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Construct Overview of Substance Abuse

Please note that this section is an archive and is no longer being updated.

Background

The Substance Abuse and Mental Health Services Administration (SAMHSA) identifies substance abuse as alcoholism, drug dependence or addiction, which are collectively known substance abuse disorders.¹ Findings by (SAMHSA) showed that, based on the 2002 and 2003 National Surveys on Drug Use & Health (NSDUH), 12.2% of older adults (aged 50 years or older) reported binge drinking (drinking five or more alcoholic drinks on the same occasion for at least one out of the past 30 days), while 3.2% reported heavy alcohol use (drinking five or more alcoholic drinks on the same occasion, with each occasion occurring at least five out of the past 30 days).² Similarly, 1.8% of older adults reported using an illicit drug during the previous month; 1.1% used Marijuana, 0.7% used prescription-type drugs for nonmedical purposes, and 0.2% used cocaine.² Given that substance abuse problems have potentially devastating consequences and are often chronic and recurrent, assessment of substance abuse has become routine in outpatient, inpatient, and career settings.

VA Relevance

The SAMHSA NSDUH findings from 2002 and 2003 found that 8% of veteran males 18 and older were alcohol abusing, alcohol dependent, or using illicit drugs. Approximately 6% of U.S. veterans reported using illicit drugs in the previous year. Data from 2000 showed that, older veterans and nonveterans reported similar rates of alcohol use; however, young male veterans aged 18-25 years were more likely to report past month alcohol use when compared to 18-25 year old nonveterans. Veterans accounted for more than 55,000 admissions to substance abuse treatment in 2000, according to the SAMHSA Treatment Episode Data Set (TEDS). When compared to male veterans, female veterans were less likely to report alcohol as their primary substance of abuse and more likely to report cocaine as such.³

In an aim to foster research and translation projects to improve quality of care among patients, the VA Health Services Research and Development (HSR&D) service, within its Quality Enhancement Research Initiative (QuERI) program, has designated a substance abuse disorder (QSUD) module. The QuERI program is a nationwide effort to use health services research to improve quality of care for both VA and non-VA patients. The QSUD has six aims for improving the care of patients with substance abuse disorders. These improvement aims include: monitoring of outcomes and care, facilitating implementation of research findings into practice, identification of patients with substance abuse disorders seen in primary care settings, specialized treatment practices, treatment for patients with comorbidities, and treatment for high-risk or underserved populations with substance abuse disorders.⁴

Measurement

Screening may consist of objective physical tests such as urine analysis, blood analysis, or analysis of psychophysiological responses.⁵ Another objective, independent source of assessment comes from collateral informant reports, which are proxy reports of an individual's behavior. These biochemical measures and collateral informants are often considered criterion measures, or the gold standard.⁶ Biochemical measures can be costly and invasive, while both biochemical and informant reports have their own set of measurement problems. For instance, biomarkers used to assess cumulative consumption effects via liver enzyme tests commonly lack specificity.⁶

Self-report and structured interviews are also used in the assessment of substance abuse, though they are subject to the biases inherent in all subjective measures. Despite skepticism concerning verbal reports of substance abuse, literature comparing verbal reports and other methods (biomarkers, informant reports) has shown that self-reports of drinking are adequately reliable and valid for the purposes of research, when steps are taken to minimize bias.⁷ One study found that self-report data on drug and alcohol use may sometimes be more accurate than that obtained by alternative (objective) measures.⁸ Each instrument has unique strengths and weaknesses that will affect response accuracy; therefore, each instrument should be evaluated in the context of the research situation. Researchers will continue to rely on verbal measures in the assessment of substance abuse, because they are inexpensive, noninvasive, and generally well accepted by respondents.⁷

Through literature review, METRIC identified five commonly used self-report or interviewer-administered substance abuse instruments and ranked them according to number of citations, as determined by the ISI Web of Knowledge.⁹ What follows is a brief summary of each instrument and three applicable references (chronological), including the developmental source.

Most Frequently Cited Instruments

1. CAGE Questionnaire
   [906 Citations]
2. Short Michigan Alcoholism Screening Test (SMAST)
   [689 Citations]
3. Alcohol Use Disorders Identification Test (AUDIT)
   [673 Citations]
4. Composite International Diagnostic Interview-Substance Abuse Interview (CIDI-SAM)
   [125 Citations]
5. Obsessive Compulsive Drinking Scale (OCDS)
   [28 Citations]

1. Center for Substance Abuse Treatment. What Is Substance Abuse Treatment? A Booklet for Families. DHHS Publication No. (SMA) 04-3955. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2004. Available: http://www.kap.samhsa.gov/products/brochures/index.htm
2. Office of Applied Studies (OAS). (Updated 2005). The National Survey on Drug Use & Health (NSDUH) Report, Substance Abuse Among Older Adults: 2002 and 2003 Update. Available: http://oas.samhsa.gov/2k5/olderadults/olderadults.htm
3. Office of Applied Studies (OAS). (Updated 2004). All Reports on Veterans. Available: http://www.oas.samhsa.gov/Veterans.htm
4. Center for Health Care Evaluation. (Updated: December 15, 2004). Quality Enhancement Research Initiative. Available: http://www.chce.research.va.gov/chce/content/queri.htmh
5. Sayette MA, Shiffman S, Tiffany ST, Niaura RS, Martin CS, Shadel WG. The measurement of drug craving.Addiction. 2000 Aug;95 Suppl 2:S189-210. PMID: [Abstract]]
6. Del Boca FK, Noll JA. Truth or consequences: the validity of self-report data in health services research on addictions. Addiction. 2000 Nov;95 Suppl 3:S347-60. PMID: [Abstract]
7. Del Boca FK, Darkes J. The validity of self-reports of alcohol consumption: state of the science and challenges for research. Addiction. 2003 Dec;98 Suppl 2:1-12. PMID: [Abstract]
8. Babor TF, Steinberg K, Anton R, Del Boca FK. Talk is cheap: measuring drinking outcomes in clinical trials. Journal of Studies in Alcohol. 2000 Jan;61(1),55-63. PMID: [Abstract]
9. ISI Web of Knowledge, Accessed April 2005. Available: http://isi01.isiknowledge.com/portal.cgi/wos/.