Test-retest reliability of psychoactive substance abuse and dependence diagnoses in telephone interviews using a modified Diagnostic Interview Schedule-Substance Abuse Module

The use of the telephone interview for research

The increasing popularity of the telephone interview as a research method may be a reflection of broader social change and technological advances, with increased use and acceptability of telecommunications to support healthcare and service industries in general. Despite its widespread use there are few definitions of the term. Studies which directly compare telephone and face-to-face interviewing tend to conclude that telephone interviewing produces data which are at least comparable in quality to those attained by the face-to-face method. While it has been used for large survey studies, in nursing research the telephone interview is used predominantly in smaller-scale qualitative studies, where contact has already been made with the participants. The telephone interview was used in a study by one of the authors (EC) which explored the experience of postoperative pain. Issues relating to ethical considerations, reliability, validity, limitations and analysis are explored. The use of the approach for pain research is reflected upon before considering the wider applications that are available for this method of data collection in healthcare practice.

Item response theory analysis of DSM-IV criteria for inhalant-use disorders in adolescents

OBJECTIVE

Inhalants are a serious public health concern and a dangerous form of substance use. An important unresolved issue in the inhalant literature concerns the validity of inhalant-use diagnoses and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, distinction between inhalant abuse and inhalant dependence. To address these limitations and provide the foundation for helping build stronger diagnostic and assessment tools related to inhalant problems, this study examined the dimensionality of the criteria set and the abuse-dependence distinction using item response theory (IRT) analysis.

METHOD

This study used data from a survey of the population of Missouri Division of Youth Services' residents of the residential treatment system. The current study focused on adolescents and young adults who reported a lifetime history of inhalant use (N = 279).

RESULTS

The results from the IRT analysis showed no consistent hierarchical ordering of abuse and dependence criteria, providing strong evidence against the abuse-dependence distinction. The abuse criterion of legal problems associated with use represented the item with the highest level of inhalant severity. The dependence criterion that was related to giving up important social, occupational, or recreational activities provided the most accurate discrimination between individuals at different levels of severity.

CONCLUSIONS

Inhalant-use disorders are best represented using a dimensional versus a categorical approach. IRT analysis provides guidance for selecting criteria that can be useful for brief assessments of inhalant-use problems.

Overview and initial validation of two detailed, multidimensional, retrospective measures of substance use: the Lifetime Substance Use Recall (LSUR) and Longitudinal Substance Use Recall for 12 Weeks (LSUR-12) Instruments

Research on comorbidities between substance use disorders and serious mental illnesses would be facilitated by new methods for collecting comprehensive data on substance use, including data on onset, progression, frequency, amounts, and consequential behaviors. Given substantial limitations of available instruments, and a nearly complete absence of methodologies that allow derivation of continuous measures that estimate dose or cumulative exposure, this report describes the development and initial validation of two interviewer-administered, multidimensional measures of substance use, the Lifetime Substance Use Recall (LSUR) and Longitudinal Substance Use Recall for 12 Weeks (LSUR-12) Instruments. Participants (n=60) in an ongoing study of first-episode psychosis were evaluated with the LSUR, LSUR-12, and a number of other concurrent measures pertaining to substance use, substance use disorder diagnoses, select demographic features, and two personality traits. Specific a priori hypothesis tests were selected to demonstrate validity, relying on effect sizes to estimate strengths of association, considering small-to-medium correlations (e.g., ρ) as |.20-.50| and medium-to-large effect sizes as >|.50|. Numerous associations were observed between key nicotine-, alcohol-, and cannabis-related variables from the LSUR and LSUR-12 and scores from other concurrently administered measures. These findings provide a thorough initial validation of scores obtained with the new multidimensional instruments. Although validity of the two new measures of lifetime and past 12-week substance use was demonstrated, empirical data on inter-rater and test-retest reliability are needed. Careful development, and demonstration of psychometric properties, of these and related instruments may advance the fields of addiction and comorbidity research.

Main predictions of the interpersonal-psychological theory of suicidal behavior: empirical tests in two samples of young adults

The interpersonal-psychological theory of suicidal behavior (T. E. Joiner, 2005) makes 2 overarching predictions: (a) that perceptions of burdening others and of social alienation combine to instill the desire for death and (b) that individuals will not act on the desire for death unless they have developed the capability to do so. This capability develops through exposure and thus habituation to painful and/or fearsome experiences and is posited by the theory to be necessary for overcoming powerful self-preservation pressures. Two studies tested these predictions. In Study 1, the interaction of (low) family social support (cf. social alienation or low belonging) and feeling that one does not matter (cf. perceived burdensomeness) predicted current suicidal ideation, beyond depression indices. In Study 2, the 3-way interaction among a measure of low belonging, a measure of perceived burdensomeness, and lifetime number of suicide attempts (viewed as a strong predictor of the level of acquired capability for suicide) predicted current suicide attempt (vs. ideation) among a clinical sample of suicidal young adults, again beyond depression indices and other key covariates. Implications for the understanding, treatment, and prevention of suicidal behavior are discussed.

Epidemiological and clinical relevance of insomnia diagnosis algorithms according to the DSM-IV and the International Classification of Sleep Disorders (ICSD)

BACKGROUND

Although the epidemiology of insomnia in the general population has received considerable attention in the past 20 years, few studies have investigated the prevalence of insomnia using operational definitions such as those set forth in the ICSD and DSM-IV, specifying what proportion of respondents satisfied the criteria to reach a diagnosis of insomnia disorder.

METHODS

This is a cross-sectional study involving 25,579 individuals aged 15 years and over representative of the general population of France, the United Kingdom, Germany, Italy, Portugal, Spain and Finland. The participants were interviewed on sleep habits and disorders managed by the Sleep-EVAL expert system using DSM-IV and ICSD classifications.

RESULTS

At the complaint level, too short sleep (20.2%), light sleep (16.6%), and global sleep dissatisfaction (8.2%) were reported by 37% of the subjects. At the symptom level (difficulty initiating or maintaining sleep and non-restorative sleep at least 3 nights per week), 34.5% of the sample reported at least one of them. At the criterion level, (symptoms+daytime consequences), 9.8% of the total sample reported having them. At the diagnostic level, 6.6% satisfied the DSM-IV requirement for positive and differential diagnosis. However, many respondents failed to meet diagnostic criteria for duration, frequency and severity in the two classifications, suggesting that multidimensional measures are needed.

CONCLUSIONS

A significant proportion of the population with sleep complaints do not fit into DSM-IV and ICSD classifications. Further efforts are needed to identify diagnostic criteria and dimensional measures that will lead to insomnia diagnoses and thus provide a more reliable, valid and clinically relevant classification.

Adolescent inhalant use, abuse and dependence

AIMS

To compare adolescent inhalant users without DSM-IV inhalant use disorders (IUDs) to youth with IUDs (i.e. abuse or dependence) across demographic, psychosocial and clinical measures.

DESIGN

Cross-sectional survey with structured psychiatric interviews.

SETTING

Facilities (n = 32) comprising the Missouri Division of Youth Services (MDYS) residential treatment system for juvenile offenders. Participants Current MDYS residents (n = 723); 97.7% of residents participated. Most youth were male (87%) and in mid-adolescence (mean = 15.5 years, standard deviation = 1.2, range = 11-20); more than one-third (38.6%, n = 279) reported life-time inhalant use.

MEASUREMENTS

Antisocial behavior, temperament, trauma-exposure, suicidality, psychiatric symptoms and substance-related problems.

FINDINGS

Among life-time inhalant users, 46.9% met criteria for a life-time DSM-IV IUD (inhalant abuse = 18.6%, inhalant dependence = 28.3%). Bivariate analyses showed that, in comparison to non-users, inhalant users with and without an IUD were more likely to be Caucasian, live in rural or small towns, have higher levels of anxiety and depressive symptoms, evidence more impulsive and fearless temperaments and report more past-year antisocial behavior and life-time suicidality, traumatic experiences and global substance use problems. A monotonic relationship between inhalant use, abuse and dependence and adverse outcomes was observed, with comparatively high rates of dysfunction observed among inhalant-dependent youth. Multivariate regression analyses showed that inhalant users with and without an IUD had greater levels of suicidal ideation and substance use problems than non-users.

CONCLUSIONS

Youth with IUDs have personal histories characterized by high levels of trauma, suicidality, psychiatric distress, antisocial behavior and substance-related problems. A monotonic relationship between inhalant use, abuse and dependence and serious adverse outcomes was observed.

A survey of inhalant use disorders among delinquent youth: prevalence, clinical features, and latent structure of DSM-IV diagnostic criteria

BACKGROUND

Inhalant use is among the most pernicious and poorly understood forms of adolescent substance use. Many youth in the juvenile justice system have used inhalants, but little is known about inhalant use disorders (IUDs) in antisocial youth populations. The purpose of this study was to examine the prevalence, clinical features, and latent structure of DSM-IV IUDs in a state population of antisocial youth.

METHODS

Cross-sectional survey conducted in 2003. Of 740 youth residing in Missouri State Division of Youth Services' (MDYS) residential treatment facilities at the time the study was conducted, 723 (97.7%) completed interviews. Eighty-seven percent were male, with a mean age of 15.5 (SD = 1.2). Nearly 4 in 10 youth (38.5%; n = 279) reported lifetime inhalant use. Youth ranged from very mildly to severely antisocial.

RESULTS

Of 279 inhalant users, 52 (18.6%) met DSM-IV inhalant abuse criteria and 79 (28.3%) met inhalant dependence criteria. Five of 10 IUD criteria were met by > 10% of the total sample. Latent class analyses demonstrated a substantial concordance between DSM-IV-defined IUDs and an empirically-derived classification based on responses to DSM-IV IUD diagnostic criteria.

CONCLUSION

IUDs and constituent criteria were prevalent among youth in the juvenile justice system. Two groups of problem inhalant users were identified, symptomatic users-DSM-IV inhalant abuse and highly symptomatic users-DSM-IV inhalant dependence, which differed primarily in severity of inhalant-related problems. Inhalant screening, prevention and treatment efforts in juvenile justice settings are rarely delivered, but critically needed.

Social anxiety disorder as a risk factor for alcohol use disorders: a prospective examination of parental and peer influences

Elucidation of mechanisms underlying the high rates of alcohol use disorder (AUD) remains a pressing clinical and research concern. Despite data indicating that social anxiety disorder (SAD) may be a psychological vulnerability that increases AUD risk, no known prospective research has examined underlying mechanisms. Given the nature of SAD, social support and peer alcohol use may be implicated. The present study set out to clarify the SAD-AUD link in several ways using a prospective dataset comprised of 1803 (47% female) young adults at T1, 1431 of whom were assessed again approximately 3 years later. First, stringent criteria were used to directly test whether SAD was a risk for AUD. Second, we examined whether social support and peer alcohol use moderated the prospective SAD-AUD link. Structured diagnostic interviews were conducted to assess DSM-IV Axis I disorders, negative life events, social support, and peer alcohol use. Among men, Time 1 (T1) SAD was not significantly related to Time 2 (T2) AUD. Yet, among women, T1 SAD was related to T2 AUD. Further, T1 SAD was the only internalizing disorder to significantly predict T2 AUD after controlling for relevant variables (e.g., T1 depression, other anxiety, alcohol and marijuana use disorders). The SAD-AUD relation demonstrated directional specificity. Family cohesion and adverse family relations significantly moderated this relation. Findings highlight the important role of SAD and familial support in the onset of AUD among women.

Cumulative lifetime adversities and alcohol dependence in adolescence and young adulthood

OBJECTIVE

Negative life events have been implicated in the development of alcohol dependence. This paper tests whether cumulative exposure to such stressors significantly predicts risk of DSM-IV alcohol dependence disorder in young adults. We also provide descriptive data that characterizes the patterns of cumulative exposure to such events and rates of alcohol dependence across gender, race/ethnic, and socioeconomic groups.

METHOD

Members of a representative urban community sample of 1786 young adults in South Florida were interviewed retrospectively using the Composite International Diagnostic Interview, and a lifetime checklist of 41 major adverse life events. The conditional risk of first onset of alcohol dependence disorder was estimated in relationship to a measure of lifetime cumulative adversity using discrete-time event history analysis.

RESULTS

Event history analysis suggested that lifetime stress exposure exhibits a pattern of association with alcohol dependence that is consistent with a cumulative impact interpretation. Both recent events and events more distant in time were significantly and independently associated with such risk. Although these results contribute toward an understanding of variations in alcohol dependence across individuals, they do not assist in the understanding of observed ethnic group differences in such dependence.

Stress burden, drug dependence and the nativity paradox among U.S. Hispanics

It seems well established that exposure to social stress, including acculturation stress, increases risk for psychiatric and substance problems, and that the disadvantaged experience higher levels of such exposure. Such evidence points to the expectation that immigrant minority groups must be at elevated risk relative to their native-born counterparts. That the opposite appears to be true for various immigrant groups within the U.S. constitutes what has been referred to as the nativity health paradox. This paper examines the association between nativity and drug dependence among the distinctive and understudied Hispanic population of South Florida and attempts to evaluate competing explanations for the apparent advantage of immigrant populations. Based on data on a representative sample young adults of Cuban and other Hispanic backgrounds (n=888), we found the paradox to be limited to women and confirmed the finding of prior research that acculturation plays a major role in explaining this difference in risk. We also found cumulative exposure to major and potentially traumatic events to be lower rather than higher among immigrants, to be a strong predictor of drug dependence and to contribute importantly toward accounting for observed nativity differences among women. Taken together, cumulative stress exposure and degree of acculturation explained 40% of the nativity difference. Finally, our results suggest that social support matters for risk primarily because such support more effectively acts to reduce exposure to social stress among foreign-born young Hispanic women.

Family structure and substance use problems in adolescence and early adulthood: examining explanations for the relationship

AIMS

Our study has two goals: to evaluate variation in symptoms of substance abuse/dependence by family structure and to examine several potential explanations for this association, including differences in socio-economic status, social support, social stress and perceived approval and use of substances by family and friends.

DESIGN

Ordinary least squares (OLS) regression is used to examine the association between family type and problematic substance use and to assess the hypothesized mediators.

SETTING

Data were collected between 1998 and 2000 as part of a study of the prevalence and social distributions of psychiatric and substance use disorders. The study involved face-to-face interviews with a representative sample of young adults in a South Florida community.

PARTICIPANTS

Respondents (n = 1760) were between 18 and 23 years of age. Approximately 25% were of Cuban origin, 25% other Caribbean basin Hispanic, 25% African American and 25% non-Hispanic white.

MEASUREMENTS

Four family types are examined: mother-father families, single-parent families, single-parent families that include other adult relative(s) and stepfamilies. Problematic substance use is measured by a set of 22 substance abuse/dependence symptoms.

FINDINGS

Controlling for race-ethnicity and gender, respondents from single-parent families report a significantly higher level of problematic substance use than those from mother-father families. Although nearly all explanations receive support, we find the strongest evidence for differential association with deviant peers and exposure to stress.

CONCLUSIONS

Our findings suggest that--rather than representing a unique and independent predictor of substance use problems--family structure can be viewed as a marker of the unequal distribution of factors influencing the risk of problematic substance use.

Anxiety and risk for substance dependence among late adolescents/young adults

This study examined the relation between comorbid and pure (non-comorbid) anxiety disorders and both substance dependence and substance use problems in a community sample of 1747 young adults ages 18-23 years. Results indicate that collectively anxiety disorders, both pure and comorbid with other psychiatric diagnoses, are predictive of substance dependence. When temporal order was controlled, anxiety disorders generally preceded the onset of substance dependence. However in analyses in which PTSD was excluded, anxiety disorders were no longer predictive of substance dependence, suggesting that the increased risk associated with anxiety disorders is largely if not wholly attributable to PTSD. Finally, comorbid and pure anxiety disorders were found to be predictive of the number of alcohol and drug use problems.

Family structure and mental health: the mediating effects of socioeconomic status, family process, and social stress

Although numerous studies reveal differences in mental health by the structure of one's family of origin, there remains debate regarding the processes generating these patterns. Using a sample of young adults (19-21 years) in Miami-Dade County in Florida, this study examines the explanatory significance of three presumed correlates of family type: socioeconomic status, family processes, and level of social stress. Consistent with prior research, our results reveal higher levels of depressive symptoms among those from stepfamilies, single parent families, and single parent families with other relatives present, compared with mother-father families. All three presumed correlates make significant independent contributions to the prediction of depressive symptomatology. Substantial mediating effects also are observed for all three explanatory dimensions. Collectively, they completely or largely explain observed family type variations in mental health risk.

Unmet need for Substance Abuse Treatment of Adults in Massachusetts

This article presents a methodology to estimate the size and cost of eliminating unmet need for substance abuse treatment services among adults who have clinically significant substance use disorders, and applies the approach to Massachusetts' information. Unmet treatment needs were derived using a statewide household telephone survey of 7,251 Massachusetts residents aged 19 and older conducted in 1996-1997, and an index of treatment mix and cost information from state and Medicaid financial data. The study estimates that 39,450 adult state residents (0.81% of the total sample) had a clinically significant past-year substance use disorder, but had not received treatment in the past year. Providing substance abuse treatment and outreach services to them would have required an additional cost of approximately 109 million dollars (17 dollars per capita), of which the state's payer of last resort, the Massachusetts Department of Public Health Bureau of Substance Abuse Services (BSAS), would need to fund 31 million dollars (5 dollars per capita). The share paid by BSAS (28%) would represent an increase of 42% over its current spending. This paper quantifies an important but sometimes overlooked objective of managed care: to improve access for substance abusers who need but do not seek treatment.

Association of cocaine withdrawal symptoms with more severe dependence and enhanced subjective response to cocaine

The purpose of this two part study was to better characterize cocaine users based on self-reported cocaine withdrawal symptoms by examining screening data and response to smoked cocaine in the human laboratory. The first study sample included male and female non-treatment seeking cocaine users who were screened as potential subjects for inpatient studies. Of the 555 subjects, 462 (82%) endorsed symptoms consistent with DSM-IV criteria for cocaine withdrawal. Cocaine users who met criteria for cocaine withdrawal, compared with those who did not, reported a significantly higher amount of cocaine use and a history of medical and psychosocial problems. Cocaine users meeting DSM-IV withdrawal criteria, which included endorsement of depression, were also more likely to have a history of depression, to have seriously considered suicide, and to have had chemical dependency treatment even when amount spent on cocaine was covaried. The second study sample, which was a subset of Study I, included those who participated in human cocaine studies following the phone screening. Cocaine users who met criteria for cocaine withdrawal (n=34), compared with those who did not (n=10), had enhanced subjective ratings of 'high' and 'feel the effect of last dose' in response to a single delivery of 0.4 mg/kg of smoked cocaine. These results suggest that history of cocaine withdrawal symptoms may be associated with enhanced cocaine responses and greater severity of cocaine dependence.

Cumulative adversity and drug dependence in young adults: racial/ethnic contrasts

AIMS

To study cumulative exposure to stressors as a risk factor for drug dependence, and evaluate whether group differences in exposure contribute to differences in prevalence.

DESIGN

Cross-sectional community survey of life-time adverse experiences and substance and psychiatric disorders.

SETTING

Data collected between 1997 and 2000 in Miami-Dade County, USA.

PARTICIPANTS

A total of 1803 former Miami-Dade public school students, 93% between ages 19 and 21 years when interviewed. Males and females of Cuban origin, other Caribbean basin Hispanics, African-Americans and non-Hispanic whites are represented equally.

MEASUREMENTS

Drug dependence disorder assessed by DSM-IV criteria using the Composite International Diagnostic Interview, and a 41-item checklist of life-time exposure to major and potentially traumatic experiences. Both measures include age at time of first occurrence.

FINDINGS

Life-time rate of drug dependence disorder (total 14.3%) did not vary significantly (P > 0.05) by socio-economic group. Male rate (17.6%) was significantly greater than female rate (10.9%). The African-American rate (6.5%) was dramatically lower than non-Hispanic white (17.0%), Cuban (18.1%) and non-Cuban Hispanic (16.0%) rates despite their dramatically higher exposure to adversity. Twenty-eight of 33 individual adversities were associated with the subsequent onset of drug dependence (P < 0.05). Cumulative life-time exposure was greatest for males and for African-Americans, and was associated inversely with socio-economic level. Multivariate discrete-time event history analysis revealed significant independent effects of distal (>1 year earlier) and proximal (previous year) exposure to adverse events (P < 0.05), controlling for childhood conduct disorder, attention deficit hyperactive disorder and previous psychiatric disorder.

CONCLUSIONS

Life-time cumulative exposure to distant as well as more recent adversity predicts risk of subsequent drug dependence, although it does not explain ethnic group differences in risk.

Individual differences in the subjective response to smoked cocaine in humans

The individual variables that determine the effects of cocaine in humans are not well understood. In this study, we examined the relationship between the subjective response to cocaine and selected individual variables in cocaine-dependent participants. A single 0.4-mg/kg dose of smoked cocaine was received by 75 smoked cocaine users. The variables associated with increased subjective response to cocaine were male sex, presence of alcohol use, higher baseline Beck Depression Inventory (BDI) scores, and duration of cocaine use. The change in heart rate and diastolic blood pressure in response to cocaine delivery were also positively associated with the subjective response to cocaine. In contrast, body weight, years of schooling, and the change in the heart rate with the expectation of cocaine delivery were associated with a diminished subjective response to cocaine. The importance of these variables in maintaining the cocaine use behavior needs to be studied further.

Characteristics of research volunteers for inpatient cocaine studies: focus on selection bias

In order to investigate the selection bias of subjects for inpatient human cocaine studies, characteristics of 859 potential subjects were examined. Excluded subjects compared with accepted group were more likely to be single and male, currently use drugs other than cocaine, have a history of intravenous cocaine use, and have medical or mental health problems or physical complaints. Subjects who were accepted but did not participate, compared with participants, were likely to spend more money on cocaine. These results suggest that potential subjects who were accepted to our research studies may not accurately represent all potential subjects for several important subject characteristics.