Use of item response theory and latent class analysis to link poly-substance use disorders with addiction severity, HIV risk, and quality of life among opioid-dependent patients in the Clinical Trials Network.

This study applied item response theory (IRT) and latent class analysis (LCA) procedures to examine the dimensionality and heterogeneity of comorbid substance use disorders (SUDs) and explored their utility for standard clinical assessments, including the Addiction Severity Index (ASI), HIV Risk Behavior Scale (HRBS), and SF-36 quality-of-life measures. The sample included 343 opioid-dependent patients enrolled in two national multisite studies of the National Drug Abuse Treatment Clinical Trials Network (protocols CTN-0001 and CTN-0002). Data were analyzed by factor analysis, IRT, LCA, and latent regression procedures. A two-class LCA model fit dichotomous SUD data empirically better than one-parameter and two-parameter IRT models. LCA distinguished 10% of severe comorbid opioid-dependent individuals who had high rates of all SUDs examined — especially amphetamine and sedative abuse/dependence — from the remaining 90% who had SUDs other than amphetamine and sedative abuse-dependence (entropy = 0.99). Item-level results from both one-parameter and two-parameter IRT models also found that amphetamine and sedative abuse/dependence tapped the more severe end of the latent poly-SUD trait. Regardless of whether SUDs were defined as a continuous trait or categorically, individuals characterized by a high level of poly-SUD demonstrated more psychiatric problems and HIV risk behaviors. In conclusion, a combined application of categorical and dimensional latent approaches may improve the understanding of comorbid SUDs and their associations with other clinical indicators. The LCA approach provides practically useful information for informing more focused interventions by pinpointing specific groups with severe comorbid SUDs; the IRT conceptualization of SUDs as a continuous condition is heuristically consistent with the nature of a medical disorder, and as such, emphasizes screening and early prevention for managing a chronic addiction to avoid more costly consequences. Abuse of sedatives and methamphetamine may serve as a useful marker for identifying subsets of opioid-dependent individuals with needs for more intensive interventions.

Supported by the Duke Clinical Research Institute (CTN DSC 1).

Related protocols: CTN-0001, CTN-0002