Validity of the Self-Reported Drug Use Section of the Addiction Severity Index and Associated Factors Used under Naturalistic Conditions

Abstract

The study examined the validity of 1848 self-reported uses of drugs determined within an Addiction Severity Index interview in comparison with urinalysis results among drug-dependent subjects undergoing treatment in outpatient clinics (Aquitaine area, southwest France, 1994–2005). Agreement and kappa statistics were calculated for each substance. Factors associated with agreement were defined using a multivariate analysis. The conditional kappa coefficients were excellent for all substances assessed. The accuracy between self-reports and urinalysis results was influenced by factors that only slightly affected conditional kappa coefficients. Clients did not underreport their substance use in naturalistic clinical assessment conditions.

RÉSUMÉ

Validité des consommations de substances rapportées dans l'Addiction Severity Index et facteurs associés en condition naturaliste de prise en charge en centre de soins spécialisés en Addictologie.

Cette étude a comparé des données de consommations de substances recueillies au cours de 1848 entretiens ASI (Addiction Severity Index) avec des dosages urinaires associés chez des patients dépendants pris en charge en ambulatoire dans des centres de soins spécialisés en addictologie (Région Aquitaine, 1994–2005). Pour chaque substance, la prévalence de concordance entre les données de l'ASI et les dosages urinaires ainsi que les coefficients kappa ont été calculés. Une analyse multivariée a été conduite pour identifier les facteurs associés à la concordance. Les coefficients Kappa étaient excellents pour l'ensemble des substances évaluées. Certains facteurs influençaient la concordance entre les données de l'ASI et le dosage urinaire, mais les coefficients Kappa n’étaient que modestement modifiés. Dans cet échantillon, les données de consommations rapportées par les patients en condition naturaliste de prise en charge étaient valides.

RESUMEN

Validez del uso de sustancias en el Addiction Severity Index y factores asociados en condiciones naturalistas en centros especializados en adicciones.

Este estudio comparó los datos de consumo de sustancias recogidas en las entrevistas en 1848 ASI (Addiction Severity Index) asociados con análisis de orina en pacientes dependientes en la atención en los centros de atención ambulatoria especializada en adicciones (Aquitania, 1994–2005). Para cada sustancia, la prevalencia de acuerdo entre los datos de la ASI, los análisis de orina y los coeficientes kappa se calcularon. El análisis multivariante se llevó a cabo para identificar los factores asociados con la concordancia. Los coeficientes kappa eran excelentes para todas las sustancias evaluadas. Algunos factores influyeron en la correlación entre los datos de la ASI y la orina, pero los coeficientes kappa fueron sólo ligeramente cambiados. En esta muestra, los datos de consumo reportados por los pacientes en condiciones naturalistas de la atención fueron válidos.

Keywords :

• urinalysis
• self-report
• accuracy
• associated factors
• naturalistic settings

THE AUTHORS

Cécile Denis, PhD, received a PhD in Addiction and Psychology from the University of Bordeaux, Bordeaux, France. She was a former clinical research project coordinator and postdoctoral fellow at Laboratoire de Psychiatrie (Addiction Team, EA 4139, then CNRS USR 3413 Sanspy) from 2003 to 2010. She received a NIDA INVEST/CTN fellowship in 2010 and she is currently a postdoctoral fellow at the Treatment Research Center, University of Pennsylvania, Philadelphia, PA, USA, and at the Treatment Research Institute, Philadelphia, PA, USA. Her PhD dissertation examined the development and the validity of a French modified version of the Addiction Severity Index (ASI). Her research interests focus on the assessment of addictive disorders (substance and non-substance), co-occurring disorders, and treatment outcomes. She pays particular attention to translating research from clinically meaningful data that can be used for clinical practice and public health decisions. She has been ASI senior trainer and supervisor in French-speaking countries since 2003. In the Department of Addiction Psychiatry of the Charles Perrens Hospital, Bordeaux, France, she is in charge of patient intake and follow-up standardized clinical assessments.

Melina Fatseas, MD, PhD, is a fully licensed psychiatrist and addiction specialist with a PhD in addiction psychology research. She is a senior staff addiction psychiatrist at the Addiction Treatment Center of the Charles Perrens Hospital, Bordeaux, France, and a Senior Lecturer at the Medical School of the University of Bordeaux, Bordeaux, France. Melina Fatseas is also senior clinician researcher in the Laboratoire de Psychiatrie/Addiction Team of Sanpsy CNRS USR 3413. Melina Fatseas was awarded a CNRS-CHU Research Award (2008–2010) to implement an addiction research program. Her research interests cover issues of assessment of addiction-related behavior for research, with a special interest in the Addiction Severity Index. Melina Fatseas is building her main research agenda on the search of predictors of relapse, with a special focus on craving and its behavioral and biological correlates in human models in both laboratory and naturalistic settings.

Virginie Beltran, MSc, received a Master's degree in Neurosciences and Addiction sciences from the University of Bordeaux, Bordeaux, France. She is a clinical research coordinator at Laboratoire de Psychiatrie/CNRS USR 3413 Sanpsy (Addiction Team). She is in charge of patient assessments, including Addiction Severity Index quality control, and supervision of clinical research at BIZIA addiction Treatment Center in Bayonne, France, in collaboration with the Addiction Treatment Center of the Charles Perrens Hospital, Bordeaux, France.

Claire Bonnet, MSc, received a Master's degree in Neurosciences and Addiction sciences from the University of Bordeaux, Bordeaux, France. She did her Master's training at Laboratoire de Psychiatrie and Addiction Treatment Center of Charles Perrens Hospital (2006–2007) and was trained as an Addiction Severity Index interviewer. Claire Bonnet also has a Master's degree in Pharmaceutical Development from the University of Poitiers, Poitiers, France, and is now working as a clinical research assistant (CRA) for clinical research organizations (CRO) and pharmaceutical industry.

Stéphane Picard, MD, is an MD with specialization in Medical Biology. He trained at the Hospital Research Center and the Medical School of the University of Bordeaux, Bordeaux, France. He is currently working in the Medical Biology Laboratory of Charles Perrens Hospital, Bordeaux, France, where he is in charge of urine toxicology screening and quality control. From 2004 to 2008, he was a clinical researcher in the Department of Clinical Pharmacology and Toxicology of INSERM (U657). In 2007, he developed methods and strategies (now routinely applied) for optimizing the treatment of leukemia, using an early follow-up of drug exposure and determining blood levels of tyrosine kinase inhibitors (such as Imatinib/Glivec). In 2009, he was consulted as a clinical biology expert for questions related to “drugs of abuse testing in the workplace” during a national congress of the French MILDT (Interministerial Mission in the Fight against Drugs and Drug Addiction).

Isabelle Combourieu, PharmD, is a pharmacist with specialization in Medical Biology. She is the director of the Medical Biology Laboratory of the Charles Perrens Hospital, Bordeaux, France. She has developed many biological assays for psychotropics and has set-up an extensive urinalysis toxicology screening system in close collaboration with the Addiction Treatment Center in Bordeaux.

Jean-Pierre Daulouède, MD, is a psychiatrist specialized in addiction psychiatry and medicine. He graduated from the University of Bordeaux and Charles Perrens Hospital, Bordeaux, France. He has worked for 40 years in collaboration with the University of Bordeaux and published numerous articles in national and international medical and scientific journals. With Jean Tignol and others, he has contributed to set-up a strong interest for addiction research and treatment evaluation in Bordeaux. He introduced opiate agonist maintenance treatments for heroin addiction in the mid-80s using opium tincture (1984), buprenorphine (1986), and methadone (1993). His group is among those that have the largest clinical experience with opiate agonist treatments in France. Dr. Daulouède is the director of the BIZIA Addiction Treatment Center in Bayonne, France. In 2009, he was awarded the price of the European Citizen, in recognition of his actions in the field of drugs and HIV harm reduction actions in the Aquitaine and Euzkadi regions. He is the general director of an international congress on Addiction, AIDS and Hepatitis in Biarritz (THS-Biarritz).

Marc Auriacombe, MD, is a Professor of Psychiatry and Addiction Medicine at the Medical School of the University of Bordeaux, Bordeaux, France, and an Adjunct Assistant Professor in the Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA. He is the director of an addiction research team at CNRS USR 3413 Sanpsy (Laboratoire de Psychiatrie) and medical director of the Addiction Treatment Services of the Charles Perrens Hospital and CHU in Bordeaux, France. He is the principal senior investigator of an integrated addiction research program funded by French national and European funds. The focus of his research is on addictive behaviors, whether related to drugs (tobacco, alcohol, cannabis, heroin, cocaine, and other drugs) or other addictions (gambling, Internet, food, etc.). The objective is to better characterize the phenomenology of addictive behavior and its determinants. With Jean-Pierre Daulouède and Jean Tignol, he has contributed to introduce the Addiction Severity Index in France in 1989. Marc Auriacombe was awarded the EUROPAD Award 2002 “Chimera d'Argento,” “dedicated to all those who dream of a better world for drug addicts”.