Public Health England, United Kingdom.
authors.forename: Pete
authors.initials: P
authors.lastname: Burkinshaw
authors.affiliation: Birmingham and Solihull NHS Mental Health Foundation Trust, United Kingdom.
authors.forename: Gagandeep
authors.initials: G
authors.lastname: Chohan
authors.affiliation: Birmingham and Solihull NHS Mental Health Foundation Trust, United Kingdom.
authors.forename: Alex
authors.initials: A
authors.lastname: Copello
authors.affiliation: Alcohol, Drug and Tobacco Division, Health and Wellbeing Directorate, Public Health England, United Kingdom.
authors.forename: Daniel
authors.initials: D
authors.lastname: Burn
authors.affiliation: Addictions Department, Institute of Psychiatry, King's College London, United Kingdom; South London and Maudsley NHS Mental Health Foundation Trust, United Kingdom; Alcohol, Drug and Tobacco Division, Health and Wellbeing Directorate, Public Health England, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Kelleher
authors.affiliation: Addictions Department, Institute of Psychiatry, King's College London, United Kingdom; South London and Maudsley NHS Mental Health Foundation Trust, United Kingdom; Alcohol, Drug and Tobacco Division, Health and Wellbeing Directorate, Public Health England, United Kingdom.
authors.forename: Luke
authors.initials: L
authors.lastname: Mitcheson
authors.affiliation: Alcohol, Drug and Tobacco Division, Health and Wellbeing Directorate, Public Health England, United Kingdom.
authors.forename: Steve
authors.initials: S
authors.lastname: Taylor
authors.affiliation: Blenheim CDP, United Kingdom.
authors.forename: Nick
authors.initials: N
authors.lastname: Wilson
authors.affiliation: East London NHS Foundation Trust, United Kingdom.
authors.forename: Chris
authors.initials: C
authors.lastname: Whiteley
authors.affiliation: Addictions Department, Institute of Psychiatry, King's College London, United Kingdom; Birmingham and Solihull NHS Mental Health Foundation Trust, United Kingdom; School of Clinical & Experimental Medicine, University of Birmingham, United Kingdom.
authors.forename: Edward
authors.initials: E
authors.lastname: Day
mesh_terms: D000328:Adult; D019969:Amphetamine-Related Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D009293:Opioid-Related Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D011569:Psychiatric Status Rating Scales / Q000592:standards; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000523:psychology / Q000628:therapy
keywords: ADAPT; Assessment; Personalised; Substance use disorder; Treatment