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Abstract: Despite previous reports of biased Short Inventory of Problems (SIP) items across racial groups of men who have sex with men, the assumption of measurement invariance has not yet been tested across African-American and non-Latino White outpatient groups for the SIP-R. This study investigated measurement invariance properties of the Short Inventory of Problems-Revised (SIP-R) across racial groups. The sample included 195 African-American and 194 non-Latino White adult participants in a clinical trial investigating the effectiveness of motivational enhancement therapy in the National Institute on Drug Abuse Clinical Trials Network (CTN-0004). The SIP-R demonstrated configural invariance and weak metric invariance between racial groups, suggesting conceptualizations of adverse consequences of substance use are equivalent across racial groups. However, the SIP-R also indicated partial strong/scalar and strict metric invariance; that is, four of the five constructs suggested differences in the normative levels of the items across racial groups. Conclusions: This study is the first to report measurement equivalence properties of the SIP-R across racial groups. This study contributes to the growing literature on how substance abuse treatment researchers can ensure unbiased assessment when studying treatment outcomes across racial/ethnic minority groups. Since MI and MET techniques have become standard social work practice in substance abuse treatment settings, the SIP-R is expected to continue to be one of the most prominent outcome measures in practices involving motivational techniques. The current findings encourage the valid use of the SIP-R with samples of African-American and non-Latino White adult outpatients to validly examine treatment outcomes and test potential differential effectiveness of treatments across racial groups. Related protocols: CTN-0004

Abstract:

A fidelity measure was developed for use with Real Men Are Safe-Culturally Adapted (REMAS-CA), an HIV prevention intervention for ethnically diverse men in substance abuse treatment developed as an outgrowth of National Drug Abuse Treatment Clinical Trials Network protocol CTN-0018 (Reducing HIV/STD Risk Behaviors: A Research Study for Men in Drug Abuse Treatment). The aims of this ancillary investigation of data from that project were to: 1) assess the reliability of the Fidelity Rating and Skill Evaluation (FRASE); 2) measure improvement in therapist competence and adherence over time while delivering REMAS-CA; and 3) identify which modules of REMAS-CA were most difficult to deliver.

Conclusions: Results showed that the FRASE was a reliable instrument for measuring the fidelity of REMAS-CA delivery, and therapists achieved adequate adherence and competence after training, demonstrating significant improvement over time. Sessions 4 and 5 of REMAS-CA were found to contain the most challenging modules for therapists to deliver. These findings offer some guidelines for increasing counselor competence in implementing REMAS-CA for research or clinical practice. Specifically, more effort should be spent on training the counselors to implement the emotionally charged discussion and the specific skill building present in Sessions 4 and 5.

Related protocols: CTN-0018

Abstract:

Hispanic Americans are substantially underrepresented in clinical and research samples for substance use treatment, with language cited as one of the major barriers to their participation, indicating a need for more validated assessments in Spanish. This study evaluated the psychometric properties of a Spanish version of the Short Inventory of Problems (SIP), used in a multisite, randomized trial conducted for Spanish-speaking substance users, National Drug Abuse Treatment Clinical Trials Network protocol CTN-0021. The sample included 405 Spanish-speaking treatment seekers, mostly male (88%) and legally mandated to treatment (71%). The Spanish version of the revised SIP (SIP-RS), as well as other commonly used assessment measures translated into Spanish, were administered at baseline and at the end of treatment. Internal consistency was excellent and construct validity was supported through correlations with composite scores from the Addiction Severity Index (ASI) and through differential SIP-RS scores according to diagnostic criteria. The SIP-RS also demonstrated an association with substance use and treatment retention, with higher baseline scores associated with significantly less abstinence during treatment and fewer days retained in treatment. However, the latter association was moderate by participants’ legal status.

Conclusions: This Spanish-translated version of the SIP (SIP-RS) appears to be a reliable and valid assessment of adverse consequences associated with alcohol and drug use, with psychometric properties comparable with the English version. This assessment may prove to be a useful outcome measure for evaluating the efficacy of treatments for substance use disorders, and it may have the potential to identify individuals at risk for early treatment drop-out. Given the growing population of Hispanics in the United States with limited English proficiency, greater effort should be placed toward validating substance abuse assessment instruments for Spanish-speakers, with a particular focus on diverse Hispanic populations.

Related protocols: CTN-0021

Abstract:

Individuals with addictive disorders often make rash decisions and behave impulsively, which can impact their treatment. This 1 hour, 45 minute webinar critically examines different ways to measure impulsivity and how performance on these measures can predict changes in addictive behaviors. The discussion highlights the important ways clinical research and basic science research can inform each other, including research from the Clinical Trials Network. It also examines various factors that impact impulsivity, including genetics, environmental history of adversity and stress, emotional state including distress due to substance withdrawal symptoms, and other psychosocial factors. The final part of this webinar outlines studies that show how these factors alter the neural functions that govern impulsivity.

Abstract:

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

Abstract:

This article reports on the development and calibration of item banks for alcohol use, negative and positive consequences of alcohol use, and negative and positive expectancies regarding drinking as part of the Patient-Reported Outcomes Measurement Information System (PROMIS). Comprehensive literature searches yielded an initial bank of more than 5000 items from over 200 instruments. After qualitative item analysis (including focus groups and cognitive interviewing), 141 items were included in field testing. Items for alcohol use and consequences were written in a first-person, past-tense format with a 30-day time frame and 5 response options reflecting frequency. Items for expectancies were written in a third-person, present-tense format with no time frame specified and 5 response options reflecting intensity. The calibration sample included 1407 respondents, 1000 from the general population (ascertained through an internet panel) and 407 from community treatment programs participating in the National Institute on Drug Abuse (NIDA) National Drug Abuse Treatment Clinical Trials Network (CTN). Final banks of 37, 31, 20, 11, and 9 items (108 total items) were calibrated for alcohol use, negative consequences, positive consequences, negative expectancies, and positive expectancies, respectively, using item response theory (IRT). Seven-item static short forms were also developed from each item bank.

Conclusions: Test information curves showed that the PROMIS item banks provided substantial information in a broad range of severity, making them suitable for treatment, observational, and epidemiological research. For more information about the NIH Roadmap initiative that resulted in the development of the PROMIS, visit http://www.nihpromis.org.

Abstract:

The National Institute on Drug Abuse created the Clinical Trials Network (CTN) to bridge the gap between research and clinical practice relative to the treatment of substance use disorders in 1999. Since that date, 27 research protocols have been completed, some involving counseling approaches, some involving medication assisted treatment, and some involving both. Currently, the CTN is composed of approximately 167 treatment programs in 34 States, with multiple treatment programs across the country involved in each research protocol. It became apparent that there was no consensus about the most appropriate outcome measures to use relative to treatment efficacy or the methods to assess those outcomes, both within the CTN and across the literature in general.

A task force was approved by the Executive Committee of the CTN in November 2008 with the following goals: (1) to recommend a definition for a clinically meaningful outcome measure on drug use to be used in CTN clinical trials, and (2) to recommend a set of key questions/instruments that would be used across CTN clinical trials. This presentation will examine the conclusions of the task force and the relevance of those conclusions to substance abuse research and clinical practice.

Abstract:

Based on recommendations from a U.S. Institute of Medicine report, the National Institute on Drug Abuse established the National Drug Abuse Treatment Clinical Trials Network (CTN) in 1999 with the goal of accelerating the translation of science-based addiction treatment research into community-based practice, and improving the quality of addition treatment using science as the vehicle. One of the CTN’s primary tasks is to serve as a platform to forge bidirectional communications and collaborations between providers and scientists to enhance the relevance of research generating empirical results that impact practice. Among the many obstacles in moving research into real-world settings, this commentary mainly describes challenges and iterative experiences in regard to how the CTN develops its research protocols, with a focus on how the CTN study teams select and utilize assessment instruments that can reasonably balance the interests of both research scientists and practice providers when applied in CTN settings. This commentary also discusses the process by which the CTN has worked to identify a core set of common assessment instruments (the Common Assessment Battery (CAB)) that may be applied across all trials. Collecting clinically-relevant data in a uniform manner over time using the CAB will greatly facilitate future cross-study analyses, which could yield rich and important information to improve treatment of individuals with substance use disorders and to enhance the advancement of substance use disorder-related clinical research.

Abstract:

This study sought to examine the psychometric properties of a revised version of the SIP (SIP-R) as a measure of adverse consequences for alcohol and drug users in both English and Spanish-speaking populations. The English version was evaluated within a large population of alcohol and drug abuse treatment seekers (N=886) pooled from two national, multisite randomized trials (protocols CTN-0004 and -0005). It was also translated into Spanish and evaluated in a large population of Spanish-speaking substance abuse treatment seekers (N=405) participating in a separate multisite randomized trial (CTN-0021). All trials utilized a common assessment battery that included the ASI, the URICA, and a substance use calendar. Reliability and validity analyses included internal consistency, confirmatory factor analysis, and correlations. Differences in reported consequences were explored using ANOVA. For the English version, results supported the internal consistency and theoretical five-factor structure. Convergent validity was evident through strong correlations with the URICA and the drug composite score from the ASI, whereas weak correlations with other composite scores provided evidence of discriminant validity. Results for the Spanish version were highly similar, with strong internal consistency, factor structure, and a similar pattern of correlations with the ASI and URICA. In both the English and Spanish-speaking samples, baseline SIP-R total scores were higher for those not legally mandated to treatment and were associated with days retained in treatment.

Conclusions: This is the first study to evaluate the SIP-R within such a large, diverse sample of treatment seekers, including evaluation of a Spanish version. Both the English and Spanish versions of the SIP-R demonstrated strong psychometric properties and should be considered a valuable measure of adverse consequences associated with drug and alcohol use.

Related protocols: CTN-0004, CTN-0005, CTN-0021

Abstract:

Assessment of the adverse consequences of substance use serves an important function in both clinical and research settings, yet there is no universally agreed upon measure of consequences relevant to multiple types of substance use disorders. One of the most commonly used measures, the Short Inventory of Problems (SIP), has been adapted and evaluated in several specific populations, but evidence is needed of its reliability and validity across broader samples of persons with substance use disorders. This study evaluated the psychometric properties of a revised version of the SIP (SIP-R) in a large combined sample of alcohol and drug use disorder treatment seekers, with participants pooled from two studies from the National Drug Abuse Treatment Clinical Trials Network (CTN-0004, about motivational enhancement therapy, and CTN-0005, about motivational interviewing).

A total of 886 participants across 10 outpatient treatment facilities completed a common assessment battery that included the SIP-R, Addiction Severity Index (ASI), University of Rhode Island Change Assessment (URICA), HIV Risk Behavior Scale (HRBS), and a substance use calendar. Results supported the SIP-R’s internal reliability (alpha = .95). Confirmatory factor analysis demonstrated that the hypothesized 5-factor model with one higher-order factor produced the best fit. Convergent validity was evident through the SIP-R’s correlation with several composite scores from the ASI and the URICA, and analyses supported its conceptual distinction from quantity indices of drug/alcohol use. The SIP-R also demonstrated an ability to predict treatment retention, with higher scores associated with poorer retention.

Conclusions: These results provide support for the SIP-R’s psychometric properties as a measure of consequences across a broad sample of treatment-seeking drug and alcohol users.

Related protocols: CTN-0004, CTN-0005

Abstract:

Growing recognition of the negative impact of anxiety disorders in the lives of youth has made their identification an important clinical task. Multiple perspective assessment (e.g., parents, children) is generally considered a preferred method in the assessment of anxiety disorder symptoms, although it has been generally thought that disagreement between parent and youth ratings of the child’s emotions is common. This study examined parent and child reports of the child’s anxiety disorder symptoms using the Diagnostic Interview Schedule for Children-Predictive Scales (DISC-PS) in a clinic-referred sample of substance using adolescents participating in the National Drug Abuse Treatment Clinical Trials Network protocol CTN-0014 (“Brief Strategic Family Therapy for Adolescent Drug Abusers”). Parents and adolescents (N=480) who were referred for substance abuse treatment were screened for anxiety disorder symptoms using the DISC-PS at pretreatment. Results suggest similar (low) levels of agreement between the parent report and child report versions as found with other anxiety symptom and anxiety disorder measures.

Conclusions: This study adds to the existing research on the assessment of anxiety disorder symptoms in both clinically and theoretically important ways. Findings provide data on multi-informant agreement and highlight issues in the use of the DISC-PS to identify anxiety problems in youth.

Related protocols: CTN-0014

Abstract:

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

Abstract:

This 2-hour webinar, produced by the National Drug Abuse Treatment Clinical Trials Network (CTN) Clinical Coordinating Center for CTN members and the public, discusses the value and principles that enable cross-study comparison through standardized biological measures, data collection forms, and assessment instruments, as recommended in the CTN’s Treatment Effect & Assessment Measures (TEAM) Task Force Outcomes. The discussion covers factors enabling cross-study analyses, implementing and maintaining standardized measures and forms, combining self-report instruments with biological measures to capture all facets of drug use, and how to maximize the value of the CTN Public Data Share web site.

The target audience includes experienced clinical research staff in the CTN or the public.

Presented by Dennis M. Donovan, PhD (Alcohol & Drug Abuse Institute, UW, PN Node), Paul VanVeldhuisen, PhD (EMMES Corporation), and Paul G. Wakim, PhD (Center for the Clinical Trials Network, NIDA).

Additional Resources:

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Abstract:

This 3-hour refresher course, produced by the National Drug Abuse Treatment Clinical Trials Network (CTN) Clinical Coordinating Center for CTN members and the public, to help assure appropriate administration of the Addiction Severity Index (ASI), a standardized screening and assessment instruments. The training will include instructional highlights of each ASI section, a review of ASI introduction and anchoring, refresher information on intent of items and coding issues, and guidance on questions not covered in the ASI manual.

The target audience is certified ASI interviewers and trainers needing an ASI Administration refresher.

Presented by T. Ronald Jackson, MSW (Evergreen Treatment Services, PN Node), Charlotte Royer-Malvestuto, MEd, MBE (University of Pennsylvania School of Medicine, DV Node), and Sabrina A. Poole, MS (University of Pennsylvania School of Medicine, DV Node).

Additional Resources:

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Abstract:

This two-hour course, produced by the National Drug Abuse Treatment Clinical Trials Network (CTN) Clinical Coordinating Center for CTN members and the public, provides an overview of important information about drugs of abuse, including intoxication and withdrawal syndromes of various drug classes, DMS-IV substance abuse and dependence criteria, and commonly used methods and procedures used to evaluate substance use, abuse, and dependence measures.

The target audience is CTN members and members of the public interested in learning the basics about drug abuse and the identification of addiction.

Presented by Gloria M. Miele, PhD (Columbia University, GNY Node).

Additional Resources:

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