Kirisci Levent, Tarter Ralph E, Reynolds Maureen, Vanyukov Michael M
Department of Pharmaceutical Sciences, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA.
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Int J Pers Cent Med. 2016;6(4):260-273.
Item response theory (IRT) based studies conducted on diverse samples showed a single dominant factor for DSM-III-R and DSM-IV substance use disorder (SUD) abuse and dependence symptoms of alcohol, cannabis, sedative, cocaine, stimulants, and opiates use disorders. IRT provides the opportunity, within a person-centered framework, to accurately gauge each person's severity of disorder that, in turn, informs required intensiveness of treatment.
The aim of this study was to determine whether the SUD symptoms indicate a unidimensional trait or instead need to be conceptualized and quantified as a multidimensional scale.
The sample was composed of families of adult SUD+ men (n=349), and SUD+ women (n=173), who qualified for DSM-III-R diagnosis of substance use disorder (abuse or dependence) and families of adult men and women who did not qualify for a SUD diagnosis (SUD- men: n=190, SUD- women: n=133). An expanded version of the Structured Clinical Interview for DSM-III-R (SCID) was administered to characterize lifetime and current substance use disorders. Item response theory methodology was used to assess the dimensionality of DSM-III-R SUD abuse and dependence symptoms.
A bi-factor model provided the optimal representation of the factor structure of SUD symptoms in males and females. SUD symptoms are scalable as indicators of a single common factor, corresponding to general (non-drug-specific, common) liability to addiction, combined with drug-specific liabilities.
IRT methodology used to quantify the continuous general liability to addiction (GLA) latent trait in individuals having SUD symptoms was found effective for accurately measuring SUD severity in men and women. This may be helpful for person-centered medicine approaches to effectively address intensity of treatment.
对不同样本进行的基于项目反应理论（IRT）的研究表明，DSM-III-R和DSM-IV中酒精、大麻、镇静剂、可卡因、兴奋剂及阿片类物质使用障碍的滥用和依赖症状存在单一主导因素。IRT在以人为主的框架内提供了机会，能够准确衡量每个人的疾病严重程度，进而为所需的治疗强度提供依据。
本研究的目的是确定物质使用障碍（SUD）症状是否表明是单维特质，还是需要被概念化为多维量表并进行量化。
样本包括符合DSM-III-R物质使用障碍（滥用或依赖）诊断标准的成年SUD+男性（n = 349）和SUD+女性（n = 173）的家庭，以及不符合SUD诊断标准的成年男性和女性家庭（SUD-男性：n = 190，SUD-女性：n = 133）。采用DSM-III-R结构化临床访谈（SCID）的扩展版来描述终生和当前的物质使用障碍。使用项目反应理论方法评估DSM-III-R SUD滥用和依赖症状的维度。
双因素模型为男性和女性SUD症状的因素结构提供了最佳表示。SUD症状可作为单一共同因素的指标进行量化，该共同因素对应于一般（非药物特异性、共同的）成瘾易感性，同时结合药物特异性易感性。
发现用于量化有SUD症状个体成瘾的连续一般易感性（GLA）潜在特质的IRT方法，对于准确测量男性和女性的SUD严重程度是有效的。这可能有助于以人为主的医学方法有效解决治疗强度问题。
