Saxon Andrew J, Kivlahan Daniel R, Doyle Suzanne, Donovan Dennis M
Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Seattle, Washington 98195, USA.
J Stud Alcohol Drugs. 2007 Jan;68(1):149-56. doi: 10.15288/jsad.2007.68.149.
The Alcohol Dependence Scale (ADS) yields continuous scores purported to reflect the severity of the dependence syndrome. We evaluated the concurrent validity of the ADS as a general measure of severity and the screening accuracy of the total score and subscales to detect Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), physiological dependence.
Treatment-seeking, alcohol-dependent individuals entering the Combining Pharmacotherapies and Behavioral Interventions for Alcohol Dependence (COMBINE) Study (N = 1,372; 69% men) completed the ADS, diagnostic interviews, and other measures before randomization. Analyses of variance tested differences between ADS quartiles on alcohol- related measures. Areas under the receiver operating characteristic (AUROC) curve assessed screening accuracy for DSM-IV physiological dependence (tolerance or withdrawal) or withdrawal alone.
ADS quartiles differed on age, other demographics, and prior treatment episodes. Linear correlation showed moderate to large magnitude associations with alcohol-related self-report measures and most indices of consumption. ADS quartiles differed significantly on proportion with DSM-IV physiological dependence, but AUROC curves indicated that the ADS had limited accuracy as a continuous measure to detect DSMIV physiological dependence (AUROC = .75 [95% confidence interval {CI}: .70-.79] and .67 [95% CI: .60-.74] for men and women, respectively; p = .08) or withdrawal alone (AUROC = .77 [95% CI: .74-.80] and .74 [95% CI: .69-.79] for men and women, respectively; p = .30). Screening accuracy was comparably limited based on ADS subscales reflecting psychoperceptual or psychophysical withdrawal.
The ADS reflected variation in symptom severity but did not adequately identify physiological dependence or withdrawal in treatment-seeking individuals with DSM-IV alcohol dependence.
酒精依赖量表（ADS）产生的连续分数据称可反映依赖综合征的严重程度。我们评估了ADS作为严重程度一般测量指标的同时效度，以及总分和分量表检测《精神疾病诊断与统计手册》第四版（DSM-IV）生理依赖的筛查准确性。
寻求治疗的酒精依赖个体参加酒精依赖联合药物治疗与行为干预研究（COMBINE研究，N = 1372；69%为男性），在随机分组前完成ADS、诊断访谈及其他测量。方差分析检验ADS四分位数在酒精相关测量指标上的差异。受试者工作特征（AUROC）曲线下面积评估DSM-IV生理依赖（耐受性或戒断）或仅戒断的筛查准确性。
ADS四分位数在年龄、其他人口统计学特征及既往治疗经历方面存在差异。线性相关显示与酒精相关的自我报告测量指标及大多数消费指数存在中度至高度关联。ADS四分位数在DSM-IV生理依赖比例上有显著差异，但AUROC曲线表明，作为检测DSM-IV生理依赖的连续测量指标，ADS的准确性有限（男性和女性的AUROC分别为0.75 [95%置信区间{CI}：0.70 - 0.79]和0.67 [95% CI：0.60 - 0.74]；p = 0.08），或仅检测戒断时准确性也有限（男性和女性的AUROC分别为0.77 [95% CI：0.74 - 0.80]和0.74 [95% CI：0.69 - 0.79]；p = 0.30）。基于反映心理感知或心理生理戒断的ADS分量表，筛查准确性同样有限。
ADS反映了症状严重程度的差异，但在寻求治疗的DSM-IV酒精依赖个体中，未能充分识别出生理依赖或戒断情况。
