Measuring Drug Use and Key Risk, Mediating and Moderating Factors
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Measuring Drug Use and Key Risk, Mediating and
Moderating Factors
Duncan B. Clark, M.D., Ph.D.
University of Pittsburgh
Assessing the Impact of Childhood Interventions on Subsequent Drug Use
Washington DC: May 23-24, 2000
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Substance Use Dimensions
• type
• frequency
• quantity
• time frame
• developmental stage
• problems
• substance use disorders
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Substance Type
alcohol barbituates
marijuana club drugs
amphetamines alcohol
methamphetamine cigarettes
heroin steroids
tranquilizers
Johnson, O’Malley, Bachman (1999):
Monitoring the Future: Overview of Key Findings
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Substance Use Frequency
Drugs other than alcohol and cigarettes• ever• past 12 months• past 30 days
Frequency:
0, 1-2, 3-5, 6-9, 10-19, 20-39, 40+
Johnson, O’Malley & Bachman (1999)
Monitoring the Future: Overview of Key Findings
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Time-line Follow Back
Daily occurrence• type (alcohol, other drugs)• frequency• quantity
Time frame: Past month
Sobell & Sobell (1994)
Time-line follow Back Users Manual
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Lifetime Drinking History
• type
• frequency
• quantity
Time frame: “phases”
Skinner & Sheu (1982) J Stud Alcohol
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CAGE Alcohol Screen• Have you felt the need to stop or cut down on drinking?
• Have you been angry or annoyed at other people talking about or criticizing your drinking?
• Have you felt guilty...something you did when...drinking?
• How often have you taken a drink first thing in the morning? (early morning drinking)
• Optimal cut-score = 1
– sensitivity = .67
– specificity = .82
Chung et al Screening adolescents… J Stud Alc (in press)
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TWEAK Alcohol Screen• How many drinks can you hold? (Tolerance)• Have close friends or relatives worried...?• Do you...drink...when you first get up? (Eye-opener)• Has a friend...you could not remember? (Amnesia)• Do you...feel the need to cut down on your drinking?
• Optimal cut-score = 2– sensitivity = .73– specificity = .90
Chung et al Screening adolescents… J Stud Alc (in press)
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AUDIT Alcohol Screen
• 3 questions: quantity, frequency, binge or risk drinking
• 4 questions: alcohol dependence
• 3 questions: alcohol-related negative consequences
• Optimal cut-score = 4– sensitivity = .95– specificity = .80
Chung et al Screening adolescents… J Stud Alc (in press)
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Adolescent Substance Problems Screening QuestionnairesClient Substance Index Thomas 1990
DAP Quick Screen Schwartz & Wirtz 1990
DUSI - R Tarter et al., 1992
PESQ Winters 1992
POSIT Rahdert 1991
AAIS Mayer & Filsted 1979
ADI Harrell & Wirtz 1989
RAPI White & Labouvie, 198Martin & Winters (1998): Alcohol Health Research World
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Drug Use Screening Inventory
• Substance type & frequency screen
• 159 true/false items
• 10 DomainsSubstance Use Family System
Behavior Pattern School Adjustment
Health Status Work Adjustment
Psychiatric Disorder Peer relationships
Social Competency Recreation
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Handbook of Psychiatric Measures
Preparation: 1995 - 1999
• APA Task Force
• 27 domains defined
• principal contributors identified
• candidate measures compiled
• outside advisors consulted
• final selection of measures
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Handbook of Psychiatric Measures
Information Provided for Each Measure
• Goals
• Description
• Practical Issues
• Psychometric Properties
• Clinical Utility
• References
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Handbook of Psychiatric Measures
Substance Use Disorders Measures (1)
• Alcohol Timeline Followback*
• AUDIT*, CAGE*, TWEAK*
• Michigan Alcohol Screening Test
• Alcohol Dependence Scale*
• Alcohol Expectancy Questionaire*
• Withdrawal Assessment for Alcohol
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Handbook of Psychiatric Measures
Substance Use Disorders Measures (2)
• OC Drinking Scale*
• Drug Abuse Screening Test
• Personal Experience Screening Ques
• Addiction Severity Index*
• Fagerstrom - Nicotine Dependence
• URI Change Assessment
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Environmental Risk Factors
• Family environment– Parent SUDs
– Parent psychopathology
• Physical or sexual abuse
• Peer environment
• Macrosocial environment
Tarter et al. (1999): Development and Psychopathology
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Risk Factor Measures
• K-SADS Trauma Interview– for each trauma experience
• mother, adolescent report
• date(s), multiple events
• perpetrator(s)
• if witness, victim
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Risk Factor Measures
• K-SADS Trauma Interview– Trauma events screen
• car accident• other accident• fire• witness natural disaster• witness violent crime• victim of violent crime• witness to domestic violence• physical abuse• sexual abuse
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Mediating Phenotypes
• Behavioral dysregulation– behavioral undercontrol
– antisocial behavior
– conduct disorder
• Emotional dysregulation– anxiety & depression
– negative affect disorders
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Dysregulation constructs
• Behavioral Undercontrol– CD symptom count
– DUSI Undercontrol Factor
– MPQ - Aggression
– MPQ - Harm Avoidance
– MPQ - Constraint
Martin, Lynch, Pollock & Clark (in press)
Psychology of Addictive Behaviors
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Dysregulation constructs
• Negative Emotionality– Beck Depression Inventory
– Hamilton Anxiety Rating Scale
– MPQ - Stress Reactivity
– CBCL - Internalizing Factor
Martin, Lynch, Pollock & Clark (in press)
Psychology of Addictive Behaviors
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Interactive Website for substance abuse Interactive Website for substance abuse Etiology of Substance Abuse—Online Etiology of Substance Abuse—Online
Reference Archive (contract funded by Reference Archive (contract funded by NIDA, 1996-present)NIDA, 1996-present)
Drug and Alcohol Forum—Online Drug and Alcohol Forum—Online education and certification of addiction education and certification of addiction counselorscounselors
CEDAR WebsiteCEDAR Websitehttp://www.pitt.edu/~cedarhttp://www.pitt.edu/~cedar
CEDAR WebsiteCEDAR Websitehttp://www.pitt.edu/~cedarhttp://www.pitt.edu/~cedar
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Website describing program Website describing program Article abstractsArticle abstracts Links to other alcohol sitesLinks to other alcohol sites Faculty addressesFaculty addresses
PAARC WebsitePAARC Websitehttp://www.pitt.edu/~paarc/paarc.htmlhttp://www.pitt.edu/~paarc/paarc.html
PAARC WebsitePAARC Websitehttp://www.pitt.edu/~paarc/paarc.htmlhttp://www.pitt.edu/~paarc/paarc.html