Evaluating brief screeners to discriminate between drug use disorders in a sample of treatment-seeking adults.

This article reports on an ancillary investigation of data from National Drug Abuse Treatment Clinical Trials Network protocols CTN-0006 and -0007 that aimed to identify a potential core set of brief screeners for the detection of individuals with a substance use disorder (SUD) in medical settings. Data from the two protocols, both multisite studies that evaluated stimulant use outcomes of an abstinence-based contingency management intervention as an addition to usual care, were analyzed by factor analysis, item response theory (IRT), sensitivity and specificity procedures. Alcohol and drug use disorders in 847 substance-using adults were assessed using the DSM-IV Checklist. Comparatively prevalent symptoms of dependence, especially inability to cut down for all substances, showed high sensitivity for detecting an SUD (low rate of false negative). IRT-defined severe (infrequent) and low discriminative items, especially withdrawal for alcohol, cannabis, and cocaine, had low sensitivity in identifying cases of an SUD. IRT-defined less severe (frequent) and high discriminative items, including inability to cut down or taking larger amounts than intended for all substances and withdrawal for amphetamines and opioids, showed good-to-high values of area under the receiver operating characteristic curve (ROC-AUC) in classifying cases and noncases of an SUD.

Conclusions: This study supports the value of combining IRT and ROC-AUC procedures to select psychometrically appropriate items to develop an efficient, simplified, and reasonably sensitive tool to screen for SUDs in medical settings, a development encouraged by the Affordable Care Act and the Health Information Technology for Economic and Clinical Health Act. Findings add to the evidence for initial single-item screens for alcohol or drug use that have shown good sensitivity and specificity in medical settings, and they expand prior research on the two-item screen for alcohol and drug disorders. The combined results from IRT and ROC-AUC analyses indicate the value of further testing “taking large amounts” and “inability to cut down” as part of a simplified screen to facilitate detection of problematic substance users with a high probability for having an SUD.

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

Related protocols: CTN-0006, CTN-0007