Department of Psychiatry and Behavioral Sciences, School of Medicine, Duke University Medical Center, Box 3419, Durham, NC 27710, USA.
J Psychiatr Res. 2012 Mar;46(3):360-9. doi: 10.1016/j.jpsychires.2011.12.002. Epub 2011 Dec 26.
To address an urgent need for screening of substance use problems in medical settings, we examined substance-specific dependence criteria as potential brief screeners for the detection of patients with a substance use disorder (SUD).
The sample included 920 opioid-dependent adults who were recruited from outpatient treatment settings at 11 programs in 10 U.S. cities and who completed intake assessments of SUDs for a multisite study of the National Drug Abuse Treatment Clinical Trials Network (CTN003). Data were analyzed by factor analysis, item response theory (IRT), sensitivity, and specificity procedures.
Across all substances (alcohol, amphetamines, cannabis, cocaine, sedatives), withdrawal was among the least prevalent symptoms, while taking large amounts and inability to cut down were among the most prevalent symptoms. Items closely related to the latent trait of a SUD showed good-to-high values of area under the receiver operating characteristic curve in identifying cases of a SUD; IRT-defined severe and less discriminative items exhibited low sensitivity in identifying cases of a SUD (withdrawal for all substances; time using for alcohol and sedatives; giving up activities for sedatives).
Study results suggest that withdrawal and time using are much less reliable indicators for a SUD than taking larger amounts than intended and inability to cut down and that the latter two items should be studied further for consideration in developing a simplified tool for screening patients for SUDs in medical settings. These findings have implications for the use of common health indicators in electronic health records systems to improve patient care.
为满足在医疗环境中筛查物质使用问题的迫切需求，我们研究了物质特异性依赖标准，作为检测物质使用障碍（SUD）患者的潜在简易筛查工具。
该样本包括 920 名阿片类药物依赖的成年人，他们是从美国 10 个城市的 11 个项目的门诊治疗环境中招募的，他们完成了国家药物滥用治疗临床试验网络（CTN003）多地点研究的 SUD 摄入评估。数据分析采用因子分析、项目反应理论（IRT）、敏感性和特异性程序。
在所有物质（酒精、安非他命、大麻、可卡因、镇静剂）中，戒断是最不常见的症状，而大量服用和无法减少服用是最常见的症状。与 SUD 潜在特征密切相关的项目在识别 SUD 病例时显示出良好到高的受试者工作特征曲线下面积值；IRT 定义的严重和低区分性项目在识别 SUD 病例时表现出低敏感性（所有物质的戒断；酒精和镇静剂的使用时间；放弃镇静剂的活动）。
研究结果表明，与意图外的大量服用和无法减少服用相比，戒断和使用时间是 SUD 的可靠性指标要差得多，后两个项目应该进一步研究，以考虑在医疗环境中开发用于筛查 SUD 患者的简化工具。这些发现对电子健康记录系统中常见健康指标的使用具有重要意义，可以改善患者护理。
