Measuring Drug Use and Key Risk, Mediating and

Moderating Factors

Duncan B. Clark, M.D., Ph.D.

University of Pittsburgh

Assessing the Impact of Childhood Interventions on Subsequent Drug Use

Washington DC: May 23-24, 2000

Substance Use Dimensions

• type

• frequency

• quantity

• time frame

• developmental stage

• problems

• substance use disorders

Substance Type

alcohol barbituates

marijuana club drugs

amphetamines alcohol

methamphetamine cigarettes

heroin steroids

tranquilizers

Johnson, O’Malley, Bachman (1999):

Monitoring the Future: Overview of Key Findings

Substance Use Frequency

Drugs other than alcohol and cigarettes• ever• past 12 months• past 30 days

Frequency:

0, 1-2, 3-5, 6-9, 10-19, 20-39, 40+

Johnson, O’Malley & Bachman (1999)

Monitoring the Future: Overview of Key Findings

Time-line Follow Back

Daily occurrence• type (alcohol, other drugs)• frequency• quantity

Time frame: Past month

Sobell & Sobell (1994)

Time-line follow Back Users Manual

Lifetime Drinking History

• type

• frequency

• quantity

Time frame: “phases”

Skinner & Sheu (1982) J Stud Alcohol

CAGE Alcohol Screen• Have you felt the need to stop or cut down on drinking?

• Have you been angry or annoyed at other people talking about or criticizing your drinking?

• Have you felt guilty...something you did when...drinking?

• How often have you taken a drink first thing in the morning? (early morning drinking)

• Optimal cut-score = 1

– sensitivity = .67

– specificity = .82

Chung et al Screening adolescents… J Stud Alc (in press)

TWEAK Alcohol Screen• How many drinks can you hold? (Tolerance)• Have close friends or relatives worried...?• Do you...drink...when you first get up? (Eye-opener)• Has a friend...you could not remember? (Amnesia)• Do you...feel the need to cut down on your drinking?

• Optimal cut-score = 2– sensitivity = .73– specificity = .90

Chung et al Screening adolescents… J Stud Alc (in press)

AUDIT Alcohol Screen

• 3 questions: quantity, frequency, binge or risk drinking

• 4 questions: alcohol dependence

• 3 questions: alcohol-related negative consequences

• Optimal cut-score = 4– sensitivity = .95– specificity = .80

Chung et al Screening adolescents… J Stud Alc (in press)

Adolescent Substance Problems Screening QuestionnairesClient Substance Index Thomas 1990

DAP Quick Screen Schwartz & Wirtz 1990

DUSI - R Tarter et al., 1992

PESQ Winters 1992

POSIT Rahdert 1991

AAIS Mayer & Filsted 1979

ADI Harrell & Wirtz 1989

RAPI White & Labouvie, 198Martin & Winters (1998): Alcohol Health Research World

Drug Use Screening Inventory

• Substance type & frequency screen

• 159 true/false items

• 10 DomainsSubstance Use Family System

Behavior Pattern School Adjustment

Health Status Work Adjustment

Psychiatric Disorder Peer relationships

Social Competency Recreation

Handbook of Psychiatric Measures

Preparation: 1995 - 1999

• APA Task Force

• 27 domains defined

• principal contributors identified

• candidate measures compiled

• outside advisors consulted

• final selection of measures

Handbook of Psychiatric Measures

Information Provided for Each Measure

• Goals

• Description

• Practical Issues

• Psychometric Properties

• Clinical Utility

• References

Handbook of Psychiatric Measures

Substance Use Disorders Measures (1)

• Alcohol Timeline Followback*

• AUDIT*, CAGE*, TWEAK*

• Michigan Alcohol Screening Test

• Alcohol Dependence Scale*

• Alcohol Expectancy Questionaire*

• Withdrawal Assessment for Alcohol

Handbook of Psychiatric Measures

Substance Use Disorders Measures (2)

• OC Drinking Scale*

• Drug Abuse Screening Test

• Personal Experience Screening Ques

• Addiction Severity Index*

• Fagerstrom - Nicotine Dependence

• URI Change Assessment

Environmental Risk Factors

• Family environment– Parent SUDs

– Parent psychopathology

• Physical or sexual abuse

• Peer environment

• Macrosocial environment

Tarter et al. (1999): Development and Psychopathology

Risk Factor Measures

• K-SADS Trauma Interview– for each trauma experience

• mother, adolescent report

• date(s), multiple events

• perpetrator(s)

• if witness, victim

Risk Factor Measures

• K-SADS Trauma Interview– Trauma events screen

• car accident• other accident• fire• witness natural disaster• witness violent crime• victim of violent crime• witness to domestic violence• physical abuse• sexual abuse

Mediating Phenotypes

• Behavioral dysregulation– behavioral undercontrol

– antisocial behavior

– conduct disorder

• Emotional dysregulation– anxiety & depression

– negative affect disorders

Dysregulation constructs

• Behavioral Undercontrol– CD symptom count

– DUSI Undercontrol Factor

– MPQ - Aggression

– MPQ - Harm Avoidance

– MPQ - Constraint

Martin, Lynch, Pollock & Clark (in press)

Psychology of Addictive Behaviors

Dysregulation constructs

• Negative Emotionality– Beck Depression Inventory

– Hamilton Anxiety Rating Scale

– MPQ - Stress Reactivity

– CBCL - Internalizing Factor

Martin, Lynch, Pollock & Clark (in press)

Psychology of Addictive Behaviors

Interactive Website for substance abuse Interactive Website for substance abuse Etiology of Substance Abuse—Online Etiology of Substance Abuse—Online

Reference Archive (contract funded by Reference Archive (contract funded by NIDA, 1996-present)NIDA, 1996-present)

Drug and Alcohol Forum—Online Drug and Alcohol Forum—Online education and certification of addiction education and certification of addiction counselorscounselors

CEDAR WebsiteCEDAR Websitehttp://www.pitt.edu/~cedarhttp://www.pitt.edu/~cedar

CEDAR WebsiteCEDAR Websitehttp://www.pitt.edu/~cedarhttp://www.pitt.edu/~cedar

Website describing program Website describing program Article abstractsArticle abstracts Links to other alcohol sitesLinks to other alcohol sites Faculty addressesFaculty addresses

PAARC WebsitePAARC Websitehttp://www.pitt.edu/~paarc/paarc.htmlhttp://www.pitt.edu/~paarc/paarc.html

PAARC WebsitePAARC Websitehttp://www.pitt.edu/~paarc/paarc.htmlhttp://www.pitt.edu/~paarc/paarc.html