Diagnosinstrument För Beroende och Missbruk

Abstract

The Swedish National Board on Health and Welfare recommends that structured assessment instruments should be used in medical as well as in social treatment of substance misusers. These should be validated in a Swedish context. Instruments for diagnoses of dependence/abuse (DSM-IV) and dependence/harmful use (ICD-10) have been used in Sweden for many years, although not yet validated in Swedish. ADDIS, the Swedish version of the American SUDDS, is used in four Nordic countries and the most often used diagnostic instrument in Sweden. This article investigates the psychometric properties of ADDIS alcohol module, including discriminant and construct validity and internal consistency. The two main constructs in DSM – dependence and abuse – as well as the seven criteria for dependence and the four criteria for abuse are studied. Further, the value of each of the 44 specific items in ADDIS for capturing these criteria is studied. Two samples are explored: 1) a clinical sample (n = 349; incl. 129 women) and 2) a sample of 400 men convicted for driving while intoxicated. Mean age was the same (41 ys.). Using discriminant analyses on lifetime prevalence, the items correctly classify 94% of the cases in the two samples. Using one-factor principal component analysis to explore homogeneity of the combined samples, all 28 items on dependence and 15 of 18 items on abuse have loadings above 0,40 (R² dependence = 0,46; abuse = 0,40). Separate analyses of the two samples, as well as on women, show similar results. Cronbach's alpha is excellent for dependence and satisfactory for abuse in all analyses. Analyses of specific criteria show satisfactory results on dependence and acceptable on abuse. Minor revisions are proposed to make ADDIS more user-friendly and to improve some specific items. In conclusion: ADDIS has acceptable to excellent discriminant and construct validity as well as internal consistency and captures the specific criteria of DSM-IV. It has the preconditions for sensitive assessment of alcohol use disorders in men and women.

Keywords

Diagnostic instrument alcohol dependence homogeneity discriminant validity reliability

References

APA (1994): Diagnostic and Statistical Manual of Mental Disorders, 4th ed. rev. (DSM-IV) Washington, DC: American Psychiatric Association (APA)

Bergmark

Å.

, & Lundström

(1998): Metoder i socialt arbete. Socialvetenskaplig Tidskrift 5 (4): 291–314

Cottler

L.B.

(1993): Comparing DSM-III-R and ICD-10 substance use disorders. Addiction 88 (5): 689–696

Davis

L. J.

Jr. , & Hoffmann

N.G.

, & Morse

R. M.

6 Luehr

(1992): Substance use disorder diagnostic schedule and an interviewer-administered format. Alcoholism: Clinical and Experimental Research 16 (2): 250–254

Dawson

D.A.

, & Grant

B.F.

, & Harford

T.C.

(1995): Variation in the association of alcohol consumption with five DSM-IV alcohol problem domains. Alcoholism: Clinical and Experimental Research 19: 66–74

DeRubeis

R.J.

, & Brotman

M.A.

, & Gibbons

C.J.

(2005): A conceptual and methodological analysis of the nonspecifics argument. Clinical psychology: Science and Practice 12: 174–183

Erickson

C.K.

(2007): The science of addiction – From neurobiology to treatment. New York: W. W. Norton & Company, Inc.

Feingold

, & Rounsaville

(1995): Construct validity of the abuse-dependence distinction as measured by DSM-IV criteria for different psychoactive substances. Drug and Alcohol Dependence 39: 99–109

Gerdner

(2004): Utfall av LVM-vård – Översikt och syntes av hittillsvarande studier. I: Forskningsrapporter, Bilagedel till LVM-utredningens betänkande “Tvång och förändring”, SOU 2004:3. Stockholm: Socialdepartementet, 303–414

10.

Gerdner

, & Fridell

(2007): Effects of psychologists' assessments of patients within compulsory care – A matched-control trial. 50th International ICAA Conference on Dependences, Stockholm, June

11.

Grant

B.F.

(1993): ICD-10 and proposed DSM-IV harmful use of alcohol/alcohol abuse and dependence, United States 1988: A nosological comparison. Alcoholism: Clinical and Experimental Research 17 (5): 1093–1101

12.

Grant

B.F.

(2000): Theoretical and observed subtypes of DSM-IV alcohol abuse and dependence in a general population sample. Drug and Alcohol Dependence 60 (3): 287–293

13.

Grant

B.F.

, & Chou

S. P.

, & Pickering

R. P.

, & Hasin

D.S.

(1992): Empirical subtypes of DSM-III-R alcohol dependence: United States, 1988”. Drug and Alcohol Dependence 30 (1): 75–84

14.

Harrison

P.A.

, & Hoffmann

N.G.

(1985): SUDDS: Substance Use Disorder Diagnostic Schedule. St. Paul, MN: Ramsey Clinic Associates

15.

Hasin

D.S.

, & Grant

B.G.

, & Harford

T.C.

, & Endicott

(1988): The drug dependence syndrome and related disabilities. British Journal of Addiction 83: 45–55

16.

Hasin

, & Paykin

(1998): Dependence symptoms but no diagnosis: diagnostic ‘orphans’ in a community sample. Drug and Alcohol Dependence 50: 19–26

17.

Hasin

, & Van Rosem

, & Mc Cloud

, & Endicott

(1997): Alcohol Dependence and Abuse Diagnoses: Validity in community sample of heavy drinkers. Alcoholism: Clinical and Experimental Research 21: 213–219

18.

Hoffmann

N. G.

, & Harrison

P.A.

(1996): SUDDS-IV (Substance use disorder diagnostic Schedule-IV) Manual

19.

Hoffmann

N.G.

, & Harrison

P.A.

, & Wickström

.(1987): ADDIS – Alkohol, Drog Diagnos InStrument, Manual. Åre: 4M Konsult AB

20.

Hoffmann

N.G.

, & Hoffmann

T.D.

(2003): Construct validity for alcohol dependence as indicated by the SUDDS-IV. Substance Use & Misuse 38 (2): 293–306

21.

Hoffmann

N.G.

, & Olofsson

, & Salén

, & Wickström

(1995): Prevalence of abuse and dependency in chronic pain patients. International Journal of the Addictions 30 (8): 919–927

22.

Jonasson

, & Jonasson

, & Ekselius

, & von Knorring

(1997): The feasibility of a new intake routine to assess substance use disorders by means of a structured interview. General Hospital Psychiatry 19: 36–41

23.

Jonasson

, & Jonasson

, & Wickström

, & Andersson

, & Saldeen

(1998): Analgesic use disorders among orthopedic and chronic pain patients at a rehabilitation clinic. Substance Use & Misuse 33 (6): 1375–1385

24.

Mee-Lee

, & Shulman

G.D.

, & Fishman

, & Gastfriend

D.R.

, & Griffith

J.H.

(2001): ASAM Patient Placement Criteria for the Treatment of Substance-Related Disorders, Second Edition-Revised (ASAM PPC-2R). Chevy Chase, MD, American Society of Addiction Medicine, Inc. (ASAM)

25.

Muthén

, & Grant

, & Hasin

(1993a): The dimensionality of alcohol abuse and dependence: factor analysis of DSM-III-R and proposed DSM-IV criteria in the 1988 National Health Interview Survey. Addiction 88: 1079–1090

26.

Muthén

, & Hasin

, & Wisnicki

K. S.

(1993b): Factor analysis of ICD-10 symptom items in the 1988 National Health Interview Survey on Alcohol Dependence. Addiction 7: 1071–1077

27.

Muthén

(1996): Psychometric evaluation of diagnostic criteria: Application to a 2-dimensional model of alcohol abuse and dependence. Drug and Alcohol Dependence 41 (2): 101–112

28.

Robins

L.N.

, & Helzer

J.E.

, & Ratcliff

K.S.

, & Seyfried

W.S.

(1982): Validity of the Diagnostic Interview Schedule, Version II-DSM-III diagnoses. Psychological Medicine 12: 855–870

29.

Rounsaville

B.J.

, & Bryant

, & Babor

T.F.

, & Kranzler

H. R.

, & Kadden

(1993): Cross system agreement for substance use disorders: DSM-III-R, DSM-IV and ICD-10. Addiction 88 (3): 337–348

30.

Sarr

, & Bucholz

K. K.

, & Phelps

D. L.

(2000): Using cluster analysis of alcohol use disorders to investigate ‘diagnostic orphans’: subjects with alcohol dependence symptoms but no diagnosis. Drug and Alcohol Dependence 60: 295–302

31.

SOU (2004): Tvång och förändring. Rättsäkerhet, vårdens innehåll och eftervård. Betänkande från LVM-utredningen. Stockholm: Statens offentliga utredningar 3, Socialdepartementet

32.

SOU (2005): Personer med tungt missbruk – Stimulans till bättre vård och behandling. Betänkande av utredningen om en vård-överenskommelse om missbrukarvården. Stockholm: Statens Offentliga Utredningar 82, Socialdepartementet

33.

SoS (2003): Organisation, resurser och insatser inom offentlig narkomanvård (ORION). Stockholm: Socialstyrelsen (SoS)

34.

SoS (2007): Nationella riktlinjer för miss-bruks- och beroendevård. Vägledning för socialtjänstens och hälso- och sjukvårdens verksamhet för personer med missbruks-och beroendeproblem. Stockholm: Social-styrelsen (SoS)

35.

Streiner

D.L.

, & Normann

G.R.

(1989): Health measurement scales: a practical guide to their development and use. Oxford: Oxford University Press

36.

WHO (1993): The ICD-10 Classification of Mental and Behavioural Disorders. Diagnostic criteria for research. Geneva: World Health Organization (WHO) 49–63

37.

Wickström

(2007): ADDIS – Alkohol, Drog Diagnos InStrument, Manual. Åre: 4M Konsult AB.

38.

Wickström

Lynn

; personlig kommunikation: e-post 16.04.2009.