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Composite International Diagnostic Interview Substance Abuse Module (CIDI-SAM)
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Overview |
Instrument Reviews |
Construct Overviews |
Book Compendium Reviews |
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Practical Information
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Instrument Name:
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Composite International Diagnostic Interview Substance Abuse Module (CIDI-SAM)
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Instrument Description:
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The CIDI-SAM is an expanded version of the substance use sections of the Composite International Diagnostic Interview (CIDI) developed to assess psychoactive substance abuse and dependence disorders. Developed at the request of the WHO/ADAMHA Task Force on Psychiatric Assessment Instruments, the CIDI-SAM standardizes the questions interviewers ask in attempting to make a clinical diagnosis of substance abuse and dependence disorders. The structured interview is precoded so that it can be administered by nonclinicians (with 1 week training). (Ref: 3) A 1990 article reported that 20 different versions of the SAM had been archived. (Ref: 3) We examined version 4.1 (revised in 2000). This version of the CIDI-SAM has six sections: demographics, nicotine dependence, alcohol dependence and abuse drug dependence and abuse, caffeine dependence, and interviewer observations. The CIDI-SAM assesses withdrawal symptoms and their duration; physical, social, and psychological effects; age at onset; course and severity; and impairment and treatment seeking. The instrument is not recommended for use with persons under 15 years of age. (Ref: http://epi.wustl.edu/epi/assessments/sam.htm)
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Price:
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Paper version of the SAM is $35.00; Computerized version (investigator's package) is $500.
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Administration Time:
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As long as 60 minutes (Ref: 2) but averages 45 minutes. (Ref: http://epi.wustl.edu/epi/)
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Publication Year:
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1989
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Item Readability:
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The CIDI-SAM is written at a 7th grade reading level (Flesch-Kincaid). However, researchers at Epidemiology and Prevention Research Group suggest that persons with a 6th grade reading education should be able to read and understand the instrument. (Ref: http://epi.wustl.edu/epi/assessments/sam.htm)
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Scale Format:
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A combination of Likert-type, dichotomous responses (yes/no), open and close-ended questions. (Ref: 1)
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Administration Technique:
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Clinicians, or non-clinicians with approximately 1 week of training. (Ref: 2-3,6)
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Scoring and Interpretation:
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Computer-scored according to pre-coded items. (Ref: 3)
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Forms:
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Other language translations include: Spanish (Ref: Caetano R, Mora MEM, Schafer J, Marino MDC. The Structure of DSM-IV Alcohol Dependence in a Treatment Sample of Mexican and Mexican American Men. Addiction 1999;94(4):533-41. [PMID 10605849]) Other versions include: the computerized SAM. (Ref: http://epi.wustl.edu/epi/assessments/sam.htm)
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Research Contacts
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Instrument Developers:
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Linda B. Cottler, PhD and Susan K. Keating, PhD
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Instrument Development Location:
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Department of Psychiatry, Washington University School of Medicine, 40 N. Kingshighway Suite 4, St. Louis, Missouri 63108
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Instrument Developer Email:
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cottler@epi.wustl.edu
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Instrument Developer Website:
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epi.wustl.edu/epi/assessments/sam.htm
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Annotated Bibliography
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1. Washington University, Department of Psychiatry, Epidemiology and Prevention Research Group. CIDI Substance Abuse Module (SAM). Updated April 6, 2004. Accessed October 2004. Available: http://epi.wustl.edu/epi/assessments/sam.htm
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Purpose:
This is the homepage of the developer’s affiliation and gives descriptive and ordering information for the CIDI-SAM.
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Sample:
N/A
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Methods:
N/A
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Implications:
N/A
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2. Cottler LB, Robins LN, Helzer JE. The Reliability of the CIDI-SAM: A Comprehensive Substance Abuse Interview. Br J Addict 1989 Jul;84(7):801-14.[PMID:2758153]
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Purpose:
To test the reliability of the Composite International Diagnostic Interview Substance Abuse Module (CIDI-SAM).
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Sample:
N = 39 interviewees. The sample included participants in an inner-city drug-free residential treatment center and inpatients and outpatients from the psychiatric services of two private St. Louis hospitals.
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Methods:
The interviewees were interviewed twice, approximately 1 week apart and were paid $15 after completion of the second interview. The CIDI-SAM took on average 60.3 minutes to administer. Participants in the study reported multiple problems with alcohol and/or drugs.
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Implications:
Most of the CIDI-SAM items had exhibited high test/retest reliability; a few items with poor reliability were revised.
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3. Cottler LB, Keating SK. Operationalization of Alcohol and Drug Dependence Criteria by Means of a Structured Interview. Recent Dev Alcohol 1990;8:69-83. [PMID:2333396]
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Purpose:
To discuss the development and evolution of the structured interviews and offer guidelines for operationalization of substance abuse and dependence criteria.
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Sample:
N/A
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Methods:
N/A
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Implications:
Discussed are the challenges of developing a measure that unifies multiple theories of dependence. The paper provides a clear and thoughtful rationale for the decisions made in developing and revising the instrument (e.g., selection of items, wording of responses, classification criteria).
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4. Compton WM, Cottler LB, Dorsey KB, Spitznagel EL, Mager DE. Comparing Assessments of DSM-IV Substance Dependence Disorders Using CIDI-SAM and SCAN. Drug Alcohol Dep 1996;41:179-87.[PMID:8842630]
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Purpose:
To compare DSM-IV substance dependence assessments using the CIDI-SAM and the WHO Schedules for Clinical Assessment in Neuropsychiatry (SCAN) with assessments made by the SAM administered twice.
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Sample:
N = 412. The sample was divided into two groups: SAM/SCAN (n = 123) and SAM/SAM (n = 289). The SAM/SCAN group had a mean age of 34.4 years (SD=7.5), was 54% female (n = 66), and 68% African American (n = 84). The SAM/SAM group had a mean age of 35.2 (SD=7.5) years, was 51% (n = 148) female, and 60% (n = 172) African American.
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Methods:
Participants were randomly assigned to either a test/retest subsample or a test/validation subsample. Those in the test/retest group were assessed with the SAM twice with approximately one week between interviews (SAM/SAM group). The second group was assessed with the SAM and then were interviewed with the SCAN by experienced clinicians with clinical training in treatment of substance abuse (SAM/SCAN group). Concordance between assessments was evaluated in each group.
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Implications:
Good diagnostic agreement was found between the SAM and SCAN for DSM-IV alcohol and cocaine dependence syndromes, and fair agreement for DSM-IV opiate and cannabis dependence.
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5. Taylor J, Carey G. Antisocial Behavior, Substance Use, and Somatization in Families of Adolescent Drug Abusers and Adolescent Controls. Am J Drug Alcohol Abuse 1998 Nov;24(4):635-46. [PMID:9849774]
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Purpose:
To examine conduct disorder (CD), antisocial personality disorder (ASP), alcohol and drug abuse, and somatization in families of adolescent drug abusers and adolescent controls.
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Sample:
N = 70 boys (35 substance abusing, 35 controls) from a Denver, CO residential treatment facility for substance abuses. The age ranged from 14 to 18 for both proband and control participants. There was a total of 177 relatives- 72 substance abusing and 105 control relatives.
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Methods:
The study participants were all interviewed by a trained interviewer. The Substance Abuse Module (SAM) was used to assess drug abuse and the Diagnostic Interview for Children and Adolescents (DICA) was used to assess CD, alcohol abuse, and somatization.
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Implications:
The substance-abusing group had significantly more CD/ASP, alcohol abuse, and drug abuse symptoms than control groups, as expected. Furthermore, a significant positive correlation was found between CD/ASP, alcohol abuse, and drug abuse for each group. There were no significant effects between male and female control relatives for drug abuse, as related to the SAM.
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6. Horton J, Compton W, Cottler LB. Reliability of Substance Use Disorder Diagnoses Among African-Americans and Caucasians. Drug Alcohol Dependence 2000;57:203-9. [PMID:10661671]
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Purpose:
To examine the reliability of substance use disorders (SUD) diagnoses between African Americans (AA) and Caucasians (C).
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Sample:
N = 303. The mean age (SD) was 35.1 (7.5) years; 196 African Americans, 107 Caucasians; 167 females, 136 males; 24% were married, 60% were employed, and the average years (SD) of education were 12.2 (2.1).
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Methods:
Two CIDI-SAM interviews were conducted two one week apart. Test/retest reliability was compared for African American and Caucasian participants.
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Implications:
The CIDI-SAM was found to be a reliable instrument for both African Americans and Caucasians. Furthermore, the DSM-IV substance use disorders diagnostic criteria proved applicable for both African Americans and Caucasians.
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7. Brown RL, Leonard T, Saunders LA, Papasouliotis O. A Two-Item Conjoint Screen for Alcohol and Other Drug Problems. J Am Board Fam Pract 2001;14:95-106.[PMID:11314930]
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Purpose:
To examine the criterion validity of a two-item conjoint screen (TICS) for alcohol and other drug abuse/dependence for a random sample of primary care patients.
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Sample:
N = 1136 (37.4% Northeast, 29.2% Verona, and 33.4% Wingra). Demographic characteristics: 32.1% male, 67.9% female; 26.6% 18-29 years, 31.5% 30-39 years, 26% 40-49 years, 15.9% 50-59 years; 12.1% African American, 1.1% Asian American, 83.3% White, 1.8% Hispanic, 0.7% Native American, 1% Other, 0.1% Missing; 68.5% had private insurance, 16.9% had public insurance, 5.5% had No insurance, and 9.1% had Other; 13.2% had less than high school education; 47.4% had high school graduate or equivalent; 12.8% had an associate/vocational/technical degree; 16.5% had a Bachelor’s degree, 9.95% had an advanced degree, and 0.2% missing. Eligibility requirements included: between 18 and 59 years old, had no mental or physical disability, had a scheduled appointment on any given day that an interviewer was present, could speak English, and was not pregnant. Slightly over 50% of the participants had lifetime disorders and more than one third had a lifetime history of substance dependence; alcohol was most involved in lifetime disorders followed by marijuana, cocaine, stimulants, sedative-tranquilizers, opioids, hallucinogens, and inhalants.
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Methods:
Patients were recruited from three clinics in Madison, Wisconsin: 1) Northeast, 2) Verona, and 3) Wingra. At the time of informed consent, participants were also informed that there was a 25% chance they would be asked to have a urine drug-screening test. The TIC CIDI-SAM, and the Marlowe-Crowne Social Desirability scale were administered. In addition, participants responded to 5 items that were being evaluated as potential screens for substance abuse.
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Implications:
Based on the results, a two-item screen was developed for identifying substance abuse. This screen, the two-item conjoint screen (TICS) had sensitivity and specificity of 80% in the study sample.
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8. Cottler LB, Nishith P, Compton WM III. Gender Differences in Risk Factors for Trauma Exposure and Post-Traumatic Stress Disorder (PTSD) Among Inner-City Drug Abusers in and out of Treatment. Compr Psychiatry 2001 Mar-Apr;42(2):111-7. [PMID:11244146]
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Purpose:
To examine the role of gender in "(1) predicting the nature of traumatic event and PTSD symptoms, (2) patterns of substance use disorders in relation to trauma exposure and PTSD symptoms, (3) comorbidity of other psychiatric disorders with trauma exposure and PTSD, and (4) the temporal association of substance use disorder, exposure to trauma, and PTSD."
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Sample:
N = 463 (1- Traumatic event, n = 166; 2- No traumatic event, n = 297). Demographic characteristics for traumatic event (PTSD, n= 30; no PTSD, n = 136) sample: mean (SD) age was 32.3 years (6.57); 34% female, 82% African American, 55% High school graduate, 32% employed (past 12 months), 44% ever married, 94% DSM-III-R drug abuse/dependence, and 38% comorbidity with DSM-III-R psychiatric disorders. Demographic characteristics for ‘no traumatic event’ (n = 297) sample: 26% female, 93% African American, 52% high school graduate, 39% employed (past 12 months), 46% ever married, 88% DSM-II-R drug abuse/dependence, and 31% comorbidity with DSM-II-R psychiatric disorders.
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Methods:
The study participants were interviewed with the DSM-III-R and the CIDI-SAM, after consent was obtained.
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Implications:
The time between the beginning of drug use and a PTSD event for men was twice as long as that for women, about 8 years.
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9. Ridenour TA, Cottler LB, Compton WM, Spitznagel EL, Cunningham-Williams RM. Is There a Progression From Abuse Disorders to Dependence Disorders? Addiction 2003 May;98(5):635-44. [PMID:12751981]
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Purpose:
To determine the prevalence and patterns of conduct disorder (CD) in American Indian (AI) adolescents who were admitted to a residential substance abuse treatment program (RSATP).
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Sample:
N = 89 (with CD, n = 66; no CD, n = 23). Demographic characteristics: ages 13-15 (n = 39), ages 16-18 (n = 50); 54 males, 35 females; alcohol abuse/dependence (n = 60), marijuana abuse/dependence (n = 75), other abuse/dependence (n = 35); attention deficit/hyperactivity disorder (n = 16), major depressive disorder (n = 13), post-traumatic stress disorder (n = 9), and generalized anxiety disorder (n = 2); mean length of stay (days), n = 83.96 for adolescents without CD and n = 77.67 for adolescents with CD.
The adolescents were recruited if they had been admitted to the RSATP between October 1998 and May 2001. Eligible participants for the diagnostic interview were those who had lived in the facility for at least seven days.
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Methods:
The study participants were interviewed in a private room and their treatment records were reviewed after they had been released from the RSATP. The measures administered were: Diagnostic Interview Schedule for Children, Youth Version (DISC-IV-Y) and the Substance Abuse Module of the Composite International Diagnostic Interview (CIDI-SAM). The DISC-IV-Y interview assessed both DSM-IV diagnoses and specific diagnostic criteria. The CIDI-SAM interviews assessed substance use and substance-related psychiatric disorders. All information was self-reported; there was no parental involvement.
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Implications:
Adolescents with CD were more likely to be male and meet the criteria for marijuana abuse/dependence and ADHD. Overall, the findings suggest that RSATPs for AI adolescents need to be able to treat comorbid CD.
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Factors and Norms
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Factor Analysis Work:
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No information found.
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Normative Information Availability:
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No information found.
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Reliability Evidence
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Test-retest:
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The Kappa statistic for test-retest of the CIDI-SAM was 0.78. Drug-specific Kappa values include: opiate dependence, 0.82; cocaine dependence, 0.61; and cannabis dependence, 0.56. (Ref: 4) In a study assessing the one-week test-retest of substance abuse diagnoses among blacks and whites, the CIDI-SAM performed equally well in both groups. (Ref: 6) The average test/retest reliability was 0.81 for CIDI-SAM-based diagnostic classifications and 0.82 for drug symptoms. (Ref: 2)
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Inter-rater:
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No information found.
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Internal Consistency:
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No information found.
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Alternate Forms:
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No information found.
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Validity Evidence
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Construct/ Convergent/ Discriminant:
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Researchers found the level of agreement in the ability of the CIDI-SAM and SCAN to diagnose dependence disorders, using the Kappa statistic: alcohol dependence (0.69), cocaine dependence (0.61), opiate dependence (0.49), and cannabis dependence (0.50). (Ref: 4)
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Criterion-related/ Concurrent/ Predictive:
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The Kappa statistic values of agreement between CIDI-SAM scores and DSM-III, DSM III-R-dependence, and DSM-III-R-dependence or abuse diagnoses were 0.84, 0.75, and 0.82, respectively. The overall agreement was 0.81. (Ref: 2)
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Content:
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No information found.
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Responsiveness Evidence:
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No information found.
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Scale Application in VA Populations:
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No information found.
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Scale Application in non-VA Populations:
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Yes. (Ref: 2,4-9)
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Comments
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The CIDI-SAM is a structured interview used to assess substance abuse or dependence. It may be administered by a clinician or layperson with training, via paper and pencil or computer, and takes approximately 45 minutes to administer.
Overall Usefulness for a Certain Population: The CIDI-SAM is appropriate for respondents who are at least 15 years old. . English and Spanish versions are available. The developers caution that those with severe mental illness or organic brain disorders will not be able to reliably complete the CIDI-SAM. We found no published study that used the CIDI-SAM in a veteran population.
Advantages: The CIDI-SAM may be completely administered by a trained nonclinician and scored via computer. Test-retest results were strong for alcohol and opiate dependence. Validity seems to be moderate to good overall, with CIDI-SAM scores having strong agreement with DSM-III and DSM-III-R diagnoses (studies of agreement with DSM-IV diagnoses were not found).
Disadvantages: We found no evidence of internal consistency studies, normative information, or responsiveness evidence.
Recommendation: Given that the CIDI-SAM may be used as a diagnostic tool in making treatment decisions, research to examine the reliability of this instrument would be beneficial, as would information on the instrument’s responsiveness to change.
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