# Presentation: 224415

## 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

**Substance Use Dimensions**

- type
- frequency
- quantity
- time frame
- developmental stage
- problems
- substance use disorders

## Substance Type

**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

**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

**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

**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? (_T_olerance)
- Have close friends or relatives _w_orried...?
- Do you...drink...when you first get up?  (_E_ye-opener)
- Has a friend...you could not remember?  (_A_mnesia)
- Do you...feel the need to _c_ut 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 Questionnaires

**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**

## Drug Use Screening Inventory

**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

## Handbook of Psychiatric Measures

**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

**Handbook of Psychiatric Measures**

**Information Provided for Each Measure**
- Goals
- Description
- Practical Issues
- Psychometric Properties
- Clinical Utility
- References

## Handbook of Psychiatric Measures

**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

**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 

**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 

**Mediating Phenotypes **

- Behavioral dysregulation
- behavioral undercontrol
- antisocial behavior
- conduct disorder
- Emotional dysregulation
- anxiety & depression
- negative affect disorders

## Dysregulation constructs 

**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 

**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**

## CEDAR Website

- 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

*http://www.pitt.edu/~cedar*

## PAARC Website

- Website describing program
- Article abstracts
- Links to other alcohol sites
- Faculty addresses

*http://www.pitt.edu/~paarc/paarc.html*