Elsevier

Drug and Alcohol Dependence

Volume 148, 1 March 2015, Pages 40-46
Drug and Alcohol Dependence

The Alcohol Use Disorder and Associated Disabilities Interview Schedule-5 (AUDADIS-5): Procedural validity of substance use disorders modules through clinical re-appraisal in a general population sample

https://doi.org/10.1016/j.drugalcdep.2014.12.011Get rights and content

Highlights

  • AUDADIS-5 DSM-5 substance diagnoses were compared to PRISM-5 clinician re-evaluations.

  • AUDADIS-5/PRISM-5 concordance on DSM-5 SUD diagnoses ranged from fair to good.

  • AUDADIS-5/PRISM-5 concordance on SUD dimensional scales was generally excellent.

  • AUDADIS-5 SUD diagnoses and dimensional measures are useful measurement tools.

Abstract

Background

The purpose of this study was to assess the procedural validity of the substance disorder modules of the lay-administered Alcohol Use Disorder and Associated Disabilities Interview Schedule, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Version (AUDADIS-5) through clinician re-appraisal re-interviews.

Methods

The study employed a test–retest design among 712 respondents from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III). A clinician-administered, semi-structured interview, the Psychiatric Research Interview for Substance and Mental Disorders, DSM-5 version (PRISM-5) was used as the re-appraisal. Kappa coeffients indicated concordance of the AUDADIS-5 and PRISM-5 for DSM-5 substance use disorder diagnoses, while intraclass correlation coefficients (ICC) indicated concordance on dimensional scales indicating the DSM-5 criteria count for each disorder.

Results

With few exceptions, concordance of the AUDADIS-5 and the PRISM-5 for DSM-5 diagnoses of substance use disorders ranged from fair to good (κ = 0.40–0.72). Concordance on dimensional scales was excellent (ICC  0.75) for the majority of DSM-5 SUD diagnoses, and fair to good (ICC = 0.43–0.72) for most of the rest.

Conclusions

As indicated by concordance with a semi-structured clinician-administered re-appraisal, the procedural validity of the AUDADIS-5 DSM-5 substance use disorder diagnoses found in this study indicates that these AUDADIS-5 diagnoses are useful tools in epidemiologic studies. The considerably stronger concordance of the AUDADIS-5 and PRISM-5 dimensional DSM-5 SUD measures supports a current movement to place more emphasis on dimensional measures of psychopathology, and suggests that such measures may be more informative than binary diagnoses for research, and possibly for clinical purposes as well.

Introduction

Relatively little is known about the procedural validity of structured diagnostic interviews used to produce epidemiologic data on substance use disorders (SUD). The Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS) is a fully structured, computer-assisted diagnostic interview designed for trained lay interviewers (Grant et al., 2001). The AUDADIS-IV, which assessed disorders according to DSM-IV, was the measurement instrument in two U.S. national surveys sponsored by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Longitudinal Alcohol Epidemiologic Survey (NLAES; 1991–1992) and the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC, Wave 1 (2001–2002) and Wave 2 (2004–2005) (Compton et al., 2004, Grant et al., 2004a, Grant et al., 2009, Grant et al., 2004b). These surveys produced a rich epidemiologic literature on alcohol, drugs and related conditions (Hasin, In Press). The AUDADIS-IV was also used in clinical (Hasin et al., 2013a), high-risk (Hasin et al., 2007), and genetic studies (Meyers et al., 2015).

In 2012-2013, NIAAA fielded the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III; Grant, 2014). The AUDADIS-5 (Grant et al., 2011), which assesses diagnoses defined by DSM-5 criteria, is the NESARC-III instrument.

In test–retest reliability studies of AUDADIS-IV SUD diagnoses in untreated (Grant et al., 2003, Grant et al., 1995, Ruan et al., 2008) and treated (Canino et al., 1999, Hasin et al., 1997) U.S. samples and in an international study (Chatterji et al., 1997, Vrasti et al., 1998), most reliability coefficients (kappa or κ) for SUDs were good to excellent (κ  0.60), and reliability of dimensional SUD measures (counts of diagnostic criteria) generally exceeded binary diagnoses (Grant et al., 1995, Hasin et al., 1997). Recently, AUDADIS-5 DSM-5 SUDs were shown to have fair to excellent test–retest reliability (κ = 0.41–0.87) (Grant et al., In Press).

Procedural validity through clinician re-appraisal constitutes an important method of validating lay-administered diagnostic interviews. In the international study, AUDADIS-IV substance dependence generally had fair to very good concordance (Cottler et al., 1997) with the clinician-administered Structured Clinical Assessment for Neuropsychiatry (κ = 0.41–0.67) (Easton et al., 1997). In Puerto Rican primary care patients, AUDADIS-IV dependence had fair to very good concordance with psychiatrist re-interviews (Canino et al., 1999).

Given the changes in DSM-5 SUD (Hasin et al., 2013b), information is needed on the procedural validity of AUDADIS-5 SUD measures. Procedural validity is important to the interpretation of NESARC-III and other studies using the AUDADIS-5 because it reflects the extent to which diagnoses from the AUDADIS-5 correspond to diagnoses based on evaluations by experienced clinicians. A subset of NESARC-III participants underwent a clinical re-appraisal using the Psychiatric Research Interview for Substance and Mental Disorders, DSM-5 version, conducted by mental health clinicians experienced in the evaluation and treatment of substance use and commonly co-occurring disorders (Hasin et al., 2011). The PRISM is a semi-structured diagnostic interview designed to address measurement issues in heavy drinkers and drug users (Hasin et al., 2006). Here, we examine the procedural validity of AUDADIS-5 DSM-5 diagnoses of alcohol, drug and tobacco disorders. Given the increasing attention to dimensional measures of psychopathology (Hasin et al., 2013b, Regier et al., 2012), we also examine the procedural validity of DSM-5 dimensional alcohol, drug and tobacco disorder measures. To our knowledge, procedural validation of such dimensional measures through clinical reappraisal has not been done previously.

Section snippets

Sample and procedures

Participants were selected from the NESARC-III sample. NESARC-III included the non-institutionalized U.S. civilian population 18 years or older, including persons in households or group quarters, e.g., group homes; worker dormitories randomly selected via multistage probability sampling (Grant, 2014), with higher selection probabilities for Hispanics, Blacks, and Asians. The NESARC-III response rate was 60.1%, comparable to most current U.S. national health surveys (Division of Health Interview

Sample characteristics I

In terms of respondent characteristics (Table 1), about two-thirds were non-Hispanic whites, slightly over half were female, most were 25–64 years old, about 39% were married or cohabiting, and slightly over half had some education past high school. There were no differences between the procedural validity sample (N = 712) and the remaining NESARC-III sample (N = 35,597) on gender (χ2 = 0.98, p = 0.32) or education (χ2 = 1.89, p = 0.49). There were differences between these two samples on race-ethnicity (χ2

Discussion

In a large, rigorous study in the general population, AUDADIS-5 diagnoses of DSM-5 substance use disorders demonstrated fair to very good concordance with PRISM-5 clinician re-appraisals for current, past and lifetime diagnoses of the DSM-5 substance use disorders examined. Concordance levels on diagnoses in the present study are comparable to those from prior procedural validity studies of the AUDADIS-IV (Canino et al., 1999, Cottler et al., 1997). This suggests that overall, results from the

Disclaimer

The views and opinions expressed in this report are those of the authors and should not be construed to represent the views of sponsoring organizations, agencies, or the U.S. government.

Author disclosures

Role of funding source

Support is acknowledged from the National Institutes of Health, Contract HHSN275200900007C, K05AA014223 (Hasin), K24DA022412 (Nunes) and the New York State Psychiatric Institute (Hasin, Nunes). The National Epidemiologic Survey on Alcohol and Related Conditions-III was sponsored by the National Institute on Alcohol Abuse and Alcoholism and funded, in part, by the Intramural Program, NIAAA, National Institutes of Health. No authors have any relevant financial interests.

Contributors

Drs. Saha, Goldstein, Jung, Zhang and Grant collected, cleaned and analyzed the data and critically reviewed drafts of the manuscript. Dr. Hasin collected the data, wrote, and revised drafts of the manuscript. Ms. Greenstein, and Ms. Aivadyan collected, cleaned and analyzed the data and critically reviewed drafts of the manuscript. Ms. Stohl analyzed the data and critically reviewed drafts of the manuscript. Drs. Aharonovich and Nunes consulted to the data collection and critically reviewed

Conflict of interest

No conflict declared.

Acknowledgements

We acknowledge the work of Shabnam Shakibaie Smith, M.D. and Anatoliy Vasilov, M.D., for their assistance in the quality assurance of the PRISM-5 interviews for this study.

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