Diagnostic Accuracy of the Drug Use Disorder Identification Test and Its Short Form, the DUDIT-C, in German Adolescent Psychiatric Patients

Dissociating social reward learning and behavior in alcohol use disorder

BACKGROUND

Alcohol use disorder (AUD) is associated with deficits in social cognition and behavior, but why these deficits are acquired is unknown. We hypothesized that a reduced association between actions and outcomes for others, i.e., social reward learning, would explain prevalent social deficiencies in AUD.

METHODS

We conducted one laboratory study (n = 234) and one confirmatory online study (n = 258), comparing young adults with AUD to age-, gender-, and education-matched healthy controls on a standardized reward learning task. In the task, participants learned to maximize reward for another person and for oneself. To elucidate the potential relation between reward learning and social behavior in AUD, we administered two measures: a dictator game task and a self-report measure. Finally, we applied reinforcement learning models to examine the computational properties of learning.

RESULTS

Social and individual learning, expressed in choice behavior, were comparable in individuals with AUD and healthy controls. Individual differences in learning were not associated with reduced social behavior in AUD. Computational modeling suggested that the learning mechanisms are comparable in AUD and healthy controls and indifferent to whether learning maximizes reward for another person or oneself.

CONCLUSIONS

Individuals with AUD demonstrated preserved reward learning abilities that do not vary with social behavior. Together, these results indicate that reward processes may not be relevant for understanding compromised social behavior in AUD.

PTSD, dysregulation profile and substance use: exploring differences in a sample of adolescents in an outpatient clinic

Introduction

Experiencing traumatic events (TEs), especially interpersonal TEs, is related to an increased risk of developing post-traumatic stress disorder (PTSD). Both TEs and PTSD are associated with a higher risk of substance use and problems in emotion regulation. Little is known about the associations between specific types of TEs, problems with general self-regulation (including cognitive and behavioral components) and substance use severity in adolescents. Knowledge on these associations could provide important approaches for prevention and therapy for adolescents with a history of trauma.

Methods

This study investigated associations between different types of TEs and PTSD, self-regulation and substance use severity. Moreover, participants were categorized into three groups according to their trauma status: (I) no history of TEs (noTEs), (II) history of TEs but no PTSD diagnosis (TEs), and (III) history of TEs and PTSD diagnosis (PTSD). Differences between the three groups were analyzed in terms of self-regulation and substance use severity. Our sample consisted of N = 89 adolescents aged 12 to 18 years in a child and adolescent psychiatric outpatient clinic in Germany. Substance use severity was only assessed in a smaller subsample (n = 37). Data were obtained from standardized diagnostic procedures and included information on types of TEs and PTSD diagnosis according to ICD-10, problems in self-regulation assessed with the Child Behavior Checklist (CBCL)/ Youth Self Report (YSR) Dysregulation Profile (DP), and substance use severity measured with the Drug Use Disorders Identification Test (DUDIT).

Results

We found that interpersonal TEs were significantly associated with higher rates of PTSD diagnosis compared to non-interpersonal TEs. We found no significant associations between different types of TEs and both problems in self-regulation and substance use severity. Moreover, our findings do not indicate differences in both self-regulation and substance use severity between trauma statuses (noTEs, TEs, PTSD).

Discussion

Future studies should consider other characteristics of TEs such as timing and duration when investigating associations with self-regulation. Longitudinal studies are needed to investigate developmental pathways, as a better understanding of the role of characteristics of TEs and self-regulation in the development of PTSD and substance use problems would provide opportunities for prevention and therapy for trauma-exposed patients.

Treatment utilization among people with drug use disorders in prison: a national longitudinal cohort study

BACKGROUND

Drug use disorders are highly prevalent among people in prison. Nevertheless, treatment coverage for individuals with drug use disorders in prison remains understudied and unknown. The aim of this study was to estimate treatment coverage among a sample of people with harmful and likely drug dependence before entering prison and to investigate the factors associated with treatment utilization.

METHODS

This was a longitudinal cohort study using baseline survey data linked to registry data on imprisonment and treatment utilization. The study is based on the Norwegian Offender Mental Health and Addiction (NorMA) cohort (n = 733) recruited in 2013-2014 from 57 Norwegian prisons. At baseline, participants reported drug use the year before imprisonment, using the Drug Use Disorder Identification Test (DUDIT). The outcome of interest was DUD treatment, defined as at least one DUD treatment episode from the specialized health services during baseline imprisonment.

RESULTS

40% of the sample had DUDIT scores that indicated likely drug dependence (≥ 25) and a need for treatment. Among this group, 64% received DUD treatment while imprisoned. Longer imprisonment (> 12 months; aOR = 8.87, p < 0.001), Nordic country of birth (aOR = 2.85, p = 0.003), daily/almost daily injecting drug use (aOR = 2.58, p < 0.001) and polydrug use (aOR = 2.19, p = 0.002) were positively associated with treatment utilization in prison.

CONCLUSIONS

Most people with likely drug dependence before entering prison in Norway received DUD treatment during their time in prison. More severe drug use (Injecting drug use and polydrug use), longer imprisonments and being born in the Nordics were positively associated with treatment utilization. People in prison must have access to adequate treatment during imprisonment, and further studies should investigate the possible individual or structural barriers resulting in treatment gaps, especially for people who are foreign born and people with short sentences.

Enhanced Cohort Methods for HIV Research and Epidemiology (ENCORE): Protocol for a Nationwide Hybrid Cohort for Transgender Women in the United States

BACKGROUND

In the United States, transgender women are disproportionately impacted by HIV and prioritized in the national strategy to end the epidemic. Individual, interpersonal, and structural vulnerabilities underlie HIV acquisition among transgender women and fuel syndemic conditions, yet no nationwide cohort monitors their HIV and other health outcomes.

OBJECTIVE

Our objective is to develop a nationwide cohort to estimate HIV incidence, identify risk factors, and investigate syndemic conditions co-occurring with HIV vulnerability or acquisition among US transgender women. The study is informed by the Syndemics Framework and the Social Ecological Model, positing that stigma-related conditions are synergistically driven by shared multilevel vulnerabilities.

METHODS

To address logistical and cost challenges while minimizing technology barriers and research distrust, we aim to establish a novel, hybrid community hub-supported digital cohort (N=3000). The digital cohort is the backbone of the study and is enhanced by hubs strategically located across the United States for increased engagement and in-person support. Study participants are English or Spanish speakers, are aged ≥18 years, identify as transgender women or along the transfeminine spectrum, reside in 1 of the 50 states or Puerto Rico, and do not have HIV (laboratory confirmed). Participants are followed for 24 months, with semiannual assessments. These include a questionnaire and laboratory-based HIV testing using self-collected specimens. Using residential zip codes, person-level data will be merged with contextual geolocated data, including population health measures and economic, housing, and other social and structural factors. Analyses will (1) evaluate the contribution of hub support to the digital cohort using descriptive statistics; (2) estimate and characterize syndemic patterns among transgender women using latent class analysis; (3) examine the role of contextual factors in driving syndemics and HIV prevention over time using multilevel regression models; (4) estimate HIV incidence in transgender women and examine the effect of syndemics and contextual factors on HIV incidence using Poisson regression models; and (5) develop dynamic, compartmental models of multilevel combination HIV prevention interventions among transgender women to simulate their impact on HIV incidence through 2030.

RESULTS

Enrollment launched on March 15, 2023, with data collection phases occurring in spring and fall. As of February 24, 2024, a total of 3084 individuals were screened, and 996 (32.3%) met the inclusion criteria and enrolled into the cohort: 2.3% (23/996) enrolled at a hub, and 53.6% (534/996) enrolled through a community hub-supported strategy. Recruitment through purely digital methods contributed 61.5% (1895/3084) of those screened and 42.7% (425/996) of those enrolled in the cohort.

CONCLUSIONS

Study findings will inform the development of evidence-based interventions to reduce HIV acquisition and syndemic conditions among US transgender women and advance efforts to end the US HIV epidemic. Methodological findings will also have critical implications for the design of future innovative approaches to HIV research.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/59846.

Substance Use, Alcohol Consumption, and Smoking Prevalence Amongst Medical Students in Erbil, Iraq

BACKGROUND

A significant proportion of medical students engage in the illicit use of drugs and indulge in heavy alcohol consumption. The utilization of substances during medical school frequently has repercussions on both the personal and professional lives of students. Therefore, we aimed to investigate the extent of substance use, alcohol consumption, and smoking among medical students in Erbil City.

METHODS

An observational cross-sectional study was conducted at Hawler Medical University (HMU) for this purpose. The study involved 368 students from stages one to six. The questionnaire covered sociodemographic information, Drug Use Disorders Identification Test (DUDIT), Alcohol Use Disorders Identification Test (AUDIT), and Fagerstrom Test for Nicotine Dependence (FTND) scales. The data was analyzed using Microsoft Excel 2016 and IBM SPSS Statistics for Windows, Version 26 (Released 2019; IBM Corp., Armonk, New York, United States).

RESULTS

A total of 368 students were involved in the study. The mean age (SD) of the respondents was 20.92 (2.01) years; 191 (51.9%) participants were males. Thirty-two (8.7%) students have used substance in the last 12 months; 10 (31.2%) of them were non-problematic drug users, 20 (62.5%) were problematic drug users, and 2 (6.3%) were dependent users. Twenty-nine (7.9%) students were alcohol users; 17 (58.7%) were categorized as low-risk users, 5 (17.2%) as hazardous users, and 7 (24.1%) as dependent users. Regarding smoking, 45 (12.2%) students were smokers, among this group, 27 (60%) were categorized as having low dependence, and 18 (40%) had high dependence.

CONCLUSION

The findings suggest a worrying trend of substance misuse among university students. There is a critical need for targeted preventive interventions that address these issues to enhance student health and educational outcomes.

Cross-sectional survey data on the socio-demographic characteristics associated with substance use among internal displaced persons in Maiduguri, Nigeria

Regression analysis was carried out to examine the association between certain socio-demographic characteristics and substance use among internally displaced persons (IDPs). Using an adapted version of the Drug Use Disorder Identification Test (DUDIT) instrument, cross-sectional survey data were obtained from 520 IDPs living in three camps located in Maiduguri, Borno state of Nigeria. The data were analyzed using Statistical Package for Social Sciences software version 21.0. Specifically, this article provides data about the participants' demographic characteristics, the types of substances they use, reasons for using such substances, and the prevalence of substance use. This dataset can offer valuable multivariate information for future research agendas in similar, or closely related study populations. This cross-sectional dataset is also valuable for policymakers who are seeking ways to intervene in the substance use problem, as well as other associated social vices, affecting the vulnerable population of IDPs.

Intensity of Psychoactive Substance Use Affects the Occurrence of Prodromal Symptoms of Psychosis

BACKGROUND

Psychosis is defined as a series of symptoms that impair the mind and lead to a kind of loss of reference to reality. Development of psychosis is usually preceded by the appearance of prodromal symptoms. Numerous attempts have been made to find out how psychoactive substances can influence the onset and development of psychotic disorders, but to date there are no studies that show a link between the onset of prodromal symptoms and the use of psychoactive substances.

METHODS

A survey consisting of epidemiological and demographic questions, the Drug Use Disorders Identification Test (DUDIT), and the Prodromal Questionnaire Brief Version (PQ-B) was conducted on social media among users of illegal psychoactive substances, covering 703 study participants.

RESULTS

A total of 39.8% of the respondents had been treated by a psychiatrist, and the most popular drugs used by respondents in their lifetime were tetrahydrocannabinol-containing products, MDMA, amphetamines, and LSD. A significant correlation was found between the DUDIT and the PQ-B values.

CONCLUSIONS

Intensity of psychoactive substance use correlated positively with the risk of appearance and intensity of prodromal symptoms of psychosis. Early exposure to psychoactive substances increased the risk of heavy substance use in adulthood and led to more frequent prodromal states.

Evaluation of the multimodal DELTA therapy for adolescents with substance use disorders: an exploratory pilot trial

Background

In order to address the lack of manualized treatment programs for adolescents with substance use disorders (SUDs), we developed a manualized group intervention (DELTA). DELTA focusses on substance use reduction and abstinence as well as alleviation of SUD symptoms via additional modules for co-occurring disorders. The goal of this exploratory trial was to assess if DELTA can be conducted in adolescent SUD patients and if participation is related to reductions in substance use, SUD-related problems, and further psychopathologies.

Method

We recruited adolescents at a psychiatric outpatient unit, which were then allocated to either DELTA intervention group (N = 85) or to a waiting-list control group (WL, N = 61) based on parental decision to start a therapy or not. Self-report measures were used as primary outcomes (substance use via interview, use-related problems via DUDIT-Drug Use Disorder Identification Test) and secondary outcomes (psychopathologies via YSR-Youth Self Report). T-tests and Pearson correlations were used to analyze between-group differences across time.

Results

On average, participants attended M = 7.7 (SD = 5.1) of the 16 sessions. Substance use and use-related problems regarding all substances but nicotine was decreased after the intervention, with small to medium not significant effects in favor of DELTA. Self-reported psychopathologies were also reduced at follow-up, with non-significant advantages for DELTA.

Conclusion

DELTA showed small effects on SUD-related and depression-related variables. However, the interpretation is limited by the small sample size. Nonetheless, the DELTA intervention is viable in SUD outpatient treatment and will be further evaluated.Clinical trial registration: The study was registered at clinicaltrials.gov under NCT03444974. Registered February, 26th 2018 (https://clinicaltrials.gov/ct2/show/NCT03444974).

An exploration of ex-boarding school adults' attachment styles and substance use behaviours

Our study examines the relationship between boarding school attendance, adult attachment styles, parental bonding, and substance use, aiming was to quantitatively investigate if caregiver deprivation caused by boarding contributes to enduring outcomes in adults. In a sample of 149 adults, measures included AUDIT and DUDIT (substance use), Parental Bonding Instrument (parental care), and Experiences in Close Relationships (adult attachment). Pearson's correlation revealed a significant negative association between age at first boarding and anxiety, avoidant attachment styles, and poorer parental care, whilst a significant positive relationship was identified between age at first boarding and perceived parental care. This was supported by a hierarchical regression which demonstrated that the model predicted 29% of the variance in age at first boarding. These results contribute towards the formulation and treatment of ex-boarders and to research considering the effects of boarding school experiences on difficulties in adult life.

Social Context and Reward Sensitivity Enhance Corticostriatal Function during Experiences of Shared Rewards

Although prior research has demonstrated enhanced striatal response when sharing rewards with close social connections, less is known about how individual differences affect ventral striatal (VS) activation and connectivity when experiencing rewards within social contexts. Given that self-reported reward sensitivity and level of substance use have been associated with differences in VS activation, we set out to investigate whether these factors would be independently associated with enhancements to neural reward responses within social contexts. In this pre-registered study, participants (N=45) underwent fMRI while playing a card guessing game in which correct or incorrect guesses resulted in monetary gains and losses that were shared evenly with either a close friend, stranger (confederate), or non-human partner. Consistent with our prior work, we found increased VS activation when sharing rewards with a socially close peer as opposed to an out-of-network stranger. As self-reported reward sensitivity increased, the difference in VS response to rewards shared with friends and strangers decreased. We also found enhanced connectivity between the VS and temporoparietal junction when sharing rewards with close friends as opposed to strangers. Finally, exploratory analyses revealed that as reward sensitivity and sub-clinical substance use increase, the difference in VS connectivity with the right fusiform face area increases as a function of social context. These findings demonstrate that responsivity to the context of close friends may be tied to individual reward sensitivity or sub-clinical substance use habits; together these factors may inform predictions of risk for future mental health disorders.

Health and well-being of serving and ex-serving UK Armed Forces personnel: protocol for the fourth phase of a longitudinal cohort study

INTRODUCTION

This is the fourth phase of a longitudinal cohort study (2022-2023) to investigate the health and well-being of UK serving (Regulars and Reservists) and ex-serving personnel (veterans) who served during the era of the Iraq and Afghanistan conflicts. The cohort was established in 2003 and has collected data over three previous phases including Phase 1 (2004-2006), Phase 2 (2007-2009) and Phase 3 (2014-2016).

METHODS AND ANALYSIS

Participants are eligible to take part if they completed the King's Centre for Military Health Research Health and Wellbeing Cohort Study at Phase 3 (2014-2016) and consented to be recontacted (N=7608). Participants will be recruited through email, post and text message to complete an online or paper questionnaire. Data are being collected between January 2022 and September 2023. Health and well-being measures include measures used in previous phases that assess common mental disorders, post-traumatic stress disorder (PTSD) and alcohol misuse. Other areas of interest assess employment, help-seeking and family relationships. New topics include the impact of the British withdrawal from Afghanistan in 2021, complex PTSD (C-PTSD), illicit drug use, gambling and loneliness. Analyses will describe the effect size between groups deployed to Iraq and/or Afghanistan or not deployed, and those who are currently in service versus ex-service personnel, respectively, reporting prevalences with 95% CIs, and ORs with 95% CI. Multivariable logistic and multiple linear regression analyses will be conducted to assess various health and well-being outcomes and associations with risk and protective factors.

ETHICS AND DISSEMINATION

Ethical approval has been granted by the Ministry of Defence Research Ethics Committee (Ref: 2061/MODREC/21). Participants are provided with information and agree to a series of consent statements before taking part. Findings will be disseminated to UK Armed Forces stakeholders and international research institutions through stakeholder meetings, project reports and scientific publications.

The eleven-item Alcohol, Smoking and Substance Involvement Screening Test (ASSIST-11): Cross-cultural psychometric evaluation across 42 countries

The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) is an instrument to screen substance-use-related health risks. However, little is known whether the ASSIST could be further shortened while remaining psychometrically sound across different countries, languages, gender identities, and sexual-orientation-based groups. The study aimed to validate a shortened 11-item ASSIST (ASSIST-11). Using the International Sex Survey data, 82,243 participants (M age = 32.39 years) across 42 countries and 26 languages completed questions from the ASSIST-11 regarding gender identity, sexual orientation, and other information. Confirmatory factor analysis (CFA) and multigroup CFA (MGCFA) evaluated the ASSIST-11's structure and tested measurement invariance across groups. Cronbach's α and McDonald's ω were used to examine the internal consistency. Cohen's d and independent t-tests were used to examine known-group validity. The ASSIST-11 was unidimensional across countries, languages, age groups, gender identities (i.e., men, women, and gender-diverse individuals), and sexual orientations (i.e., heterosexual and sexual minority individuals). Cronbach's α was 0.63 and McDonald's ω was 0.68 for the ASSIST-11. Known-group validity was supported by Cohen's d (range between 0.23 and 0.40) with significant differences (p-values<0.001). The ASSIST-11 is a modified instrument with a unidimensional factor structure across different languages, age groups, countries, gender identities, and sexual orientations. The low internal consistency of the ASSIST-11 might be acceptable as it assesses a broad concept (i.e., use of several different substances). Healthcare providers and researchers may use the ASSIST-11 to quickly assess substance-use information from general populations and evaluate the need to follow up with more detailed questions about substance use.

Comparing self-report and parental report of psychopathologies in adolescents with substance use disorders

Both internalizing and externalizing psychopathologies interfere with the treatment of substance use disorders (SUD) in adolescents. Self-reports of psychopathologies are likely biased and may be validated with parental reports. We compared N = 70 standardized self-reports of adolescents entering outpatient SUD treatment (13.2-18.6 years old, 43% female) to parental reports on the same psychopathologies, and explored biases due to gender, age, SUD diagnoses and SUD severity. Bivariate bootstrapped Pearson correlation coefficients revealed several small to moderate correlations between both reporting sources (r = 0.29-0.49, all p_corrected ≤ 0.039). A repeated measures MANOVA revealed moderately stronger parental reports of adolescent psychopathologies compared to adolescent self-reports for most externalizing problems (dissocial and aggressive behaviors, p ≤ 0.016, η²_part = 0.09-0.12) and social/attention problems (p ≤ 0.012, η²_part = 0.10), but no differences for most internalizing problems (p ≥ 0.073, η²_part = 0.02-0.05). Differences were not associated with other patient or parental characteristics including age, gender, number of co-occurring diagnoses or presence/absence of a certain SUD (all p_uncorrected ≥ 0.088). We concluded that treatment-seeking German adolescents with SUD present with a multitude of extensive psychopathologies. The relevant deviation between self- and parental reports indicate that the combination of both reports might help to counteract dissimulation and other reporting biases. The generalizability of results to inpatients, psychiatry patients in general, or adolescents without SUD, as well as the validity of self- and parental reports in comparison to clinical judgements remain unknown.

Swedish High School Students' Drug and Alcohol Use Habits throughout 2020

This study describes gender-specific patterns in alcohol and drug use among Swedish high school students throughout 2020 and questions the current cutoffs for identifying addiction in this population. From September 2020 to February 2021, 1590 Swedish upper secondary high school students (mean age 17.15 years, age range 15-19 years, 39.6% male, and 60.4% female) completed the anonymous, electronic survey of the Mental and Somatic Health without borders study. The respondents reported their substance use habits during the previous 12 months using the Drug Use Disorders Identification Test (DUDIT) and Alcohol Use Disorders Identification Test (AUDIT). They also answered questions about changes in their alcohol and illegal drug use habits after the COVID-19 outbreak. No gender differences were detected in the prevalence and degree of alcohol use. Compared to female adolescents, significantly more male adolescents used drugs (and to a significantly higher degree, although with a small effect size). Substance use problems peaked in females at age 17 and in males at age 18. The COVID-19 outbreak affected alcohol consumption and illegal drug use in male and female adolescents similarly. For both genders, of those who used illegal drugs, over 40% reported increased use after the outbreak. Our results reinforce previous suggestions of the narrowing of gender differences in Swedish adolescents' risk behaviors and challenge the previously validated gender-specific cutoffs for the AUDIT and DUDIT. An improved understanding of the impacts of gender diversity and evolving gender roles and norms on behaviors and mental health is warranted.

Drug use and re-imprisonment: A prospective study of the Norwegian Offender Mental Health and Addiction (NorMA) cohort

Background

Re-imprisonments are common among people in prison who use drugs. This study aims to describe sociodemographic factors, mental health and level of pre-prison substance use in a cohort of people in prison, and to investigate re-imprisonment during follow-up according to their level of pre-prison drug use.

Methods

This was a prospective study using baseline data from the Norwegian Offender Mental Health and Addiction (NorMA) cohort (n = 733) recruited in 2013-2014 linked to data from the Norwegian Prison Registry and the Norwegian Cause of Death Registry. Self-reported drug use before imprisonment was measured at baseline using the Drug Use Disorder Identification Test (DUDIT). The outcome of interest was re-imprisonment examined using Cox regression. We excluded 32 persons because they were not released before the study ended. The study sample included 701 persons, with a total time-at-risk of 2479 person-years.

Results

Almost half of the study sample reported high-risk drug use before imprisonment (DUDIT score >24). During the study period, 43% (n = 267) were re-imprisoned. People with high-risk use had a hazard ratio (HR) of 4.20 (95% CI: 2.95-5.97) of re-imprisonment compared with people with low-risk use (DUDIT score <6). Older age and more education than primary school were associated with a reduced risk of re-imprisonment.

Conclusion

Compared with low-risk use, high-risk drug use is highly prevalent among people in prison and is associated with higher rates of re-imprisonment. This highlights the need for screening and treatment of drug use disorders among people in prisons.

Alcohol Use Disorder Displays Trait-Related Reductions in Prosocial Decision Making

BACKGROUND

Alcohol use disorder (AUD) is associated with deficits in social cognition, but the relationship between harmful alcohol use and the processes underlying interactive social behavior is still unknown. We hypothesized that prosocial decision making is reduced in AUD and that individual differences in the underlying processes are key to better understanding these reductions.

METHODS

In one laboratory study (Swedish participants, n = 240) and one confirmatory online study (American participants, n = 260), we compared young adults with AUD with age-, gender-, and education-matched healthy control subjects on 6 facets of prosocial decision making. We used standardized behavioral economic tasks, namely the dictator game, ultimatum game, trust game, and third-party game. To better understand the expected differences in prosociality, we evaluated attention by tracking eye gaze, decision response time, clinical symptoms, and social cognition.

RESULTS

Altruism (lab study: p = .007; online study: p < .001), fairness (lab study: p = .003; online study: p = .007), and reciprocal trust (lab study: p = .007; online study: p = .039) were reduced in individuals with AUD compared with healthy control subjects, whereas trust and third-party punishment and compensation were comparable in both studies. Reduced prosociality was associated with attending to the selfish response option, faster response time, and moral attitudes, while being dissociated from both psychiatric symptoms and drinking history in AUD.

CONCLUSIONS

Individuals with AUD have trait-related reductions in prosocial decision making that do not vary with drinking history or psychiatric symptom load. These reductions were confined to one-to-one interactions accompanied by differences in attention, decision time, and moral attitudes.

An evaluation of eight short versions of the Drug Use Disorder Identification Test (DUDIT). A prison population study

Background

The eleven-item Drug Use Disorder Identification Test (DUDIT) is a recommended screening tool, but its length may impede its use in prison intake assessments. Hence, we examined the performance of eight brief DUDIT screeners against the full DUDIT, employing a sample of male inmates.

Methods

Our study included male participants in the Norwegian Offender Mental Health and Addiction (NorMA) study who reported pre-prison drug use and who had been incarcerated three months or less (n = 251). We performed receiver operating characteristic curve (ROC) analyses and estimated the area under the curve (AUROC) to assess the performance of DUDIT-C (four drug consumption items) and five-item versions that consisted of DUDIT-C and one additional item.

Results

Almost all (95%) screened positive on the full DUDIT (scores ≥6) and 35% had scores that were indicative of drug dependence (scores ≥25). The DUDIT-C performed very well in detecting likely dependence (AUROC=0.950), but some of the five-item versions performed significantly better. Of these, the DUDIT-C + item 5 (craving) had the highest AUROC (0.097). A cut-point of ≥9 on the DUDIT-C and ≥11 on the DUDIT-C + item 5 identified virtually all (98% and 97%, respectively) cases of likely dependence, with a specificity of 73% and 83%, respectively. At these cut-points, the occurrence of false positives was modest (15% and 10%, respectively) and only 4-5% were false negatives.

Conclusions

The DUDIT-C was highly effective in detecting likely drug dependence (according to the full DUDIT), but some combinations of DUDIT-C and one additional item performed better.