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Transcript of Measuring Drug Use and Key Risk, Mediating and Moderating Factors Duncan B. Clark, M.D., Ph.D....
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
Substance Use Dimensions
• type
• frequency
• quantity
• time frame
• developmental stage
• problems
• substance use disorders
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
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
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
Lifetime Drinking History
• type
• frequency
• quantity
Time frame: “phases”
Skinner & Sheu (1982) J Stud Alcohol
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)
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)
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)
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
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
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
Handbook of Psychiatric Measures
Information Provided for Each Measure
• Goals
• Description
• Practical Issues
• Psychometric Properties
• Clinical Utility
• References
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
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
Environmental Risk Factors
• Family environment– Parent SUDs
– Parent psychopathology
• Physical or sexual abuse
• Peer environment
• Macrosocial environment
Tarter et al. (1999): Development and Psychopathology
Risk Factor Measures
• K-SADS Trauma Interview– for each trauma experience
• mother, adolescent report
• date(s), multiple events
• perpetrator(s)
• if witness, victim
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
Mediating Phenotypes
• Behavioral dysregulation– behavioral undercontrol
– antisocial behavior
– conduct disorder
• Emotional dysregulation– anxiety & depression
– negative affect disorders
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
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
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
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