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Baggio S, Trächsel B, Rousson V, Rothen S, Studer J, Marmet S, Heller P, Sporkert F, Daeppen JB, Gmel G, Iglesias K. Identifying an accurate self-reported screening tool for alcohol use disorder: evidence from a Swiss, male population-based assessment. Addiction 2020; 115:426-436. [PMID: 31656049 DOI: 10.1111/add.14864] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/21/2019] [Accepted: 10/14/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND AIMS Short screenings for alcohol use disorder (AUD) are crucial for public health purposes, but current self-reported measures have several pitfalls and may be unreliable. The main aim of our study was to provide empirical evidence on the psychometric performance of self-reports currently used. Our research questions were: compared with a gold standard clinical interview, how accurate are (1) self-reported AUD, (2) self-reported alcohol use over time and (3) biomarkers of alcohol use among Swiss men? Finally, we aimed to identify an alternative screening tool. DESIGN A single-center study with a cross-sectional design and a stratified sample selection. SETTING Lausanne University Hospital (Switzerland) from October 2017 to June 2018. PARTICIPANTS We selected participants from the French-speaking participants of the ongoing Cohort Study on Substance Use and Risk Factors (n = 233). The sample included young men aged on average 27.0 years. MEASUREMENTS We used the Diagnostic Interview for Genetic Studies as the gold standard for DSM-5 AUD. The self-reported measures included 11 criteria for AUD, nine alcohol-related consequences, and previous 12 months' alcohol use. We also assessed biomarkers of chronic excessive drinking (ethyl glucuronide and phosphatidylethanol). FINDINGS None of the self-reported measures/biomarkers taken alone displayed both sensitivity and specificity close to 100% with respect to the gold standard (e.g. self-reported AUD: sensitivity = 92.3%, specificity = 45.8%). The best model combined eight self-reported criteria of AUD and four alcohol-related consequences. Using a cut-off of three, this screening tool yielded acceptable sensitivity (83.3%) and specificity (78.7%). CONCLUSIONS Neither self-reported alcohol use disorder nor heavy alcohol use appear to be adequate to screen for alcohol use disorder among young men from the Swiss population. The best screening alternative for alcohol use disorder among young Swiss men appears to be a combination of eight symptoms of alcohol use disorder and four alcohol-related consequences.
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Affiliation(s)
- Stéphanie Baggio
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Thônex, Switzerland.,Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland
| | - Bastien Trächsel
- Division of Biostatistics, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Valentin Rousson
- Division of Biostatistics, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Stéphane Rothen
- Addiction Division, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Joseph Studer
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Simon Marmet
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Patrick Heller
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Thônex, Switzerland.,Adult Psychiatry Division, Department of Mental Health and Psychiatry, Geneva University Hospitals, Thônex, Switzerland
| | - Frank Sporkert
- Centre of Legal Medicine, Forensic Toxicology and Chemistry Unit, Lausanne and Geneva Universities, Lausanne, Switzerland
| | - Jean-Bernard Daeppen
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Gerhard Gmel
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland.,Addiction Switzerland, Lausanne, Switzerland.,Centre for Addiction and Mental Health, Toronto,, ON, Canada.,University of the West of England, Bristol, UK
| | - Katia Iglesias
- School of Health Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Fribourg, Switzerland
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Bagley SM, Cheng DM, Winter M, Alford DP, LaBelle C, Walley AY, Samet JH. Opioid and cocaine use among primary care patients on buprenorphine-Self-report and urine drug tests. Drug Alcohol Depend 2018; 192:245-249. [PMID: 30290291 PMCID: PMC6291245 DOI: 10.1016/j.drugalcdep.2018.08.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 08/10/2018] [Accepted: 08/14/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Urine drug tests (UDTs) are recommended to monitor patients treated for opioid use disorder in primary care. The aims are to (1) estimate the frequency of self-report and UDT results of opioid and cocaine use and (2) evaluate the association between treatment time with non-disclosure of opioid or cocaine use and having a positive UDT. METHODS We conducted a retrospective review of patients enrolled in a primary care-based buprenorphine program between January 2011-April 2013. We describe three clinical visits types: no disclosure of opioid/cocaine use and positive UDT; disclosure of opioid or cocaine use and a negative or positive UDT; and no disclosure of opioid or cocaine use and a negative UDT. We fit generalized estimating equations logistic regression models to evaluate whether treatment time is associated with non-disclosure of opioids or cocaine use and a positive UDT. RESULTS Among all UDT results (n = 1755) from 130 patients, 10% were positive for illicit opioids and 4% for cocaine. Among UDTs with illicit opioid or cocaine positive results, in 57% and 76% of these scenarios, the patient did not disclose. The odds of non-disclosure and having a positive UDT was higher in the first 180 days for opioids and 90 days for cocaine. CONCLUSION Among primary care patients treated with buprenorphine, a small but substantial percentage of UDTs were cocaine or opioid positive. As treatment time increased, non-disclosure was less common but persisted even after six months. Among primary care patients treated with buprenorphine, UDTs contribute information to optimize clinical care.
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Affiliation(s)
- Sarah M Bagley
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, United States; Department of Pediatrics, Boston University School of Medicine, Boston, MA, United States.
| | - Debbie M Cheng
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States
| | - Michael Winter
- Biostatistics and Epidemiology Analytics Center, Boston University School of Public Health, Boston, MA, United States
| | - Daniel P Alford
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, United States
| | - Colleen LaBelle
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, United States
| | - Alexander Y Walley
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, United States
| | - Jeffrey H Samet
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, United States; Boston University School of Public Health, Boston, MA, United States
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Japuntich SJ, Arditte Hall KA, Joos CM, Rasmusson AM, Pineles SL. Methods to reduce false reporting of substance abstinence in clinical research. Int J Methods Psychiatr Res 2018; 27:e1603. [PMID: 29314410 PMCID: PMC6877230 DOI: 10.1002/mpr.1603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 11/01/2017] [Accepted: 11/13/2017] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Substance use may influence study results in human subjects research. This study aims to report the concordance between self-report and biochemical assessments of substance use and test the effect of methods to reduce false reports of abstinence in trauma-exposed women participating in a research study. METHODS In this pilot study, substance use was assessed during telephone prescreening and via self-report and biochemical verification (i.e., urine toxicology and alcohol breathalyzer tests) at an in-person evaluation. Due to the high number of participants who tested positive for substances despite self-reporting abstinence during prescreening, study procedures were modified to disincentivize false self-reports of substance use two thirds of the way through recruitment. New potential participants were explicitly informed during prescreening and informed consent that a positive drug or alcohol test during screening would result in exclusion from the study and withholding of payment. RESULTS Prior to modifying study methods, 20% of participants who had reported abstinence during the telephone prescreen had a positive substance use test at the in-person visit. Modifying study procedures resulted in an 81% decrease in positive substance use assessments. CONCLUSIONS Adoption of this methodology may decrease inadvertent confounding of clinical research outcomes by undetected and/or misreported substance use.
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Affiliation(s)
- Sandra J. Japuntich
- Centers for Behavioral and Preventive MedicineThe Miriam HospitalProvidenceRhode IslandUSA
- Department of Psychiatry and Human BehaviorAlpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | - Kimberly A. Arditte Hall
- National Center for PTSD, Women's Health Sciences DivisionVA Boston Healthcare SystemBostonMassachusettsUSA
- Department of PsychiatryBoston University School of MedicineBostonMassachusettsUSA
| | - Celina M. Joos
- Department of PsychologyPennsylvania State UniversityState CollegePennsylvaniaUSA
| | - Ann M. Rasmusson
- National Center for PTSD, Women's Health Sciences DivisionVA Boston Healthcare SystemBostonMassachusettsUSA
- Department of PsychiatryBoston University School of MedicineBostonMassachusettsUSA
| | - Suzanne L. Pineles
- National Center for PTSD, Women's Health Sciences DivisionVA Boston Healthcare SystemBostonMassachusettsUSA
- Department of PsychiatryBoston University School of MedicineBostonMassachusettsUSA
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