Efficacy of the Substance Abuse Subtle Screening Inventory-3 (SASSI-3) in identifying substance dependence disorders in clinical settings

Highly endorsed screening and assessment scales for alcohol problems: A systematic review

BACKGROUND

Problems associated with alcohol use are multidimensional with psychiatric, psychological, physical, and social aspects, which makes it challenging to choose appropriate assessment scales. However, there has been no systematic evaluation of existing alcohol scales.

METHODS

A systematic literature search was conducted for articles that assessed the psychometric properties of scales for alcohol use disorder on March 19, 2023, using Medline, EMBASE, and PsycINFO. Only scales whose original development papers were cited more than 20 times were included. The methodological quality and psychometric properties of the scales were evaluated using COnsensus-based Standards for the selection of health Measurement INstruments. The overall rating of the scales were assessed with a score ranging from 0 to 18.

RESULTS

In total, 314 studies and 40 scales were identified. These scales differ widely in measurement methods, target populations, and psychometric properties. The overall mean score was 6.3, and only the following three scales received >9 points suggesting a moderate level of evidence: Alcohol Use Disorders Identification Test (AUDIT), Alcohol Dependence Scale (ADS), and Short Alcohol Dependence Data Questionnaire (SADD). Measurement error and responsiveness were not evaluated or reported in the included scales.

CONCLUSIONS

Although the AUDIT, ADS, and SADD were rated the highest among the 40 scales, they showed, at most, a moderate level of evidence. These findings underscore the need to accumulate further evidence to assure the quality of the scales. It may be advisable to select and combine scales to meet the purpose of the assessment.

Comparing Women's and Men's Sexual Offending Using a Statewide Incarcerated Sample: A Two-Study Design

This study identifies the characteristics that distinguish between women's and men's sexual offending. We compare women and men currently incarcerated for a sex offense in one state using two data sources: administrative data on sex offenders in the state prison (N = 9,235) and subsample surveys (n = 129). Bivariate and logistic regressions were used in these analyses. Women account for a small proportion (1.1%, N = 98) of incarcerated sex offenders. In the population, women and men were convicted of similar types of sex offenses. The subsample was demographically similar to the population. In the subsample, women were more likely than men to have a child victim, be the parent/guardian of the victim, have a co-offender, and repeatedly perpetrate against the same victim. Findings suggest that women convicted and sentenced for a sex offense differ from their male counterparts, with predictive factors being dependent upon the age of their victim(s). Sex offender treatment interventions developed for men are poorly suited to and may have limited efficacy for women.

Bright Light Treatment of Combat-related PTSD: A Randomized Controlled Trial

INTRODUCTION

Post-traumatic stress disorder (PTSD) is a prevalent consequence of combat with significant associated morbidity. Available treatments for PTSD have had limitations, suggesting a need to explore alternative or adjuvant treatments. Numerous rationales for bright light treatment of PTSD include its benefits for common PTSD comorbidities of depression, anxiety, and circadian misalignment and its relative ease of use with few side effects. The primary aims of this research were to examine the effects of bright light treatment for combat-related PTSD and associated morbidity.

MATERIALS AND METHODS

A randomized controlled trial was performed in N = 69 veterans with PTSD attributable to combat in Afghanistan and/or Iraq. Following a 1-week baseline, participants were randomized to 4 weeks of daily morning bright light treatment (10,000 lux for 30 min/day) or a control treatment (inactivated negative ion generator). At baseline and at the end of treatment, participants were rated blindly on the Clinician Assessed PTSD Scale (CAPS), the Clinical Global Impressions Scale (CGI), and the Hamilton Depression Scale and rated themselves on the PTSD Checklist-Military (PCL-M). Following baseline and each treatment week, participants completed self-reported scales of state anxiety, depression, and sleep, and sleep and the circadian rhythm of wrist activity were also assessed with wrist actigraphy.

RESULTS

Compared with the control treatment, bright light elicited significantly greater improvements in the CAPS and CGI-Improvement. The bright light also elicited a significantly greater rate of treatment response (reduction ≥33%) for the CAPS (44.1% vs. 8.6%) and PCL-M (33% vs. 6%), but no participant had remission from PTSD. Changes in depression, anxiety, and sleep did not differ between treatments. Improvement in CAPS was significantly correlated with a phase advance of the circadian rhythm of wrist activity.

CONCLUSIONS

The most comprehensive study on the topic to date indicated significant short-term efficacy of bright light treatment on the primary variables (CAPS and CGI) with clinical relevance (i.e., treatment response) in veterans with chronic PTSD who did not report extremely high habitual light exposure. No significant effects were found for anxiety, depression, or sleep disturbance. Further research is warranted, particularly exploration of circadian phase-shifting mechanisms of bright light for PTSD.

Mentally disordered offenders and the law: Research update on the insanity defense, 2004-2019

The insanity defense is among the most controversial legal constructs that has attracted the attention of scholars, practitioners and policy makers. Here, we conducted a systematic review of the literature spanning 2004 to 2019 that produced 58 studies of insanity defense research. Findings are organized according to: (1) assessments and assessment-related issues, (2) juror decision-making in defense trials, (3) characteristics of insanity acquittees, (4) release recommendations for insanity acquittees, (5) revocation of conditional release status of insanity acquittees, and (6) additional areas of insanity defense research. Implications of the research for the insanity defense and cognate legal issues are proffered.

Validation of the Adult Substance Abuse Subtle Screening Inventory-4 (SASSI-4)

Abstract. The study objective was to develop a revision of the adult Substance Abuse Subtle Screening Inventory-3 to include new items to identify nonmedical use of prescription medications, as well as additional subtle and symptom-related identifiers of substance use disorders (SUDs) and to evaluate its psychometric properties and screening accuracy against a criterion of DSM-5 diagnoses for SUD. Clinical professionals throughout the nine US Census Bureau regions and two Canadian provinces who used the SASSI Online screening tool submitted 1,284 completed administrations of the provisional SASSI-4 along with their independent DSM-5 diagnoses of SUD. Validation sample findings demonstrated SASSI-4 sensitivity of 93% and specificity of 90%, AUC = .91. Items added to identify respondents who were abusing prescription medications showed 94% overall screening accuracy. Logistic regression showed no significant effects of client demographic characteristics or type of screening setting on the accuracy of SASSI-4 screening outcomes. In Study 2, 120 adults in recovery from SUD completed the SASSI-4 under instructions to fake good. Sensitivity of 79% was demonstrated for the full scoring protocol and was 47% when only face valid scales were utilized. Clinical utility is discussed.

Substance-related disorders: A review of prevalence and correlates among patients with chronic pain

Over the past few decades, research has revealed high rates of substance-related disorders among patients with chronic pain. In addition to their potentially deleterious health consequences, substance-related disorders have consistently been associated with negative pain-related outcomes among patients with chronic pain. The goal of this narrative review was to provide an overview of studies that have examined the prevalence and correlates of substance-related disorders among patients with chronic pain. A particular focus was placed on opioids, sedatives/hypnotics, cannabis, tobacco, and alcohol given that these substances have received the bulk of research attention among patients with pain. Research conducted to date suggests that a host of biological and psychological factors are likely to contribute to the elevated rates of substance-related disorders among patients with chronic pain. In this review, in addition to reviewing the prevalence and correlates of substance-related disorders among patients with pain, we briefly discussed the changes that were recently made from the DSM-4 to the DSM-5 in the diagnostic criteria for substance-related disorders, and the implications of these changes for the assessment of patients with chronic pain. We also provided a brief overview of instruments that can be used for the assessment of these disorders in clinical and research settings.

Comparing Female- and Male-Perpetrated Child Sexual Abuse: A Mixed-Methods Analysis

This mixed-methods study compares experiences of female- and male-perpetrated child sexual abuse using self-report data from a correctional subsample of 26 women and 25 men currently incarcerated for a sex crime against a child. First, we use bivariate and logistic regression analyses to determine whether there are differences in offender, victim, and offense characteristics between women and men who commit child sexual abuse. Second, we examine participants' open-ended responses eliciting details about their offenses. Quantitative results reveal some differences between women and men in victim characteristics, presence of a co-offender, and adulthood experiences with violence but no differences between women and men in experiences of childhood adversity, including prior child sexual abuse victimization. Qualitative results, however, suggest marked differences in the way women and men characterize their offenses. Overall, findings indicate that women and men report unique experiences with child sexual abuse perpetration and therefore would benefit from gender-specific treatment.

Assessment and Treatment for Persons with Coexisting Ability and Substance Use Issues: A Review and Analysis of the Literature

Persons with ability issues are at considerably higher risk to develop substance use problems when compared to the general population. Yet, little is known about the current status of substance use treatment for this population. A comprehensive search of the literature revealed a need for (a) population-specific instruments for screening and assessment of the use of alcohol and drugs, including the misuse of prescription medication; (b) tailored treatment methods and individualized treatment plans that meet diverse literacy or cognitive needs;

Lifetime substance use as a predictor of postpartum mental health

Postpartum mood disorders (PPMD) affect approximately 10-20% of women and have adverse consequences for both mom and baby. Lifetime substance use has received limited attention in relation to PPMD. The present study examined associations of lifetime alcohol and drug use with postpartum mental health problems. Women (n = 100) within approximately 3 months postpartum (M = 2.01, SD = 1.32) participated in semi-structured interviews querying lifetime substance use, mental health history, and postpartum symptoms of anxiety, stress, posttraumatic stress disorder (PTSD), depression, and obsessive compulsive disorder. The study was conducted in an urban Canadian city from 2009 to 2010. Analyses revealed that lifetime substance use increased the variability explained in postpartum PTSD (p = .011), above and beyond sociodemographic characteristics and mental health history. The same trend, though not significant, was observed for stress (p = .059) and anxiety (p = .070). Lifetime drug use, specifically, was associated with postpartum stress (p = .021) and anxiety (p = .041), whereas lifetime alcohol use was not (ps ≥ .128). Findings suggest that lifetime drug use is associated with PPMD. Future research should examine whether screening for lifetime drug use during antenatal and postpartum care improves identification of women experiencing PPMD.

Examining Perpetration of Physical Violence by Women: The Influence of Childhood Adversity, Victimization, Mental Illness, Substance Abuse, and Anger

Research on women's perpetration of physical violence has focused primarily on partners, often neglecting perpetration against nonpartners. This study proposes a conceptual model with direct and indirect relationships between childhood adversity and different targets of violence (partners and nonpartners), mediated by victimization experiences (by partner and nonpartners), mental illness, substance abuse, and anger. Using survey data from a random sample of incarcerated women (N = 574), structural equation modeling resulted in significant, albeit different, indirect paths from childhood adversity, through victimization, to perpetration of violence against partners (β = .20) and nonpartners (β = .19). The results indicate that prevention of women's violence requires attention to specific forms of victimization, anger expression, and targets of her aggression.

Predictors of preoperative weight loss achievement in adult bariatric surgery candidates while following a low-calorie diet for 4 weeks

BACKGROUND

Achieving program-mandated preoperative weight loss poses a challenge for many bariatric surgery candidates. No systematic method exists to identify at-risk patients early in preoperative care.

OBJECTIVES

This study sought to explore predictors of preoperative weight loss achievement and to develop a treatment algorithm for guiding clinical decision-making.

SETTING

Greenville Health System, South Carolina.

METHODS

A retrospective chart review was conducted for 378 patients who followed a program-mandated low-calorie diet (LCD) for 4 weeks to achieve≥8% excess weight loss (EWL). Associations between weight loss achievement and patient demographic, nutrition, psychological, clinical, anthropometric, and treatment characteristics documented at 5 preoperative evaluation events were analyzed using logistic regression.

RESULTS

During the LCD, 62.7% of patients achieved≥8% EWL. Independent predictors of achievement (all P<.05) were male sex (OR 2.31, 95% CI 1.21-4.42), Caucasian race (OR 2.45, 95% CI 1.38-4.34), body mass index (BMI) at surgeon evaluation (50.0-59.9 kg/m²: OR .44, 95% CI .20-.97;≥60 kg/m²: OR .15, 95% CI .05-.42), number of co-morbidities (OR .83, 95% CI .74-.93), hypertension diagnosis (OR 2.42, 95% CI 1.42-4.13), prediet weight change (OR 1.08, 95% CI 1.01-1.16), and time between surgeon evaluation and preoperative LCD initiation (61-90 d: OR .46, 95% CI .23-.93).

CONCLUSION

Patients of female sex or non-Caucasian race; with a BMI≥50 kg/m², many co-morbidities, or no hypertension diagnosis at surgeon evaluation; who demonstrate prediet weight loss or extended wait time between surgeon evaluation and preoperative LCD initiation may be at risk for preoperative weight loss failure and may require preemptive diet modification to improve outcomes.

Further evidence of self-medication: personality factors influencing drug choice in substance use disorders

According to Khantzian's (2003) self-medication hypothesis (SMH), substance dependence is a compensatory means to modulate affects and self-soothe in response to distressing psychological states. Khantzian asserts: (1) Drugs become addicting because they have the power to alleviate, remove, or change human psychological suffering, and (2) There is a considerable degree of specificity in a person's choice of drugs because of unique psychological and physiological effects. The SMH has received criticism for its variable empirical support, particularly in terms of the drug-specificity aspect of Khantzian's hypothesis. We posit that previous empirical examinations of the SMH have been compromised by methodological limitations. Also, more recent findings supporting the SMH have yet to be replicated. Addressing previous limitations to the research, this project tested this theory in a treatment sample of treatment-seeking individuals with substance dependence (N = 304), using more heterogeneous, personality-driven measures that are theory-congruent. Using an algorithm based on medical records, individuals were reliably classified as being addicted to a depressant, stimulant, or opiate by two independent raters. Theory-based a priori predictions were that the three groups would exhibit differences in personality characteristics and emotional-regulation strategies. Specifically, our hypotheses entailed that when compared against each other: (1) Individuals with a central nervous system (CNS) depressant as drug of choice (DOC) will exhibit defenses of repression, over-controlling anger, and emotional inhibition to avoid acknowledging their depression; (2) Individuals with an opiate as DOC will exhibit higher levels of aggression, hostility, depression, and trauma, greater deficits in ego functioning, and externalizing/antisocial behavior connected to their use; and (3) Individuals with a stimulant as DOC will experience anhedonia, paranoia, have a propensity to mania, and display lower levels of emotional inhibition. MANOVAs were used to test three hypotheses regarding drug group differences on the personality variables that were in keeping with the SMH. The MANOVAs for Hypothesis I (Depressant group) and Hypothesis II (Opiate group) were statistically significant. Findings partially support the SMH, particularly in its characterization of personality functioning in those addicted to depressants and opiates.

Neural correlates of working memory training in HIV patients: study protocol for a randomized controlled trial

Background

Potent combined antiretroviral therapy decreased the incidence and severity of HIV-associated neurocognitive disorders (HAND); however, no specific effective pharmacotherapy exists for HAND. Patients with HIV commonly have deficits in working memory and attention, which may negatively impact many other cognitive domains, leading to HAND. Since HAND may lead to loss of independence in activities of daily living and negative emotional well-being, and incur a high economic burden, effective treatments for HAND are urgently needed. This study aims to determine whether adaptive working memory training might improve cognitive functions and neural network efficiency and possibly decrease neuroinflammation. This study also aims to assess whether subjects with the LMX1A-rs4657412 TT(AA) genotype show greater training effects from working memory training than TC(AG) or CC(GG)-carriers.

Methods/Design

60 HIV-infected and 60 seronegative control participants will be randomized to a double-blind active-controlled study, using adaptive versus non-adaptive Cogmed Working Memory Training® (CWMT), 20–25 sessions over 5–8 weeks. Each subject will be assessed with near- and far-transfer cognitive tasks, self-reported mood and executive function questionnaires, and blood-oxygenation level-dependent functional MRI during working memory (n-back) and visual attention (ball tracking) tasks, at baseline, 1-month, and 6-months after CWMT. Furthermore, genotyping for LMX1A-rs4657412 will be performed to identify whether subjects with the TT(AA)-genotype show greater gain or neural efficiency after CWMT than those with other genotypes. Lastly, cerebrospinal fluid will be obtained before and after CWMT to explore changes in levels of inflammatory proteins (cytokines and chemokines) and monoamines.

Discussion

Improving working memory in HIV patients, using CWMT, might slow the progression or delay the onset of HAND. Observation of decreased brain activation or normalized neural networks, using fMRI, after CWMT would lead to a better understanding of how neural networks are modulated by CWMT. Moreover, validating the greater training gain in subjects with the LMX1A-TT(AA) genotype could lead to a personalized approach for future working memory training studies. Demonstrating and understanding the neural correlates of the efficacy of CWMT in HIV patients could lead to a safe adjunctive therapy for HAND, and possibly other brain disorders.

Trial registration

ClinicalTrial.gov, NCT02602418.

Psychiatric Treatment of the Homeless in a Group—Based Therapeutic Community: A Preliminary Field Investigation

This preliminary study investigated the effectiveness of a group-based therapeutic community for the homeless. Thirty-seven individuals residing at a homeless shelter participating in a therapeutic community were assessed across time on several variables: psychiatric symptoms, social functioning, and substance abuse. Significant initial improvements in overall distress, psychiatric symptoms, and substance abuse were found. Improvements in social functioning were exhibited in the therapeutic community participants after six months.

Patterns of women's aggression against partners and others: broadening our understanding of violence

Research on women's aggression typically focuses on relational aggression. However, the study of violence must include multiple forms of violence such as aggression against partners and non-partner others, while also considering victimization experiences by partners and non-partners. The focus of this study is the multiple experiences of violence (perpetration and victimization) of women who are incarcerated. Incarcerated women are likely to experience higher rates of both than women in community settings, but most will be released in a brief period of time. Using a random sample (N = 580) we conducted cluster analyses to identify five patterns of women's aggression. Clusters varied depending on the target/s of aggression (i.e., partner and/or others), and type of aggression (i.e., physical and/or intimidation). Multinomial logistic regression was performed to determine the relationship between women's membership in a perpetration cluster and their victimization. Victimization history was related to an increased risk of perpetrating aggression, and varied depending on the target and type of aggression. Our findings provide support that research and interventions addressing women's use of aggression must also address their victimization history. Furthermore, results indicate that for some women, aggression towards partners and others is related. Future research should investigate multiple forms of aggression.

Alcohol and substance abuse in solid-organ transplant recipients

This review focuses on alcohol and substance abuse in the context of solid-organ transplantation. Alcohol and substance abuse are common and may lead to a need for solid-organ transplantation and may also contribute to significant physical and psychologic problems that impact upon the recipient. Damaging levels of alcohol intake can occur in the absence of dependence. Alcohol or substance abuse after transplantation is associated with poor medication compliance and this may increase risk of graft loss. Intravenous drug use is associated with increased risk of infections (especially secondary to opportunistic organisms-bacterial, viral, protozoal, and others-and such infections may be more severe in the immunosuppressed), but there is only anecdotal evidence that such behavior has a worse outcome in transplant recipients. Whereas previous alcohol excess and drug use in kidney recipients are both associated with a small but statistically significantly increased risk of adverse outcomes (hazard ratio, 1.16-1.56), alcohol use within recommended guidelines after transplantation appears safe and possibly beneficial. Robust data are lacking for other organs, but those available suggest that heart transplantation is safe in individuals with a history of alcohol or substance abuse. Health specialists in drug or alcohol addiction should carefully screen all potential transplant candidates for these conditions, and where there is evidence of dependency or abuse, effective psychologic and physical treatment should be offered. Studies have shown that interventions such as psychologic intervention have improved alcohol behavior in the context of liver transplantation. Although there are no comparable studies with other solid-organ recipients, it is reasonable to expect transferable outcomes.

Differences among incarcerated women with assaultive offenses: isolated versus patterned use of violence

A majority of the existing research on women's use of violence focuses on intimate partner violence, often excluding other types of violence for which women may be incarcerated. The current study expands this area of research by assessing between and within-group differences among a randomly selected group of incarcerated women (n = 543). Comparisons between violent and nonviolent offense types among women found few differences, but significant differences among women with an assaultive offense, based on the presence or absence of a self-reported uncaught violence, were found. Differences in women with isolated (i.e., single incident of violence perpetration through a review of formal and self-report data) and patterned uses of violence were present in relation to issues of mental health, substance abuse, criminogenic risk, and expressions of anger and personality factors. These findings have important implications for intervention as well as future research.

Results of a statewide survey of adolescent substance use screening rates and practices in primary care

Professional guidelines recommend annual screening, brief intervention, and referral to treatment (SBIRT) as part of health maintenance for all adolescents, but reported screening rates have been low and no report has documented the techniques being used. The objective of this study was to describe the results of a statewide questionnaire regarding adolescent substance use screening rates and techniques used by primary care physicians practicing in Massachusetts. A questionnaire was mailed to every licensed physician registered as practicing pediatrics (N = 2176), family medicine (N = 1335), or both (N = 8) in the Massachusetts Board of Medicine database. After eliminating physicians who did not provide care for adolescents, the survey response rate was 28% and the final analyzable sample consisted of 743 surveys. Less than half of respondents reported using a validated adolescent screening tool. The majority of respondents used ineffective screening practices for adolescent substance use. Further physician training is recommended to encourage the use of developmentally appropriate screening tools and interventions for adolescents.

Co-morbidity of substance use disorder and psychopathology in women who use methamphetamine during pregnancy in the US and New Zealand

BACKGROUND

Methamphetamine (MA) abuse is a worldwide problem. Little is known about the co-morbidity of substance use disorders (SUD) and other psychiatric disorders of mothers who use MA prenatally. The Infant Development, Environment and Lifestyle (IDEAL) Study is a prospective, investigation of prenatal MA use and child outcome in the United States (US) and New Zealand (NZ). This study examined prenatal MA use and the co-morbidity of SUD and psychiatric disorders at 1-month postpartum.

METHOD

Mothers who used MA (US=127, NZ=97) were compared to a matched comparison group (US=193, NZ=110). The Substance Abuse Subtle Screening Inventory-3 was used to measure the probability of a SUD. The Brief Symptom Inventory (BSI) was used to measure the likelihood of a positive diagnosis of a psychiatric disorder.

RESULTS

In the US and NZ, MA groups had lower SES, increased single parenting, delayed prenatal care, and increased polydrug use. In the US only, MA mothers had lower income than the comparison group. MA users were 10 times more likely to have a SUD and twice as likely to meet BSI criteria for a diagnosable psychiatric disorder. In NZ, but not the US, MA users were five times more likely to have co-morbidity of both. This disparity may be due to higher quantities of prenatal alcohol use associated with increased psychiatric symptoms.

CONCLUSION

These findings suggest that addressing both substance abuse and psychiatric disorders in mothers who use MA may be required to effectively treat maternal MA use.

Reports of past alcohol and drug use following participation in a motivation enhancing intervention: implications for clinical assessment and program evaluation

BACKGROUND

There is significant interest in the value of motivational approaches that enhance participant readiness to change, but less is known about clients' self-reports of problematic behavior when participating in such interventions.

METHODS

We examined whether participants in a motivationally-based intervention for DUI offenders changed their reports of substance use at postintervention (when reporting on the same 30 days that they reported on at preintervention). Specifically, Study 1 (N = 8,387) tested whether participants in PRIME For Life (PFL) changed their reports about baseline substance levels when asked at postintervention versus at preintervention. Study 2 (N = 192) compared changes in self-reported baseline drinking between PFL and intervention as usual (IAU) participants.

RESULTS

Many participants in Study 1 did not change their reports about how much they used substances during the 30-day period before baseline. Among those who did, the most common change was an increase in reported amounts of baseline drug use, and typical and peak alcohol use. This sample also showed changes in reports of their baseline pattern of high-risk-use (consistent versus occasional). At postintervention, participants who were younger, single, or endorsing more indicators of alcohol dependence were more likely to later report greater frequency of baseline drug use, and greater peak and typical number of baseline drinks. Gender, education, and race were also associated with reporting inconsistency on some behaviors. In Study 2, PFL participants showed greater increases in reports of peak alcohol use compared to IAU, but both conditions showed similar increases for drugs and typical alcohol use.

CONCLUSIONS

In both research and clinical settings, a segment of participants may initially report less substance use than they do when asked later about the same baseline period. These preliminary findings suggest clinicians and researchers may find postintervention evaluations yield reports of greater baseline alcohol or drug use for some people. For some behaviors, this may occur more often in interventions that target client motivation. Future research should attempt to identify which reports - preintervention vs. postintervention - better reflect actual baseline substance use.

Gender differences in the validity of the substance abuse subtle screening inventory--3 (SASSI-3) with a criminal justice population

The Substance Abuse Subtle Screening Inventory-3 is a brief, self-administered screening tool designed to measure the probability of having a substance dependence disorder. The present study assessed the validity of this instrument with an inmate population using a DSM-IV diagnosis of substance dependence as the criterion measure. The study also examined instrument validity by gender. Findings revealed differences in the prediction of dependence between male and female inmates. The advantages and shortcomings of the instrument are discussed in light of these findings, and suggestions for future research are advanced.

Substance Dependence and Level of Treatment Need Among Recently-Incarcerated Prisoners

This study assessed both prevalence rates of substance dependence and level of treatment need among recently-incarcerated prisoners in a southeastern state. Participants were 752 consecutive admissions to the state prison system in 2002. They were administered the 93-item Substance Abuse Subtle Screening Inventory (SASSI). The results indicated that approximately 72% of participants met criteria for substance dependence and 46% of participants met criteria for prison-based residential treatment. The results of this study can be used to inform allocation of prison-based treatment resources.

Implicit family process rules in eating-disordered and non-eating-disordered families

Family environment has been shown to be one of the factors related to the presence of eating disorders among young-adult females. Clinical experience and theories about eating disorders postulate that implicit family rules are an intricate part of family process that may have a great effect on the creation and maintenance of such problems. This study compared implicit family process rules (specifically rules pertaining to kindness; expressiveness and connection; constraining thoughts, feelings, and self; inappropriate caretaking; and monitoring) in families with a young-adult female diagnosed with an eating disorder-either anorexia nervosa, bulimia nervosa, or eating disorder not otherwise specified-and families with a young-adult female without an eating disorder diagnosis. One hundred two families (51 eating disordered and 51 comparison) participated in the study. Mothers, fathers, young-adult female children, and siblings completed the Family Implicit Rules Profile (Harper, Stoll, & Larson, 2007). Results indicated that eating-disordered families are governed by a greater proportion of constraining family rules than are non-eating-disordered families. Additionally, eating-disordered youth reported a lower proportion of facilitative family rules and a higher proportion of constraining family rules than did parents and siblings. Theoretical, research, and clinical implications are discussed.

Assessing the reliability of scores produced by the substance abuse subtle screening inventory

The Substance Abuse Subtle Screening Inventory (SASSI) is a 10 scale indirect screening instrument used to detect substance use disorders. The current meta-analytic study described reliability reporting practices across 48 studies involving the SASSI. Reliability generalization methods were then employed to evaluate typical score reliability for the screening measure. Results showed approximately 73% of studies did not report reliability estimates. Analysis of data from the remaining studies revealed adequate reliability for the total scale (alpha = .87) and face valid scales (FVA alpha = .88 and FVOD alpha = .92), but substantially lower reliability estimates for the indirect scales (range of alpha = .23-.65). The study's findings underscore the need for improved reliability reporting for the SASSI and suggest cautious use of the measure, especially its indirect scales, as an indicator of problematic substance use/abuse in clinical settings.

Psychiatric consultation and substance use disorders

Background

A substantial number of patients in general hospitals will evince substance abuse problems but a majority is unlikely to be adequately identified in the referral-consultation process. This failure may preclude patients from receiving effective interventions for substance use disorders.

Objectives

1. To evaluate all referred patients for possible substance use disorders. 2. To ascertain the degree of convergence between patients referred for chemical problems and the corresponding DSM diagnosis. 3. To compare demographic data for substance abusing patients and referrals not so classified. 4. To evaluate conditions concomitant with substance use disorders.

Method

Consecutive one-year referrals (524) to consultation-liaison psychiatric services were scrutinized for chemically-related problems by psychiatric consultants.

Results

Of the referrals, 176 met criteria for substance use disorders (SUD) (57% alcohol; 25% other drugs; 18% both alcohol and other drugs). Persons diagnosed with SUD tended to be younger, male, non-Caucasian, unmarried, and unemployed. They were more likely to be depressed, have liver and other gastrointestinal problems, and to have experienced traumatic events; they also tended to have current financial difficulties. Most were referred for SUD evaluation by personnel in general medicine and family practice. Following psychiatric consultation, SUD designated patients were referred mainly to substance abuse treatment programs. The only variable related to recommended inpatient versus outpatient services for individuals with SUD was the Global Assessment of Functioning Axis (GAF) with persons having lower estimated functioning more likely to be referred for inpatient interventions.

Conclusions

These data are similar to the results of past studies in this area. Unlike previous investigations in the domain of consultative-liaison psychiatry, financial stressors and specific consultant recommendations were included in data gathering. Although the results are encouraging in that individuals with SUD were identified and potentially sent for appropriate treatment, the likelihood is that many patients with SUD remain unrecognized and do not receive necessary consultative and treatment services.

Screening, brief interventions, referral to treatment (SBIRT) for illicit drug and alcohol use at multiple healthcare sites: comparison at intake and 6 months later

OBJECTIVES

Alcohol screening and brief interventions in medical settings can significantly reduce alcohol use. Corresponding data for illicit drug use is sparse. A Federally funded screening, brief interventions, referral to treatment (SBIRT) service program, the largest of its kind to date, was initiated by the Substance Abuse and Mental Health Services Administration (SAMHSA) in a wide variety of medical settings. We compared illicit drug use at intake and 6 months after drug screening and interventions were administered.

DESIGN

SBIRT services were implemented in a range of medical settings across six states. A diverse patient population (Alaska Natives, American Indians, African-Americans, Caucasians, Hispanics), was screened and offered score-based progressive levels of intervention (brief intervention, brief treatment, referral to specialty treatment). In this secondary analysis of the SBIRT service program, drug use data was compared at intake and at a 6-month follow-up, in a sample of a randomly selected population (10%) that screened positive at baseline.

RESULTS

Of 459,599 patients screened, 22.7% screened positive for a spectrum of use (risky/problematic, abuse/addiction). The majority were recommended for a brief intervention (15.9%), with a smaller percentage recommended for brief treatment (3.2%) or referral to specialty treatment (3.7%). Among those reporting baseline illicit drug use, rates of drug use at 6-month follow-up (4 of 6 sites), were 67.7% lower (p<0.001) and heavy alcohol use was 38.6% lower (p<0.001), with comparable findings across sites, gender, race/ethnic, age subgroups. Among persons recommended for brief treatment or referral to specialty treatment, self-reported improvements in general health (p<0.001), mental health (p<0.001), employment (p<0.001), housing status (p<0.001), and criminal behavior (p<0.001) were found.

CONCLUSIONS

SBIRT was feasible to implement and the self-reported patient status at 6 months indicated significant improvements over baseline, for illicit drug use and heavy alcohol use, with functional domains improved, across a range of health care settings and a range of patients.

Assessing DUI risk: examination of the Behaviors & Attitudes Drinking & Driving Scale (BADDS)

Despite research findings indicating attitudinal differences among drivers with and without a history of driving under the influence (DUI) offenses, there are no well-established instruments specifically designed to clinically assess drinking and driving attitudes and behaviors among adults. The purpose of this current series of three studies was to investigate the psychometric properties of the Behaviors & Attitudes Drinking & Driving Scale (BADDS). The BADDS was developed in previous studies by the authors and assesses respondents' rationalizations for drinking and driving, likelihood of future drinking and driving, drinking and driving behaviors, and riding with a drinking driver behavior in the previous month. Study 1 (N=179) and Study 2 (N=338) assessed college participants, while Study 3 gathered data from adult DUI offenders (N=160) and non-DUI offenders (N=166). Results indicate good to excellent test-retest reliability and internal consistency estimates for BADDS scale scores. Support for the construct validity as well as concurrent and predictive criterion validity of BADDS scores was also demonstrated. Potential applications for the measure, as well as need for future research are described.

Women arrested for partner violence and substance use: an exploration of discrepancies in the literature

Discrepancies exist in research examining substance problems within groups of women arrested for intimate partner violence (IPV). In some studies women IPV arrestees have been found to be at high risk for substance-related problems, whereas in others they are found to be at low risk for substance-related problems. The current study explores these discrepancies then compares a sample of women court ordered to a domestic violence diversion program (n = 78) to a matched sample of men (n = 78) in the same program using police report information, self-report measures, the Substance Abuse Subtle Screening Inventory-3, and the Millon Clinical Multiaxial Inventory-III alcohol and drug subscales. Women IPV arrestees had a low occurrence of substance use during the arresting incident, a low incidence of substance-related diagnoses, and fewer substance-related problems than did men IPV arrestees. However, women demonstrated personality structures susceptible to nondiagnosable, hazardous drinking patterns.

Screening psychiatric patients for illicit drug use disorders and problems

BACKGROUND

Illicit drug use is prevalent but under-detected among psychiatric patients. This paper reviews the need for a valid, practical screening instrument for detecting drug problems and disorders among psychiatric patients, and describes the appropriateness of existing screening instruments for this purpose.

METHODS

Research literature on illicit drug screening instruments is reviewed.

RESULTS

All existing instruments lack one or more of the following characteristics that would enable them to be used routinely in psychiatric settings: brief and easy to administer, demonstrated validity for male and female psychiatric patients, measuring illicit drug use problems without confounding with alcohol use problems, and assessing drug problems over an optimal timeframe for screening (e.g., past 12 months).

CONCLUSION

Current instruments are not appropriate for routine drug screening of psychiatric patients. A brief, easy to use drug screen should be developed and validated on male and female psychiatric patients for routine screening of drug disorders and problems.

The self-report Drug Use Disorders Identification Test—Extended (DUDIT-E): Reliability, validity, and motivational index

Among clients who have been screened already for drug-related problems, the Drug Use Disorders Identification Test--Extended (DUDIT-E) maps the frequency of illicit drug use (D), the positive (P) and negative (N) aspects of drug use, and treatment readiness (T). D scores correlated with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnoses among 154 heavy drug users from criminal justice and drug detoxification settings, as well as with urine test results in drug detoxification units. One-week test/retest intraclass correlation coefficients among 92 male prison inmates were .90, .78, .75, and .84 for D, P, N, and T scores, respectively. Cronbach's alpha were .88-.95 for P score, .88-.93 for N score, and .72-.81 for T score. Principal components analysis supported construct validity for P, N, and T scores. T scores were higher in prison treatment units than in motivational and regular units without treatment emphasis. Motivational index scores differentiated between three categories of heavy drug users; they did not differentiate between prisons and unit types, but this corresponded to unclear structural differentiation between units.

Does subtle screening for substance abuse work? A review of the Substance Abuse Subtle Screening Inventory (SASSI)

AIM

Through a complex combination of direct (face-valid) and indirect (subtle) subscales, the Substance Abuse Subtle Screening Inventory (SASSI) is purported to detect substance use disorders with a high degree of validity regardless of respondent honesty or motivation. This review evaluates empirical evidence regarding the reliability and validity of this widely used screening instrument.

METHODS

Source documents were 36 peer-reviewed reports yielding data regarding the SASSI's internal consistency, test-retest reliability, psychometric structure, convergent and divergent validity and criterion (predictive) validity.

RESULTS

The total N of the studies reviewed equaled 22 110. Internal consistency is high for the overall SASSI and for its direct but not its indirect (subtle) subscales, suggesting that the instrument taps a single face-valid construct. SASSI classifications converged with those from other direct screening instruments, and were also correlated with ethnicity, general distress and social deviance. Studies found test-retest reliability lower than that reported in the test manuals. Sensitivity was found to be similar to that for public domain screening instruments, but on specificity the SASSI appears to yield a high rate of false positives.

CONCLUSION

No empirical evidence was found for the SASSI's claimed unique advantage in detecting substance use disorders through its indirect (subtle) scales to circumvent respondent denial or dishonesty. Recommendations for screening and for future research with the SASSI are offered.