NZ Measures of Addiction

7/23/2019 NZ Measures of Addiction

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Measures of Addiction

Joseph R DiFranza, MD

Department of Family Medicine and

Community HealthUniversity of Massachusetts Medical School


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he Sta!es of "hysical Addiction#hat does it measure$

he pro!ression throu!h the % sta!esof physical addiction


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Stage 1 Stage 2 Stage 3 Sta!e %

Most advanced

symptom

Abstinence doesnot trigger a

desire to smoke

Wanting Craving Needing

Duration NA Transient More persistent Unremitting

Saience NA !asiy ignored Di""icut to ignore #mpossibe toignore

#ntrudes on

t$oug$tsNA No %es %es

Sense o" urgency NA No No %es

&revents norma

"unctioningNA No No %es

Dysp$oric

e'perienceNA No No %es

Sta!es of "hysical Addiction


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T$is describes me( not at a a itte pretty)e

very)e

#" # go too ong )it$out smoking t$e

"irst t$ing # )i notice is a mid

desire to smoke t$at # can ignore*

#" # go too ong )it$out smoking+ t$e

desire "or a cigarette becomes so

strong t$at it is $ard to ignore and it

interrupts my t$inking*

#" # go too ong )it$out smoking #,ust can-t "unction rig$t+ and # kno) #

)i $ave to smoke ,ust to "ee norma

again*

Measure of Sta!e of "hysicalAddiction


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Sta!e & Sta!e ' Sta!e ( Sta!e %)

&)

')

()

%)

*)

+)

Distribution of Stages in 347 Adolescent Smokers


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Sta!e & Sta!e ' Sta!e ( Sta!e %)

*

&)

&*

')

'*

()

(*

%)

%*

*)

Distribution of Stages in 271 Adult Smokers


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he Sta!es of "hysical Addiction"sychometrics

Discriminates across all other measures ofnicotine dependence

Correlates ith -rain structural chan!es

.r/ 012*3


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The dorsal anterior cingulate gyrus- the locationof ma4imal correlation -eteen FA and Sta!e of

"hysical Addiction


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Structural connectivity increases -eteen the dorsalanterior cingulateand prefrontal corte4 ith

advancin! Sta!e of Addiction1


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he Sta!es of "hysical Addiction"ros and Cons

5ery easily assessed and scored

A physiolo!ical measure thatcorrelates ith -rain structure

Demonstrates concurrent validityith dozens of measures

6t is not su-7ect to cultural -ias

Can -e used ith children and adults

Can -e used ith all types of to-acco


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he Autonomy 8ver o-acco Scale#hat does it measure$

hree aspects of addiction thatcontri-ute to a loss of autonomy #ithdraal

"sycholo!ical Dependence

Cue06nduced Ur!es to Use o-acco

6t measures current symptoms only,

so it can -e used after cessation1


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he Autonomy 8ver o-acco ScaleWithdraal

#hen 6 !o too lon! ithout a ci!arette, 6 !et impatient1 #hen 6 !o too lon! ithout a ci!arette, 6 !et stron! ur!es that are

hard to !et rid of1

#hen 6 !o too lon! ithout a ci!arette, 6 lose my temper moreeasily1

#hen 6 !o too lon! ithout a ci!arette, 6 !et nervous or an4ious1

!sychological De"endence 6 rely on smo9in! to focus my attention1

6 rely on smo9in! to ta9e my mind o: -ein! -ored1

6 rely on smo9in! to deal ith stress1

6 ould !o crazy if 6 couldn;t smo9e1

#ue-$nduced %rges to Smoke #hen 6 feel stressed, 6 ant a ci!arette1

#hen 6 see other people smo9in!, 6 ant a ci!arette1

#hen 6 smell ci!arette smo9e, 6 ant a ci!arette1

After eatin!, 6 ant a ci!arette1


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he Autonomy 8ver o-acco Scale

Response options Descri-es me not at all .)3

Descri-es me a little .&3

Descri-es me pretty ell .'3

Descri-es me very ell .(3

Scorin! options Add up total score .)0(+3

Score items dichotomously .)0&'3


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he Autonomy 8ver o-acco Scale"sychometrics

%

#ithdraal = / 1>(

"sycholo!ical Dependence = / 1??

Cue06nduced Ur!es = / 12& Correlates ith

F@D r / 1?)

H8@C r / 12%

Smo9in! days per monthr/ 1+2

atency to antin! r = .56

5alidated for children and adults

"redictive validity in cessation study


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he Autonomy 8ver o-acco Scale"ros and Cons


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he atency to @eedin! a Ci!arette#hat does it measure$

&After you ha'e smoked a cigarette( ho long can you gobefore you need to smoke again)* 6 don;t feel a re!ular need to smo9e More than four ee9s four ee9s

three ee9s to ee9s one ee9 si4 days ve days four days

three days to days one day less than one day .ho many hours$3 less than an hour .ho many minutes$3


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he atency to #ithdraal"sychometrics

est0retest relia-ility is e4cellent .r / 12*3

@C correlates ith

otal AU8S score, r / 01+)

Cue06nduced Cravin!, r / 01+% "sycholo!ical Dependence, r / 01%(

#ithdraal, r / 01*?

"leasure, r / 01(> @C varies moderately ith daily

ci!arette consumption 01*(, 01*(, 01*(


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he atency to @eedin! a Ci!arette

Mean @C as '%( hours forsu-7ects ith &)) ci!arette lifetimeconsumption

Mean @C as ' hours for su-7ectsith E&)) lifetime consumption


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he atency to #ithdraal"ros and Cons

5ery short and relia-le

Relatively easily scored

Continuous measure 6f they have a atency, they are

addicted1

"hysiolo!ic measure Applica-le to all forms of to-acco

Can -e used in children and adults


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"leasure From Smo9in!

Ho much pleasure do you !et fromsmo9in! a ci!arette$G

i9ert scale zero / none, > / a !reatdeal

Adolescent smo9ers mean pleasure/ *1?, +1>

Adult smo9ers mean pleasure / *1>

est0retest relia-ility r / 12% 0 1>%


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"leasure From Smo9in!

"leasure correlates ith #ithdraal, r/ 1?*

"sycholo!ical Dependence, r/ 1?>

Cue06nduced Cravin!, r/ 12%

"roportion of time smo9in! out of need,r/ 1%*

atency to @eedin! a Ci!arette, r/ 01(>


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he Hoo9ed on @icotine Chec9list#hat does it measure$

&) symptoms that ma9e Buittin!more dicult


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Hoo9ed on @icotineChec9list

&3 Have you ever tried to Buit, -ut couldn;t$

'3 Do you smo9e no -ecause it is really hardto Buit$

(3 Have you ever felt li9e you ere addicted toto-acco$

%3 Do you ever have stron! cravin!s to smo9e$

*3 Have you ever felt li9e you really needed a

ci!arette$+3 6s it hard to 9eep from smo9in! in places

here you are not supposed to$


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Hoo9ed on @icotineChec9list

#hen you havenIt smo9ed for a hiledo you

?3 nd it hard to concentrate$

23 feel more irrita-le$

>3 feel a stron! need or ur!e tosmo9e$

&)3 feel nervous, restless or an4ious$


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he Hoo9ed on @icotine Chec9list"sychometrics

(


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he Hoo9ed on @icotine Chec9list"ros and Cons


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he Fa!erstrLm est for @icotine Dependence#hat does it measure$

Severity of nicotine dependence

Does not dia!nose dependence

@o consensus on hat it measures

6ndirect -ehavioral measure ofithdraal and the atency to#ithdraal


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he Fa!erstrLm est for @icotine Dependence

1+ ,o soon after you ake u" do you smoke your rst cigarette)

After +) minutes .)3

(&0+) minutes .&3

+0() minutes .'3

#ithin * minutes .(3

2+ Do you nd it di.cult to refrain from smoking in "laces here it is forbidden)

@o .)3

es .&3

3+ Which cigarette ould you hate most to gi'e u")

he rst in the mornin! .&3Any other .)3

4+ ,o many cigarettes "er day do you smoke)

&) or less .)3

&&0') .&3

'&0() .'3

(& or more .(3

/+ Do you smoke more fre0uently during the rst hours after aakening thanduring the rest of the day)

@o .)3

es .&3

+ Do you smoke e'en if you are so ill that you are in bed most of the day)

@o .)3

es .&3


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he Fa!erstrLm est for @icotine Dependence"sychometrics

= / 1?( .compared to 1>' for H8@C and 1>( forAU8S in the same sample3

est0retest, r/ 12201>&

Correlates ith

AU8S, r / 1?)

H8@C, r/ 1?&

Chan!es in -rain structure, r / 01*', r / 01*2,and r / 01+% .compared to 012* for Sta!e of"hysical Addiction3

atency to @eedin! a Ci!arette, r/ 1%*

Smo9in! days per month, r / 1*>


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he Fa!erstrLm est for @icotine Dependence"ros and Cons

"ros Short


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he Dia!nostic and Statistical Manual#hat does it measure$

A dia!nosis of nicotine dependence


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he Dia!nostic and StatisticalManual

&1 Unsuccessful e:orts to cut don or Buit

'1 Use despite harm

(1 #ithdraal

%1 olerance

*1 Use in !reater amounts or lon!er thanintended

+1 A !reat deal of time spent usin!?1 Social, occupational or recreational

activities !iven up1


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he Dia!nostic and StatisticalManual

iterature revie of &+> articles @o validity to a three0criteria dia!nostic

threshold

@o validity to a four0symptomithdraal threshold

"redictive validity as poor

6t correlates poorly to modestly ith allother measures of dependence and-ehavior


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he Dia!nostic and Statistical Manual"sychometrics

AdeBuate to e4cellent retestrelia-ility

Unaccepta-le internal relia-ility )1%&0 )1+%

Unaccepta-le sensitivity .6n onestudy DSM dia!nosed only to thirds

of smo9ers ho had si4 of morefailed Buit attempts13

Correlates poorly ith self0dia!nosed

addiction, r/ 1%2


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he Dia!nostic and Statistical Manual"ros and Cons

6t provides a dia!nosisG -ased oncompletely ar-itrary criteria ith noesta-lished connection ith the

pathophysiolo!y en!thy and dicult to administer

5ery su-7ective criteria


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he 6nternational Classication of Diseases#hat does it measure$

A dia!nosis of to-acco dependence


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he 6nternational Classication ofDiseases

&1 A stron! desire or compulsion to ta9e thesu-stance

'1 6mpaired capacity to control use

(1 A physiolo!ical ithdraal state%1 olerance

*1 "reoccupation ith use .activities !iven

up, time spent3+1 "ersistent use despite harm


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he 6nternational Classication of Diseases"sychometrics

iterature search0')&)

@o psychometric data on the ocial instrument

@o data supportin!

Dia!nostic validity

"redictive validity

( symptom dia!nostic threshold

' symptom ithdraal threshold


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he 6nternational Classication of Diseases"sychometrics

Does not correlate stron!ly ith Self0rated addiction, r/ 1*2

Self0rated diculty Buittin!, r / 1*?

Daily ci!arette consumption, r/ 1''ime to rst mornin! ci!arette, r/ 01)+


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he 6nternational Classication of Diseases"ros and Cons

en!thy to administer

6t provides a dia!nosisG -ased oncompletely ar-itrary criteria ith no

esta-lished connection ith thepathophysiolo!y


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Summary

rief alidandeliable

Allformsoftobacco

#hildren andadults

Aftercessation

5oculturalbias

Sta!es O O O O O@C O O O O O

AU8S O O O O O

H8@C O O O O

F@D O O

DSM065

6CD0&)

"leasure O O O O O

NZ Measures of Addiction

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