Measuring Drug Use and Key Risk, Mediating and Moderating Factors

1. 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

2. Substance Use Dimensions • type • frequency • quantity • time frame • developmental stage • problems • substance use disorders

3. 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

4. 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

5. 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

6. Lifetime Drinking History • type • frequency • quantity Time frame: “phases” Skinner & Sheu (1982) J Stud Alcohol

7. 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)

8. 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)

9. 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)

10. Adolescent Substance Problems Screening Questionnaires Client 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, 198 Martin & Winters (1998): Alcohol Health Research World

11. Drug Use Screening Inventory • Substance type & frequency screen • 159 true/false items • 10 Domains Substance Use Family System Behavior Pattern School Adjustment Health Status Work Adjustment Psychiatric Disorder Peer relationships Social Competency Recreation

12. 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

13. Handbook of Psychiatric Measures Information Provided for Each Measure • Goals • Description • Practical Issues • Psychometric Properties • Clinical Utility • References

14. 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

15. 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

16. Environmental Risk Factors • Family environment • Parent SUDs • Parent psychopathology • Physical or sexual abuse • Peer environment • Macrosocial environment Tarter et al. (1999): Development and Psychopathology

17. Risk Factor Measures • K-SADS Trauma Interview • for each trauma experience • mother, adolescent report • date(s), multiple events • perpetrator(s) • if witness, victim

18. 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

19. Mediating Phenotypes • Behavioral dysregulation • behavioral undercontrol • antisocial behavior • conduct disorder • Emotional dysregulation • anxiety & depression • negative affect disorders

20. 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

21. 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

22. CEDAR Website http://www.pitt.edu/~cedar • Interactive Website for substance abuse • Etiology of Substance Abuse—Online Reference Archive (contract funded by NIDA, 1996-present) • Drug and Alcohol Forum—Online education and certification of addiction counselors

23. PAARC Website http://www.pitt.edu/~paarc/paarc.html • Website describing program • Article abstracts • Links to other alcohol sites • Faculty addresses