Hulvershorn Leslie A, Adams Zachary W, Smoker Michael P, Aalsma Matthew C, Gibbons Robert D
Department of Psychiatry, Pediatric Care Center, Indiana University, 1002 Wishard Blvd., Suite 4110, Indianapolis, IN 46202, United States.
Department of Pediatrics, Section of Adolescent Medicine, Indiana University School of Medicine, 410 West 10th Street Suite 2000, Indianapolis, IN, 46202, United States.
Drug Alcohol Depend Rep. 2022 Mar 23;3:100047. doi: 10.1016/j.dadr.2022.100047. eCollection 2022 Jun.
The Computerized Adaptive Test for Substance Use Disorder (CAT-SUD), an adaptive test based on multidimensional item response theory, has been expanded to include 7 specific Diagnostic and Statistical Manual, 5th edition (DSM-5) defined SUDs. Initial testing of the new measure, the CAT-SUD expanded (CAT-SUD-E) is reported here.
275 Community-dwelling adults (ages 18-68) responded to public and social-media advertisements. Participants virtually completed both the CAT-SUD-E and the Structured Clinical Interview for DSM-5, Research Version (SCID) to assess the validity of the CAT-SUD-E in determining whether participants met criteria for specific DSM-5 SUDs. Diagnostic classifications were based on 7 SUDs, each with 5 items, for current and lifetime SUDs.
For SCID-based presence of any lifetime SUD, predictions based on the overall CAT-SUD-E diagnosis and severity score were AUC=0.92, 95% CI = 0.88, 0.95 for current and AUC=0.94, 95% CI = 0.91, 0.97 for lifetime. For individual diagnoses, classification accuracy for current SUDs ranged from an AUC=0.76 for alcohol to AUC=0.92 for nicotine/tobacco. Classification accuracy for lifetime SUDs ranged from an AUC=0.81 for hallucinogens to AUC=0.96 for stimulants. Median CAT-SUD-E completion time was under 4 min.
The CAT-SUD-E quickly produces similar results as lengthy structured clinical interviews for overall SUD and substance-specific SUDs, with high precision and accuracy, through a combination of fixed-item responses for diagnostic classification and adaptive SUD severity measurement. The CAT-SUD-E harmonizes information from mental health, trauma, social support and traditional SUD items to provide a more complete characterization of SUD and provides both diagnostic classification and severity measurement.
物质使用障碍计算机自适应测试（CAT-SUD）是一种基于多维项目反应理论的自适应测试，现已扩展到包括7种特定的《精神疾病诊断与统计手册》第5版（DSM-5）定义的物质使用障碍。本文报告了新测量工具CAT-SUD扩展版（CAT-SUD-E）的初步测试情况。
275名社区居住成年人（年龄在18 - 68岁之间）回应了公共和社交媒体广告。参与者通过虚拟方式完成了CAT-SUD-E和《精神疾病诊断与统计手册》第5版研究版结构化临床访谈（SCID），以评估CAT-SUD-E在确定参与者是否符合特定DSM-5物质使用障碍标准方面的有效性。诊断分类基于7种物质使用障碍，每种障碍有5个项目，涵盖当前和终生物质使用障碍情况。
对于基于SCID的任何终生物质使用障碍的存在情况，基于CAT-SUD-E总体诊断和严重程度评分的预测，当前物质使用障碍的曲线下面积（AUC）=0.92，95%置信区间（CI）=0.88, 0.95；终生物质使用障碍的AUC=0.94，95% CI = 0.91, 0.97。对于个体诊断，当前物质使用障碍的分类准确率范围从酒精使用障碍的AUC=0.76到尼古丁/烟草使用障碍的AUC=0.92。终生物质使用障碍的分类准确率范围从致幻剂使用障碍的AUC=0.81到兴奋剂使用障碍的AUC=0.96。CAT-SUD-E的中位完成时间不到4分钟。
CAT-SUD-E通过结合用于诊断分类的固定项目反应和自适应物质使用障碍严重程度测量，能够快速产生与冗长的结构化临床访谈在总体物质使用障碍和特定物质的物质使用障碍方面相似的结果，具有高精度和准确性。CAT-SUD-E整合了来自心理健康、创伤、社会支持和传统物质使用障碍项目的信息，以更全面地描述物质使用障碍，并提供诊断分类和严重程度测量。
