OBJECTIVE: The Alcohol Dependence Scale (ADS) yields continuous scores purported to reflect the severity of the dependence syndrome. We evaluated the concurrent validity of the ADS as a general measure of severity and the screening accuracy of the total score and subscales to detect Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), physiological dependence. METHOD: Treatment-seeking, alcohol-dependent individuals entering the Combining Pharmacotherapies and Behavioral Interventions for Alcohol Dependence (COMBINE) Study (N = 1,372; 69% men) completed the ADS, diagnostic interviews, and other measures before randomization. Analyses of variance tested differences between ADS quartiles on alcohol- related measures. Areas under the receiver operating characteristic (AUROC) curve assessed screening accuracy for DSM-IV physiological dependence (tolerance or withdrawal) or withdrawal alone. RESULTS: ADS quartiles differed on age, other demographics, and prior treatment episodes. Linear correlation showed moderate to large magnitude associations with alcohol-related self-report measures and most indices of consumption. ADS quartiles differed significantly on proportion with DSM-IV physiological dependence, but AUROC curves indicated that the ADS had limited accuracy as a continuous measure to detect DSMIV physiological dependence (AUROC = .75 [95% confidence interval {CI}: .70-.79] and .67 [95% CI: .60-.74] for men and women, respectively; p = .08) or withdrawal alone (AUROC = .77 [95% CI: .74-.80] and .74 [95% CI: .69-.79] for men and women, respectively; p = .30). Screening accuracy was comparably limited based on ADS subscales reflecting psychoperceptual or psychophysical withdrawal. CONCLUSIONS: The ADS reflected variation in symptom severity but did not adequately identify physiological dependence or withdrawal in treatment-seeking individuals with DSM-IV alcohol dependence.
RCT Entities:
OBJECTIVE: The Alcohol Dependence Scale (ADS) yields continuous scores purported to reflect the severity of the dependence syndrome. We evaluated the concurrent validity of the ADS as a general measure of severity and the screening accuracy of the total score and subscales to detect Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), physiological dependence. METHOD: Treatment-seeking, alcohol-dependent individuals entering the Combining Pharmacotherapies and Behavioral Interventions for Alcohol Dependence (COMBINE) Study (N = 1,372; 69% men) completed the ADS, diagnostic interviews, and other measures before randomization. Analyses of variance tested differences between ADS quartiles on alcohol- related measures. Areas under the receiver operating characteristic (AUROC) curve assessed screening accuracy for DSM-IV physiological dependence (tolerance or withdrawal) or withdrawal alone. RESULTS: ADS quartiles differed on age, other demographics, and prior treatment episodes. Linear correlation showed moderate to large magnitude associations with alcohol-related self-report measures and most indices of consumption. ADS quartiles differed significantly on proportion with DSM-IV physiological dependence, but AUROC curves indicated that the ADS had limited accuracy as a continuous measure to detect DSMIV physiological dependence (AUROC = .75 [95% confidence interval {CI}: .70-.79] and .67 [95% CI: .60-.74] for men and women, respectively; p = .08) or withdrawal alone (AUROC = .77 [95% CI: .74-.80] and .74 [95% CI: .69-.79] for men and women, respectively; p = .30). Screening accuracy was comparably limited based on ADS subscales reflecting psychoperceptual or psychophysical withdrawal. CONCLUSIONS: The ADS reflected variation in symptom severity but did not adequately identify physiological dependence or withdrawal in treatment-seeking individuals with DSM-IV alcohol dependence.
Authors: Anna Mejldal; Kjeld Andersen; Randi Bilberg; Barbara Braun; Michael Bogenschutz; Gerhard Bühringer; Anette Søgaard Nielsen; Behrendt Silke Journal: Int J Methods Psychiatr Res Date: 2019-12-05 Impact factor: 4.035