The concurrent validity of the Problem Oriented Screening Instrument for Teenagers (POSIT) substance use/abuse subscale in adolescent patients in an urban federally qualified health center

ABSTRACT

Background: The Problem Oriented Screening Instrument for Teenagers (POSIT) substance use/abuse subscale has been validated with high school students, adolescents with criminal justice involvement, and adolescent substance use treatment samples using the Diagnostic and Statistical Manual of Mental Disorders (DSM)-III-R and DSM-IV. This study examines the concurrent validity of the POSIT's standard 17-item substance use/abuse subscale and a revised, shorter 11-item version using DSM-5 substance use disorder diagnoses. Methods: Adolescents (N = 525; 93% African American, 55% female) 12–17 years of age awaiting primary care appointments at a Federally Qualified Health Center in Baltimore, Maryland completed the 17-item POSIT substance use/abuse subscale and items from a modified World Mental Health Composite International Diagnostic Interview corresponding to DSM-5 alcohol use disorder (AUD) and cannabis use disorder (CUD). Receiver operating characteristic curves, sensitivities, and specificities were examined with DSM-5 AUD, CUD, and a diagnosis of either or both disorders for the standard and revised subscales using risk cutoffs of either 1 or 2 POSIT “yes” responses. Results: For the 17-item subscale, sensitivities were generally high using either cutoff (range: 0.79–1.00), although a cutoff of 1 was superior (sensitivities were 1.00 for AUD, CUD, and for either disorder). Specificities were also high using either cutoff (range: 0.81–0.95) but were higher using a cutoff of 2. For the 11-item subscale, a cutoff of 1 yielded higher sensitivities than a cutoff of 2 (ranges for 1 and 2: 0.96–1.00 and 0.79–0.86, respectively). Specificities for this subscale were higher using a cutoff of 2 (ranges for 1 and 2: 0.82–0.89 and 0.89–0.96, respectively). Conclusions: Findings suggest that the POSIT's substance use/abuse subscale is a potentially useful tool for screening adolescents in primary care for AUD or CUD using a cutoff of 1 or 2. The briefer, revised subscale may be preferable to the standard subscale in busy pediatric practices.

KEYWORDS:

• Adolescents
• DSM-5
• screening
• substance use disorder

Acknowledgments

We thank Dr. Geetha Subramaniam for her guidance and the medical staff and patients at Total Health Care for their assistance. Finally, we thank Carly Bickel for helping to prepare the manuscript.

Funding

Research reported in this publication was supported by the National Institute on Drug Abuse (NIDA) R01DA026003-03S1 (Principal Investigator: Schwartz). NIDA had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Author contributions

Kelly, Gryczynski, O'Grady, Mitchell, Kirk, and Schwartz contributed to the conceptualization of the study, the writing of the research protocol, and all phases of manuscript preparation. Kelly and O'Grady assisted with data analysis and interpretation of results. All authors assisted with manuscript revisions and approved the final manuscript as submitted.