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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.

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 U.S. National Drug Abuse Treatment Clinical Trials Network (CTN001-002). Patients were recruited from inpatient and outpatient addiction treatment settings at 12 programs. 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.A combined application of categorical and dimensional latent approaches may improve the understanding of comorbid SUDs and their associations with other clinical indicators. Abuse of sedatives and methamphetamine may serve as a useful marker for identifying subsets of opioid-dependent individuals with needs for more intensive interventions.

SUBMITTER: Wu LT

PROVIDER: S-EPMC3170493 | biostudies-other | 2011 Nov

REPOSITORIES: biostudies-other

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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.

Wu Li-Tzy LT Ling Walter W Burchett Bruce B Blazer Dan G DG Yang Chongming C Pan Jeng-Jong JJ Reeve Bryce B BB Woody George E GE

Drug and alcohol dependence 20110417 2-3

<h4>Background</h4>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.<h4>Methods</h4>The sample included 343 opioid-dependent patients enrolled in two national multisite studies of the U.S. Natio ...[more]

PMID: 21501933

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Project description:BackgroundThe Health of the Nation Outcome Scale (HoNOS) is a widely used 12-item tool to assess mental health and social functioning. The French version has an added 13th item measuring adherence to psychotropic medication. The aim of the current study is to uncover the unknown pattern of the new item 13 and to compare the unidimensional and multidimensional fit of the new HoNOS-13 using Item Response Theory (IRT). This research question was studied among inpatients with substance use disorder (SUD).MethodsSix hundred and nine valid questionnaires of HoNOS-13 were analyzed using unidimensional (one-factor) and multidimensional (two-factor) IRT modeling.ResultsThe multidimensional model suggesting a first factor capturing psychiatric/impairment-related issues and a second factor reflecting social-related issues yielded better goodness-of-fit values compared to the unidimensional solution. This resulted in an improvement of all slope parameters which in turn translates to better discriminative power. Significant improvement in item location parameters were observed as well. The new item 13 had a good discriminative power (1.17) and covered a wide range of the latent trait (- 0.14 to 2.64).ConclusionsWe were able to validate the 13-item questionnaire including medication compliance and suggest that the HoNOS-13 can be recommended as a clinical evaluation tool to assess the problems and treatment needs for inpatients with SUD. Interestingly, the majority of item response categories are endorsed by respondents who are below and above the average levels of HoNOS. This indicates that the scale is able to discriminate between participants both at the low and at the high ends of the latent trait continuum. More importantly, the new item 13 has a good discriminative power and covers a broad range of the latent trait below and above the mean. It therefore has the desired profile of a good item and is a useful measure for the assessment of mental health and social functioning. Trial registration ClinicalTrials.gov, Identifier: NCT03551301. Registered: 11.06.2018. Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03551301 .

Project description:BackgroundComorbidities between Substance Use Disorder (SUD) and mental health disorders are highly prevalent, yet there remains a lack of information regarding how mental health conditions may affect addiction severity. Consequently, this study sought to investigate the relationship between internalizing disorders (anxiety and mood disorders) and addiction severity in patients hospitalized for SUD-related medical complications. Individual difference predictors and history of prior treatment for SUD were also examined.MethodsParticipants (N = 200) were hospitalized patients who consented to receive peer-based recovery support services for their SUD. To be eligible for the study, participants needed to have a SUD diagnosis due to alcohol, opioids, methamphetamine, cocaine, or a combination of these substances (polysubstance use). Participants completed self-report questionnaires regarding demographics, mental health history, prior SUD treatment, and addiction severity (Drug and Alcohol Screening Test; DAST-10) during their hospitalization.ResultsResults showed that patients with Generalized Anxiety Disorder (GAD) (M = 6.68, SD = 2.97) had greater addiction severity compared to those without GAD (M = 5.41, SD = 3.34), P = .016. Addiction severity results stratified by SUD type showed that the relationship was significant among patients with Alcohol Use Disorder (P = .014), but not among those with other SUD types (Ps > .27). Major Depressive Disorder (MDD) and Post-Traumatic Stress Disorder (PTSD) were not linked to addiction severity. Among those with GAD, 81.4% had previously been to treatment compared to only 53.1% of those without GAD, P = .010. The only participant characteristic linked with addiction severity was insurance status.ConclusionsGAD may represent a risk factor for advanced alcohol addiction trajectories, including greater addiction severity and severe health complications requiring inpatient hospitalization.

Dataset Information

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.

Publications

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.

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