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
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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