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Hernandez-Vallant A, Votaw VR, Herron JL, Stein ER, Swan JE, Ulrich DM, Blackwell MA, McCrady BS. A clinical science guide for reviewing the cross-cultural rigor of assessments in an alcohol training clinic. Psychol Serv 2024; 21:305-316. [PMID: 36689373 PMCID: PMC10363250 DOI: 10.1037/ser0000738] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
A standard component of service delivery in alcohol treatment clinics is evidence-based assessment (EBA). Although EBA is essential for selecting appropriate treatment modalities for alcohol use and associated problems, there are limitations in existing EBAs concerning evidence of cultural equivalence and utility among individuals seeking alcohol treatment. However, training in EBA, addictions, and clinical applications with diverse populations all are gaps in clinical training in doctoral programs in clinical psychology. The present work used the clinical science model to review the psychometric properties, cross-cultural utility, and measurement invariance of measures in an assessment battery used in an alcohol treatment training clinic. This article describes the results of that review, recommendations for retaining or replacing common assessment measures used in alcohol treatment clinics, and recommendations for alcohol treatment clinics interested in engaging in similar processes. Findings suggested that more research is needed to evaluate the psychometric properties of EBAs utilized in an alcohol treatment assessment battery, particularly among American Indian and Alaska Native people, and to test measurement invariance across race/ethnicity and other identity groups in alcohol treatment-seeking populations. Overall, routine reviews of cultural relevance are needed in clinical settings to stay current with the emerging literature. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Alexandra Hernandez-Vallant
- Department of Psychology, University of New Mexico
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico
| | - Victoria R. Votaw
- Department of Psychology, University of New Mexico
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico
| | - Jalene L. Herron
- Department of Psychology, University of New Mexico
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico
| | - Elena R. Stein
- Department of Psychology, University of New Mexico
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico
| | - Julia E. Swan
- Department of Psychology, University of New Mexico
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico
| | | | | | - Barbara S. McCrady
- Department of Psychology, University of New Mexico
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico
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2
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Boness CL, Carlos Gonzalez J, Sleep C, Venner KL, Witkiewitz K. Evidence-Based Assessment of Substance Use Disorder. Assessment 2024; 31:168-190. [PMID: 37322848 PMCID: PMC11059671 DOI: 10.1177/10731911231177252] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The current review describes updated information on the evidence-based assessment of substance use disorder. We offer an overview of the state of the science for substance-related assessment targets, instruments (screening, diagnosis, outcome and treatment monitoring, and psychosocial functioning and wellbeing) and processes (relational and technical) as well as recommendations for each of these three components. We encourage assessors to reflect on their own biases, beliefs, and values, including how those relate to people that use substances, and to view the individual as a whole person. It is important to consider a person's profile of symptoms and functioning inclusive of strengths, comorbidities, and social and cultural determinants. Collaborating with the patient to select the assessment target that best fits their goals and integration of assessment information in a holistic manner is critical. We conclude by providing recommendations for assessment targets, instruments, and processes as well as recommendations for comprehensive substance use disorder assessment, and describe future directions for research.
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Affiliation(s)
- Cassandra L Boness
- University of New Mexico, Center on Alcohol, Substance use, And Addictions, Albuquerque, NM, USA
| | | | - Chelsea Sleep
- Cincinnati VA Medical Center, OH, USA
- University of Cincinnati, OH, USA
| | - Kamilla L Venner
- University of New Mexico, Center on Alcohol, Substance use, And Addictions, Albuquerque, NM, USA
| | - Katie Witkiewitz
- University of New Mexico, Center on Alcohol, Substance use, And Addictions, Albuquerque, NM, USA
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3
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Beresford TP, Ronan PJ, Taub J, Learned B, Mi Z, Anderson M. Working Toward a Gold Standard: The Severity of Ethanol Withdrawal Scale (SEWS) Versus the Clinical Institute Withdrawal Assessment Alcohol Scale (CIWA-Ar). Alcohol Alcohol 2023; 58:324-328. [PMID: 36935201 PMCID: PMC10168711 DOI: 10.1093/alcalc/agad016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/14/2023] [Accepted: 02/14/2023] [Indexed: 03/21/2023] Open
Abstract
AIM Proving the Severity of Ethanol Withdrawal Scale (SEWS) significantly reduces Alcohol Withdrawal Syndrome (AWS) treatment Time on Medication Protocol (TOMP). METHOD Head-to-head Quality Assurance outcome compared separate cohorts of SEWS or Clinical Institute Withdrawal Assessment Alcohol Scale, Revised (CIWA-Ar) data using Student's t and Wilcoxon tests. RESULTS SEWS-driven treatment (n = 244) reduced TOMP to 2.2 days versus 3.4 days for CIWA-Ar (n = 137); P < 0.0001. CONCLUSION The SEWS is the superior measure of AWS symptoms.
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Affiliation(s)
- Thomas P Beresford
- Laboratory for Clinical and Translational Research in Psychiatry, Rocky Mountain Regional VA Medical Center, Aurora, CO 80045, USA
- Department of Psychiatry, School of Medicine, University of Colorado Denver, Aurora, CO 80045, USA
| | - Patrick J Ronan
- Research Service, Sioux Falls VA Healthcare System, Sioux Falls, SD 57105, USA
- Department of Psychiatry and Division of Basic Biomedical Research, Sanford School of Medicine, University of South Dakota, Sioux Falls, SD 57105 USA
| | - Julie Taub
- Department of Internal Medicine, Denver Health Medical Center, Denver, CO 80204, USA
- Department of Psychiatry, School of Medicine, University of Colorado Denver, Aurora, CO 80045, USA
| | - Brenda Learned
- VHA Office of Community Care - Revenue, VISN 19: Rocky Mountain Network
| | - Zhibao Mi
- Cooperative Studies Program, Perry Point VA Medical Center, Perry Point, MD 21902, USA
- University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Mel Anderson
- Laboratory for Clinical and Translational Research in Psychiatry, Rocky Mountain Regional VA Medical Center, Aurora, CO 80045, USA
- Department of Psychiatry, School of Medicine, University of Colorado Denver, Aurora, CO 80045, USA
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4
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Watts AL, Watson D, Heath AC, Sher KJ. Alcohol use disorder criteria exhibit different comorbidity patterns. Addiction 2023. [PMID: 36606740 DOI: 10.1111/add.16121] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 12/12/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND AIMS Alcohol use disorder is comorbid with numerous other forms of psychopathology, including externalizing disorders (e.g. conduct disorder) and, to a lesser extent, internalizing conditions (e.g. depression, anxiety). Much of the time, overlap among alcohol use disorder and other conditions is explored at the disorder level, assuming that criteria are co-equal indicators of other psychopathology, even though alcohol use disorder criteria span numerous varied domains. Emerging evidence suggests that there are symptom clusters within the construct of alcohol use disorder that relate differentially with important external criteria, including psychopathology and allied personality traits (e.g. impulsivity, novelty-seeking). The present study mapped individual alcohol use disorder criteria onto internalizing and externalizing dimensions. DESIGN AND PARTICIPANTS We used multivariate and factor analytical modeling and data from two large nationally representative samples of past year drinkers (n = 25 604; 19 454). SETTING United States. MEASUREMENTS Psychopathology was assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule, yielding alcohol use disorder criteria, internalizing diagnoses (i.e. major depressive disorder, dysthymia, social anxiety disorder, generalized anxiety disorder, specific phobia, agoraphobia and panic disorder) and externalizing diagnoses and symptoms (i.e. antisocial personality disorder, conduct disorder and three impulsivity items drawn from borderline personality disorder criteria). Alcohol consumption was assessed in terms of past-year drinking frequency, usual amount of alcohol consumed on drinking days, binge drinking frequency, intoxication frequency, and maximum number of drinks in a 24-hour period. FINDINGS Four different patterns emerged. First, several alcohol use disorder criteria were relatively weakly associated with externalizing and internalizing. Secondly, withdrawal was associated with internalizing, but this association was not specific to distress. Thirdly, there was a general lack of specificity between alcohol use disorder criteria and narrower forms of internalizing, despite what might be predicted by modern models of addiction. Fourthly, recurrent use in hazardous situations reflected higher degrees of externalizing and lower internalizing liability. CONCLUSIONS Different symptom combinations appear to yield differential expressions of alcohol use disorder that are disorder-specific, or reflect broader tendencies toward externalizing, internalizing or both.
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Affiliation(s)
- Ashley L Watts
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
| | - David Watson
- Department of Psychology, University of Notre Dame, Notre Dame, IN, USA
| | - Andrew C Heath
- School of Medicine, Department of Psychiatry, Washington University, St Louis, MI, USA
| | - Kenneth J Sher
- Department of Psychological Sciences, University of Missouri, Columbia, MO, USA
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5
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Dora J, Piccirillo M, Foster KT, Arbeau K, Armeli S, Auriacombe M, Bartholow B, Beltz AM, Blumenstock SM, Bold K, Bonar EE, Braitman A, Carpenter RW, Creswell KG, De Hart T, Dvorak RD, Emery N, Enkema M, Fairbairn C, Fairlie AM, Ferguson SG, Freire T, Goodman F, Gottfredson N, Halvorson M, Haroon M, Howard AL, Hussong A, Jackson KM, Jenzer T, Kelly DP, Kuczynski AM, Kuerbis A, Lee CM, Lewis M, Linden-Carmichael AN, Littlefield A, Lydon-Staley DM, Merrill JE, Miranda R, Mohr C, Read JP, Richardson C, O’Connor R, O’Malley SS, Papp L, Piasecki TM, Sacco P, Scaglione N, Serre F, Shadur J, Sher KJ, Shoda Y, Simpson TL, Smith MR, Stevens A, Stevenson B, Tennen H, Todd M, Treloar Padovano H, Trull T, Waddell J, Walukevich-Dienst K, Witkiewitz K, Wray T, Wright AG, Wycoff AM, King KM. The daily association between affect and alcohol use: A meta-analysis of individual participant data. Psychol Bull 2023; 149:1-24. [PMID: 37560174 PMCID: PMC10409490 DOI: 10.1037/bul0000387] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Influential psychological theories hypothesize that people consume alcohol in response to the experience of both negative and positive emotions. Despite two decades of daily diary and ecological momentary assessment research, it remains unclear whether people consume more alcohol on days they experience higher negative and positive affect in everyday life. In this preregistered meta-analysis, we synthesized the evidence for these daily associations between affect and alcohol use. We included individual participant data from 69 studies (N = 12,394), which used daily and momentary surveys to assess affect and the number of alcoholic drinks consumed. Results indicate that people are not more likely to drink on days they experience high negative affect, but are more likely to drink and drink heavily on days high in positive affect. People self-reporting a motivational tendency to drink-to-cope and drink-to-enhance consumed more alcohol, but not on days they experienced higher negative and positive affect. Results were robust across different operationalizations of affect, study designs, study populations, and individual characteristics. These findings challenge the long-held belief that people drink more alcohol following increases in negative affect. Integrating these findings under different theoretical models and limitations of this field of research, we collectively propose an agenda for future research to explore open questions surrounding affect and alcohol use.
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Affiliation(s)
- Jonas Dora
- University of Washington; Seattle, United States
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Noah Emery
- Colorado State University; Fort Collins, United States
| | | | | | | | | | | | | | | | | | | | | | - Andrea Hussong
- University of North Carolina; Chapel Hill, United States
| | | | | | | | | | - Alexis Kuerbis
- Hunter College of the City University of New York; New York, United States
| | | | - Melissa Lewis
- University of North Texas; Fort Worth, United States
| | | | | | | | | | | | - Cynthia Mohr
- Portland State University; Portland, United States
| | | | | | | | | | - Lauren Papp
- University of Wisconsin; Madison, United States
| | | | - Paul Sacco
- University of Maryland; Baltimore, United States
| | | | | | | | | | - Yuichi Shoda
- University of Washington; Seattle, United States
| | - Tracy L. Simpson
- University of Washington; Seattle, United States
- VA Puget Sound Healthcare System; Seattle, United States
| | | | | | | | - Howard Tennen
- University of Connecticut; Farmington, United States
| | | | | | - Timothy Trull
- University of Missouri-Columbia; Columbia, United States
| | | | | | | | - Tyler Wray
- Brown University; Providence, United States
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6
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Howe LK, Bailey AJ, Ingram PF, Finn PR. An exploration of multivariate symptom clusters of cannabis use disorder in young adults. Addict Behav 2022; 135:107465. [PMID: 35995015 DOI: 10.1016/j.addbeh.2022.107465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/01/2022] [Accepted: 08/15/2022] [Indexed: 11/16/2022]
Abstract
AIMS Since the release of the DSM-V, CUD has been understood as a unidimensional construct. However, continued research has identified separate symptom clusters relating to consumption, loss of control, and withdrawal within substance use disorder criteria that may pose separate risk factors and functional difficulties. The current study aims to examine how symptom clusters commonly manifest in young adults that use cannabis using a latent class analysis (LCA) and explore how these clusters are related to co-occurring psychological constructs. METHODS 1174 (aged 18-34) participants completed a battery of assessments on substance use and other psychological constructs. LCA was conducted on 17 symptoms corresponding with DSM-V CUD criteria. Multinomial regressions were used to examine class membership and commonly co-occurring psychopathology and psychological constructs. RESULTS LCA results identified a 'No problems' class, a 'Moderate consumption' class characterized by moderate probability of endorsing consumption items, a 'Consumption with Moderate Loss of Control' class, characterized by endorsing consumption and loss of control items but minimal endorsement of withdrawal items, a 'Consumption with Moderate Withdrawal' class characterized by moderate probability of endorsing all item types, and 'High Consumption, Loss of Control, Withdrawal' class characterized by high probability of endorsing all items. Multinomial regressions indicated some class differences in psychological constructs. CONCLUSIONS Symptom clusters differed in terms of CUD criteria, especially for those in our sample with moderate/severe problems. Findings suggest intervention efforts may benefit from treatment targeted at various presentations of CUD.
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Affiliation(s)
- Lindy K Howe
- Department of Psychological & Brain Sciences, Indiana University Bloomington, IN 47405, USA.
| | - Allen J Bailey
- Department of Psychological & Brain Sciences, Indiana University Bloomington, IN 47405, USA
| | - Polly F Ingram
- Department of Psychological & Brain Sciences, Indiana University Bloomington, IN 47405, USA
| | - Peter R Finn
- Department of Psychological & Brain Sciences, Indiana University Bloomington, IN 47405, USA
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7
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Boness CL, Gatten N, Treece M, Miller MB. A mixed-methods approach to improve the measurement of alcohol-induced blackouts: ABOM-2. Alcohol Clin Exp Res 2022; 46:1497-1514. [PMID: 35702924 PMCID: PMC9427728 DOI: 10.1111/acer.14882] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/16/2022] [Accepted: 06/07/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Alcohol-induced blackouts describe memory loss resulting from alcohol consumption. Approximately half of college students report experiencing a blackout in their lifetime. Blackouts are associated with an increased risk for negative consequences, including serious injury. Research has documented two types of blackouts, en bloc (EB) and fragmentary (FB). However, research is limited by the lack of a validated measure that differentiates between these two forms of blackout. This study used a mixed-methods approach to improve the assessment of FB and EB among young adults. Specifically, we sought to improve the existing Alcohol-Induced Blackout Measure (ABOM), which was derived from a relatively small pool of items that did not distinguish FB from EB. METHODS Study 1 used three rounds of cognitive interviewing with U.S. college students (N = 31) to refine existing assessment items. Nineteen refined blackout items were retained for Study 2. Study 2 used face validity, factor analysis, item response theory, and external validation analyses to test the two-factor blackout model among U.S. heavy-drinking college students (N = 474) and to develop and validate a new blackout measure (ABOM-2). RESULTS Iterative factor analyses demonstrated that the items were well represented by correlated EB and FB factors, consistent with our hypothesis. External validation analyses demonstrated convergent and discriminant validity. These analyses also provided preliminary evidence for the two factors having differential predictive validity (e.g., FB correlated with enhancement drinking motives, while EB correlated with coping and conformity motives). CONCLUSIONS The Alcohol-Induced Blackout Measure-2 (ABOM-2) improves the measurement of blackout experiences among college students. Its use could facilitate the examination of EB and FB as differential predictors of alcohol-related outcomes in future studies.
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Affiliation(s)
- Cassandra L. Boness
- Center on Alcohol, Substance use, And Addictions, University of New Mexico,Department of Psychological Science, University of Missouri
| | - Natalie Gatten
- Department of Psychological Science, University of Missouri
| | - McKenna Treece
- Department of Psychological Science, University of Missouri,Department of Counseling and Counseling Psychology, University of Missouri Kansas City
| | - Mary Beth Miller
- Department of Psychological Science, University of Missouri,Department of Psychiatry, University of Missouri
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Livne O, Feinn R, Knox J, Hartwell EE, Gelernter J, Hasin DS, Kranzler HR. Alcohol withdrawal in past-year drinkers with unhealthy alcohol use: Prevalence, characteristics, and correlates in a national epidemiologic survey. Alcohol Clin Exp Res 2022; 46:422-433. [PMID: 35275407 PMCID: PMC8928097 DOI: 10.1111/acer.14781] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/19/2021] [Accepted: 01/22/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Despite its potential to produce serious adverse outcomes, DSM-5 alcohol withdrawal syndrome (AWS) has not been widely studied in the general population. METHODS We used cross-sectional data from 36,309 U.S. adults from the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III to examine the past-year prevalence of AWS and its correlates. We focused on an important clinical population-past-year drinkers with unhealthy alcohol use-i.e., those with a positive score on the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) questionnaire. We also examined the association of AWS with sociodemographic measures, psychiatric disorders, alcohol-related measures, and healthcare utilization. RESULTS Approximately one-third (n = 12,634) of respondents reported unhealthy alcohol use (AUDIT-C+). Of these, 14.3% met criteria for a DSM-5 AWS diagnosis. The mean (SE) number of withdrawal symptoms among individuals with AWS was 2.83 (1.88), with the most common being nausea/vomiting and insomnia (19.8% and 11.6%, respectively). Among AUDIT-C+ respondents, the odds of AWS were significantly higher among males (adjusted odds ratio [aOR] = 1.17 [95% CI, 1.02-1.33]), unmarried participants (aOR = 1.55 [95% CI, 1.25-1.92]), and those at the lowest (vs. highest) income levels (aOR = 1.62 [95% CI, 1.37-1.92]). Among AUDIT-C+ respondents, AWS was also associated with psychiatric disorders (with aORs that ranged from 2.08 [95% CI, 1.79-2.41]) for major depressive disorder to 3.14 (95% CI, 1.79-2.41) for borderline personality disorder. AUDIT-C+ respondents with AWS also had higher odds of past-year alcohol use disorder (aOR = 11.2 [95% CI, 9.66-13.07]), other alcohol-related features (e.g., binge drinking), and healthcare utilization. CONCLUSIONS Among individuals with unhealthy alcohol use, AWS is prevalent, highly comorbid, and disabling. Given the risk of AWS among unhealthy drinkers, a comparatively large segment of the general population, clinicians should seek to identify individuals with AWS and intervene with them to prevent serious adverse outcomes.
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Affiliation(s)
- Ofir Livne
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
| | - Richard Feinn
- Department of Medical Sciences, Frank H. Netter School of Medicine at Quinnipiac University, North Haven, CT
| | - Justin Knox
- Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York, NY,New York State Psychiatric Institute, HIV Center for Clinical and Behavioral Studies, New York, NY
| | - Emily E. Hartwell
- Center for Studies of Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine and Veterans Integrated Service Network 4 Mental Illness Research, Education and Clinical Center, Crescenz Veterans Affairs Medical Center, Philadelphia, PA
| | - Joel Gelernter
- Department of Psychiatry, Yale University School of Medicine and VA CT Healthcare Center, West Haven, CT
| | - Deborah S. Hasin
- Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, New York, NY
| | - Henry R. Kranzler
- Center for Studies of Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine and Veterans Integrated Service Network 4 Mental Illness Research, Education and Clinical Center, Crescenz Veterans Affairs Medical Center, Philadelphia, PA
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9
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Jargin S. Indications for magnesium supplementation an example of alcoholism. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:118-122. [DOI: 10.17116/jnevro2022122051118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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10
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Atroszko PA, Atroszko B, Charzyńska E. Subpopulations of Addictive Behaviors in Different Sample Types and Their Relationships with Gender, Personality, and Well-Being: Latent Profile vs. Latent Class Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8590. [PMID: 34444338 PMCID: PMC8394473 DOI: 10.3390/ijerph18168590] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/09/2021] [Accepted: 08/10/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Relatively strong theoretical assumptions and previous studies concerning co-occurring addictive behaviors suggest a subpopulation representing general proclivity to behavioral addictions (BAs), and there are gender-specific subpopulations. This study aimed to compare latent profile analysis (LPA) and latent class analysis (LCA) as the methods of investigating different clusters of BAs in the general student population and among students positively screened for at least one BA. Participants and procedure: Analyses of six BAs (study, shopping, gaming, Facebook, pornography, and food) and their potential antecedents (personality) and consequences (well-being) were conducted on a full sample of Polish undergraduate students (N = 1182) and a subsample (n = 327) of students including individuals fulfilling cutoff for at least one BA. RESULTS LPA on the subsample mostly replicated the previous four profiles found in the full sample. However, LCA on a full sample did not replicate previous findings using LPA and showed only two classes: those with relatively high probabilities on all BAs and low probabilities. LCA on the subsample conflated profiles identified with LPA and classes found with LCA in the full sample. CONCLUSIONS LCA on dichotomized scores (screened positively vs. negatively) were less effective in identifying clear patterns of interrelationships between BAs based on relatively strong theoretical assumptions and found in previous research. BAs can be investigated on the whole spectrum of behavior, and person-centered analyses might be more useful when they are based on continuous scores. This paper provides more detailed analyses of the four basic clusters of BAs, prevalence, and co-occurrence of particular BAs within and between them, their gender and personality risk factors, relationships to well-being, and their interrelationships as emerging from the results of this and previous studies.
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Affiliation(s)
- Paweł A. Atroszko
- Faculty of Social Sciences, University of Gdańsk, 80-309 Gdańsk, Poland; (P.A.A.); (B.A.)
| | - Bartosz Atroszko
- Faculty of Social Sciences, University of Gdańsk, 80-309 Gdańsk, Poland; (P.A.A.); (B.A.)
| | - Edyta Charzyńska
- Faculty of Social Sciences, University of Silesia in Katowice, 40-007 Katowice, Poland
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11
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Vergés A, Lee MR, Martin CS, Trull TJ, Martens MP, Wood PK, Sher KJ. Not all symptoms of alcohol dependence are developmentally equivalent: Implications for the false-positives problem. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2021; 35:444-457. [PMID: 33956473 PMCID: PMC8184633 DOI: 10.1037/adb0000723] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Recent studies have examined the extent to which alcohol dependence (AD) criteria prospectively predict the course of AD. Critically, these studies have lacked a developmental perspective. However, the differential performance of criteria by age might indicate overendorsement in younger individuals. The current study examined AD criteria in terms of persistence and prediction of AD course and alcohol use by age in order to identify criteria that are likely to be overly endorsed by younger individuals. METHOD The current study used longitudinal data from the National Epidemiologic Survey on Alcohol and Related Conditions to depict age differences in rates of new onset, recurrence, and persistence for each AD criterion, thereby showing how these three factors contribute to the overall age-prevalence curve of each criterion. Additionally, we tested age moderation of the predictive association between each criterion at baseline and new onset, recurrence, and persistence of syndromal AD. RESULTS Some criteria (particularly, persistent desire or unsuccessful efforts to cut down or control drinking, and drinking despite physical/psychological problems) are both less persistent and less predictive of AD course among younger adults compared to older adults. CONCLUSIONS These findings raise the possibility of elevated rates of false-positive AD among younger adults and suggest ways to improve the assessment of AD criteria. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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12
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Boness CL, Sher KJ. The Case for Cognitive Interviewing in Survey Item Validation: A Useful Approach for Improving the Measurement and Assessment of Substance Use Disorders. J Stud Alcohol Drugs 2020; 81:401-404. [PMID: 32800075 PMCID: PMC7437554 DOI: 10.15288/jsad.2020.81.401] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 03/30/2020] [Indexed: 12/30/2023] Open
Abstract
OBJECTIVE To accurately identify substance use disorders, we must be confident of our ability to define and measure the construct itself. To date, research has demonstrated that the ways in which substance use disorder criteria are operationalized or assessed can significantly affect the information we obtain from these diagnoses. For example, differing operationalizations of the same construct, such as impaired control over substance use, can result in markedly different estimates of prevalence. This points to the need for approaches that aim to improve the validity of diagnostic assessments during the measure development phase. METHOD We performed a scoping review of the cognitive interviewing literature, a technique that aims to provide a systematic way of identifying and reducing measurement error associated with the structure and content of assessment items. Along with this, we apply cognitive interviewing to items assessing alcohol tolerance. RESULTS We argue that cognitive interviewing is well suited for reducing measurement error in substance use disorder assessment items. CONCLUSIONS Incorporating cognitive interviewing into the item generation stage of measure development for substance use disorder assessments is a worthwhile endeavor for improving validity.
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Affiliation(s)
- Cassandra L. Boness
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri
| | - Kenneth J. Sher
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri
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13
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Boness CL, Stevens JE, Steinley D, Trull T, Sher KJ. Deriving alternative criteria sets for alcohol use disorders using statistical optimization: Results from the National Survey on Drug Use and Health. Exp Clin Psychopharmacol 2019; 27:283-296. [PMID: 30556734 PMCID: PMC6538450 DOI: 10.1037/pha0000249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Much of the foundation of clinical practice, psychiatric epidemiology, and research into the etiology, course, prevention, and treatment of alcohol use disorder (AUD) rests on psychiatric diagnosis. However, existing research has failed to adequately exploit empirical techniques and existing databases to derive criteria considered optimal with respect to predicting external correlates. The current project adopts a novel approach to deriving new diagnostic criteria sets and rules for AUD. Utilizing the 2010 (N = 24,120) and 2013 (N = 23,627) National Survey on Drug Use and Health (NSDUH; Substance Abuse and Mental Health Services Administration [SAMHSA], 2011, 2014) data sets, we performed a statistical optimization procedure, using complete enumeration, on participants 21 or older who had consumed at least 1 alcoholic beverage in the past year. The goal was to maximize the distance (based on Cohen's d) between mean levels of the optimization criteria (i.e., consumption and functional impairment) in those with an AUD diagnosis versus those without. In contrast with current convention, AUD is derived transparently using a data-driven approach. The best solution included 9 criteria with a diagnostic threshold of 3, while the second-best solution comprised 5 criteria with a threshold of 2. External validation demonstrated both solutions perform similarly, suggesting it is appropriate to use either, depending on the goal of the diagnosis. Overall, statistical optimization approaches can yield highly efficient criteria sets and rules, although multiple, near equivalently performing solutions can be generated. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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McDowell YE, Vergés A, Sher KJ. Are Some Alcohol Use Disorder Criteria More (or Less) Externalizing than Others? Distinguishing Alcohol Use Symptomatology from General Externalizing Psychopathology. Alcohol Clin Exp Res 2019; 43:483-496. [PMID: 30620411 PMCID: PMC6397083 DOI: 10.1111/acer.13952] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 01/02/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND The externalizing spectrum contains a range of disinhibition-related conditions, such as conduct disorder, antisocial personality disorder, and substance use disorders. Comorbidity among externalizing disorders is commonly investigated at the syndromal and trait level precluding insight into the relationship of symptoms across externalizing disorders. It is unknown whether comorbidity across externalizing disorders holds constant across highly varied, individual alcohol use disorder (AUD) criteria. AUD criteria range from symptoms reflecting neuroadaptation (e.g., tolerance) to symptoms reflecting behavioral problems (e.g., social problems). The present study aimed to determine the degree to which individual AUD criteria are associated with symptomatology from other externalizing disorders. Characterization of the degree to which AUD criteria reflect neuroadaptation versus behavioral problems can be used to identify symptom profiles, which, in turn, can be used to inform diagnostic and treatment approaches. METHODS Data from 2 large nationally representative samples were used to examine associations between AUD criteria and externalizing behavior. Psychometric inquiries via multivariate and factor analytic approaches estimated relative associations of externalizing behavior and AUD criteria endorsement, as compared to alcohol consumption. RESULTS Our results indicate differential relations of externalizing behavior and AUD criteria endorsement. For example, social problems and role interference criteria were most strongly associated with externalizing behavior across analytic approaches, with general and unique associations with externalizing behavior. Additionally, tolerance was most weakly associated with externalizing behavior across approaches. CONCLUSIONS Results highlight potential etiological heterogeneity among AUD criteria that could guide future diagnostic refinements and aid in the identification of treatment targets.
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Affiliation(s)
- Yoanna E McDowell
- Department of Psychological Sciences , University of Missouri, Columbia, Missouri
| | - Alvaro Vergés
- Escuela de Psicología , Pontificia, Universidad Católica de Chile, Santiago, Región Metropolitana, Chile
| | - Kenneth J Sher
- Department of Psychological Sciences , University of Missouri, Columbia, Missouri
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Boness CL, Lane SP, Sher KJ. Not all alcohol use disorder criteria are equally severe: Toward severity grading of individual criteria in college drinkers. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2019; 33:35-49. [PMID: 30676037 DOI: 10.1037/adb0000443] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Alcohol use disorder (AUD) diagnosis in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013) contains a severity gradient based on number of criteria endorsed, implicitly assuming criteria are interchangeable. However, criteria vary widely in endorsement rates, implying differences in the latent severity associated with a symptom (e.g., Lane, Steinley, & Sher, 2016) and demonstrating criteria are not interchangeable (Lane & Sher, 2015). We evaluated whether variation in the severity of criteria could be resolved by employing multiple indicators of each criterion varying in item-level severity. We assessed 909 undergraduate students aged 18 years or older with at least 12 drinking occasions in the past year. Participants self-administered questions on alcohol consumption and past year AUD symptoms via an online survey. For each of the 11 AUD criteria, we selected three indicators based on the difficulty values of the one-parameter logistic item response theory model ranging from low to high. We first tested a higher order AUD factor defined by 11 lower order criterion factors, χ2(551) = 2,959.35, p < .0001; root mean square error of approximation = 0.09. The 33 items were used to create severity scores: a criterion count (0-11), symptom count (0-33), and factor scores derived from a bifactor model. Though our new scores resulted in incremental validity over DSM-5 across a range of external validators, when the standardized regression estimates were compared, the new scores did not consistently outperform the DSM-5 suggesting this approach is viable for developing more sensitive diagnostic instruments but needs further refinement. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | - Sean P Lane
- Department of Psychological Sciences, Purdue University
| | - Kenneth J Sher
- Department of Psychological Sciences, University of Missouri
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Martin CS, Vergés A, Langenbucher JW, Littlefield A, Chung T, Clark DB, Sher KJ. Algorithm Analysis of the DSM-5 Alcohol Withdrawal Symptom. Alcohol Clin Exp Res 2018; 42:1073-1083. [PMID: 29570805 DOI: 10.1111/acer.13633] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 03/13/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Alcohol withdrawal (AW) is an important clinical and diagnostic feature of alcohol dependence. AW has been found to predict a worsened course of illness in clinical samples, but in some community studies, AW endorsement rates are strikingly high, suggesting false-positive symptom assignments. Little research has examined the validity of the DSM-5 algorithm for AW, which requires either the presence of at least 2 of 8 subcriteria (i.e., autonomic hyperactivity, tremulousness, insomnia, nausea, hallucinations, psychomotor agitation, anxiety, and grand mal seizures), or, the use of alcohol to avoid or relieve these symptoms. METHODS We used item and algorithm analyses of data from waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (current drinkers, n = 26,946 at wave 1) to study the validity of DSM-5 AW as operationalized by the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV (AUDADIS-IV). RESULTS A substantial proportion of individuals given the AW symptom reported only modest to moderate levels of alcohol use and alcohol problems. Alternative AW algorithms were superior to DSM-5 in terms of levels of alcohol use and alcohol problem severity among those with AW, group difference effect sizes, and predictive validity at a 3-year follow-up. The superior alternative algorithms included those that excluded the nausea subcriterion; required withdrawal-related distress or impairment; increased the AW subcriteria threshold from 2 to 3 items; and required tremulousness for AW symptom assignment. CONCLUSIONS The results indicate that the DSM-5 definition of AW, as assessed by the AUDADIS-IV, has low specificity. This shortcoming can be addressed by making the algorithm for symptom assignment more stringent.
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Affiliation(s)
- Christopher S Martin
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Alvaro Vergés
- Escuela de Psicología, Pontifica Universidad Católica de Chile, Santiago, Chile
| | | | - Andrew Littlefield
- Department of Psychological Sciences, Texas Tech University, Lubbock, Texas
| | - Tammy Chung
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Duncan B Clark
- Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Kenneth J Sher
- Department of Psychological Sciences, University of Missouri-Columbia, Columbia, Missouri
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Beresford T, Anderson M, Pitts B, Learned B, Thumm B, Maravilla F, Emrick C, Taub J. The Severity of Ethanol Withdrawal Scale in Scale-Driven Alcohol Withdrawal Treatment: A Quality Assurance Study. ALCOHOLISM TREATMENT QUARTERLY 2017. [DOI: 10.1080/07347324.2017.1322418] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Thomas Beresford
- Laboratory for Clinical and Translational Research in Psychiatry, Department of Veterans Affairs, Denver, Colorado, USA
- Psychiatry Service Department of Veterans Affairs, Department of Psychiatry, Denver, Colorado, USA
| | - Mel Anderson
- Medicine Service Department of Veterans Affairs, Denver, Colorado, USA
- Department of Medicine, School of Medicine, University of Colorado Denver, Denver, Colorado, USA
| | - Brian Pitts
- Laboratory for Clinical and Translational Research in Psychiatry, Department of Veterans Affairs, Denver, Colorado, USA
| | - Brenda Learned
- Quality Assurance Program, Department of Veterans Affairs, Denver, Colorado, USA
| | - Brie Thumm
- Laboratory for Clinical and Translational Research in Psychiatry, Department of Veterans Affairs, Denver, Colorado, USA
| | - Francisco Maravilla
- Laboratory for Clinical and Translational Research in Psychiatry, Department of Veterans Affairs, Denver, Colorado, USA
| | - Chad Emrick
- Laboratory for Clinical and Translational Research in Psychiatry, Department of Veterans Affairs, Denver, Colorado, USA
| | - Julie Taub
- Department of Medicine, School of Medicine, University of Colorado Denver, Denver, Colorado, USA
- Department of Medicine, Denver Health Medical Center, Denver, Colorado, USA
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