成瘾评估与个性化治疗维度（ADAPT）的开发。

Development of the Addiction Dimensions for Assessment and Personalised Treatment (ADAPT).

作者信息

Marsden John, Eastwood Brian, Ali Robert, Burkinshaw Pete, Chohan Gagandeep, Copello Alex, Burn Daniel, Kelleher Michael, Mitcheson Luke, Taylor Steve, Wilson Nick, Whiteley Chris, Day Edward

机构信息

Addictions Department, Institute of Psychiatry, King's College London, United Kingdom; South London and Maudsley NHS Mental Health Foundation Trust, United Kingdom; Alcohol, Drug and Tobacco Division, Health and Wellbeing Directorate, Public Health England, United Kingdom.

Addictions Department, Institute of Psychiatry, King's College London, United Kingdom; Alcohol, Drug and Tobacco Division, Health and Wellbeing Directorate, Public Health England, United Kingdom.

出版信息

Drug Alcohol Depend. 2014 Jun 1;139:121-31. doi: 10.1016/j.drugalcdep.2014.03.018. Epub 2014 Mar 22.

DOI:10.1016/j.drugalcdep.2014.03.018

PMID:24731538

Abstract

BACKGROUND

Convergent research reveals heterogeneity in substance use disorders (SUD). The Addiction Dimensions for Assessment and Personalised Treatment (ADAPT) is designed to help clinicians tailor therapies.

METHODS

Multicentre study in 21 SUD clinics in London, Birmingham (England) and Adelaide (Australia). 132 clinicians rated their caseload on a beta version with 16 ordinal indicators of addiction severity, health and social problem complexity, and recovery strengths constructs. In Birmingham, two in-treatment outcomes were recorded after 15-months: 28-day drug use (Treatment Outcome Profile; n=703) and Global Assessment of Functioning (GAF; DSM-IV Axis V; n=695). Following item-level screening (inter-rater reliability [IRR]; n=388), exploratory structural equation models (ESEM), latent profile analysis (LPA), and mixed-effects regression evaluated construct, concurrent and predictive validity characteristics, respectively.

RESULTS

2467 patients rated (majority opioid or stimulant dependent, enrolled in opioid medication assisted or psychological treatment). IRR-screening removed two items and ESEM models identified and recalibrated remaining indicators (root mean square error of approximation 0.066 [90% confidence interval 0.055-0.064]). Following minor re-specification and satisfactory measurement invariance evaluation, ADAPT factor scores discriminated patients by sample, addiction therapy and drug use. LPA identified three patient sub-types: Class 1 (moderate severity, moderate complexity, high strengths profile; 46.9%); Class 2 (low severity, low complexity, high strengths; 25.4%) and Class 3 (high severity, high complexity, low strengths; 27.7%). Class 2 had higher GAF (z=4.30). Class 3 predicted follow-up drug use (z=2.02) and lower GAF (z=3.51).

CONCLUSION

The ADAPT is a valid instrument for SUD treatment planning, clinical review and outcome evaluation. Scoring and application are discussed.

摘要

背景

整合性研究揭示了物质使用障碍（SUD）的异质性。成瘾评估与个性化治疗维度（ADAPT）旨在帮助临床医生量身定制治疗方案。

方法

在伦敦、伯明翰（英国）和阿德莱德（澳大利亚）的21家物质使用障碍诊所开展多中心研究。132名临床医生使用一个包含16个成瘾严重程度、健康和社会问题复杂性以及康复优势结构的序数指标的测试版，对他们的病例量进行评分。在伯明翰，15个月后记录了两项治疗中的结果：28天药物使用情况（治疗结果概况；n = 703）和功能总体评估（GAF；《精神疾病诊断与统计手册》第四版轴V；n = 695）。在项目层面筛选（评分者间信度[IRR]；n = 388）之后，探索性结构方程模型（ESEM）、潜在类别分析（LPA）和混合效应回归分别评估了结构效度、同时效度和预测效度特征。

结果

对2467名患者进行了评分（大多数为阿片类药物或兴奋剂依赖者，接受阿片类药物辅助治疗或心理治疗）。IRR筛选剔除了两个项目，ESEM模型识别并重新校准了其余指标（近似均方根误差为0.066[90%置信区间0.055 - 0.064]）。经过轻微的重新设定和令人满意的测量不变性评估后，ADAPT因子得分能够按样本、成瘾治疗和药物使用情况区分患者。LPA识别出三种患者亚型：第1类（中度严重程度、中度复杂性、高优势特征；46.9%）；第2类（低严重程度、低复杂性、高优势；25.4%）和第3类（高严重程度、高复杂性、低优势；27.7%）。第2类患者的GAF得分更高（z = 4.30）。第3类患者预测随访期药物使用情况（z = 2.02）且GAF得分更低（z = 3.51）。