Development of a Brief Version of the Current Opioid Misuse Measure (COMM): The COMM-9.

Objective: The Current Opioid Misuse Measure (COMM) is a commonly used self-report instrument to identify and monitor aberrant opioid-related behavior in chronic pain patients on opioid therapy. However, the length of the COMM may limit its clinical utility. Additionally, this paper-and-pencil screener requires hand scoring, which increases paperwork and staff burden. Therefore, the current study presents development of the "COMM-9," a brief electronically administered form of the COMM. Methods: Patients (N = 517) with chronic noncancer pain on opioid therapy completed the COMM. Patients were classified as either being positive or negative for aberrant drug-related behavior based on self-report data from a structured interview, physician-report data, and urine toxicology screen (the Aberrant Drug Behavior Index [ADBI]). COMM items with the strongest classification accuracy were identified using the LASSO method as the selection criterion in conjunction with the leave-one-out cross-validation method as the stop criterion. A sub-set of patients (n=55) completed a second administration of the COMM one week later to evaluate test-retest reliability. Results: Nine items were identified before the selection criterion stopped, and logistic regression was utilized to predict probabilities of positive ADBI from the 9 COMM items using all data and the cross-validation procedure. Receiver operating characteristic curves revealed high levels of classification accuracy that were essentially equivalent to the full COMM. Cut-points were identified to classify patients as having no/low risk, moderate risk, and high risk for aberrant opioid-related behavior. Test-retest reliability of the COMM-9 was comparable to the full 17-item COMM. Conclusions: This study presents the successful development of a brief electronic screener to identify current aberrant opioid-related behavior in chronic pain patients on long-term opioid therapy.

Development and Validation of an Eight-Item Brief Form of the SOAPP-R (SOAPP-8).

Objective: Although the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R) has become a widely used screener for aberrant opioid-related behavior in adults, the length of the instrument may limit its utility. The purpose of the current study was to develop a short form of the SOAPP-R by retaining as few items as possible while maximizing predictive accuracy. Methods: Participants (N = 555), recruited from pain clinics, completed the 24-item SOAPP-R and participated in a five-month follow-up visit to evaluate aberrant drug-related behaviors. Opioid aberrant-related behavior was determined through self-report, physician report, and urine toxicology screen. The optimal subset of SOAPP-R items to predict aberrant opioid-related behavior was identified empirically by employing the LASSO selection method and the leave-one-out cross-validation (LOOCV) method offered in the GLMSELECT procedure in SAS 9.4 in conjunction with content expertise. Results: Eight items were identified before the selection method stopped. The receiver operating characteristic curve generated from the predicted probabilities from the model produced an area under the curve (AUC) value greater than the AUC value produced by the 24-item SOAPP-R total score and yielded a sensitivity of 0.74 and a specificity of 0.66. Conclusions: These results provide strong preliminary support for the SOAPP-8 as a brief screening tool of aberrant opioid-related behavior in chronic pain patients.

Burden of Schizophrenia or Psychosis-Related Symptoms in Adults Undergoing Substance Abuse Evaluation.

This study evaluated the biopsychosocial characteristics of adults undergoing substance abuse evaluation with potential schizophrenia/psychotic disorder, or possible schizophrenia/psychosis-like symptoms, compared with those with no schizophrenia/psychosis-like symptoms. A cross-sectional, observational study examined 170,201 adults, aged 18 to 30, who completed the Addiction Severity Index-Multimedia Version (ASI-MV). Approximately 10% were classified as having possible schizophrenia/psychosis-like symptoms or potential schizophrenia/psychotic disorder. These patients were more likely to exhibit moderate to extreme severity on employment, medical, legal, substance use, social, and psychiatric status than nonsymptomatic patients. The potential schizophrenia or psychotic disorder cohort was also more likely to have ever experienced physical abuse (odds ratio [OR] = 4.30, 95% confidence interval [CI] = 4.12-4.48) and/or sexual abuse (OR = 4.32, 95% CI = 4.15-4.51) versus the no schizophrenia/psychosis-like symptoms cohort. Findings support a recommendation for routine screening for mental health issues, particularly schizophrenia/psychosis-like symptoms, for adults entering substance use disorder treatment settings. This may increase the likelihood of appropriate and earlier intervention.

CHAT: development and validation of a computer-delivered, self-report, substance use assessment for adolescents.

The current study was conducted to construct and validate a computer-delivered, multimedia, substance use self-assessment for adolescents. Reliability and validity of six problem dimensions were evaluated in two studies, conducted from 2003 to 2008. Study 1 included 192 adolescents from five treatment settings throughout the United States (N = 142) and two high schools from Greater Boston, Massachusetts (N = 50). Study 2 included 356 adolescents (treatment: N = 260; school: N = 94). The final version of Comprehensive Health Assessment for Teens (CHAT) demonstrated relatively strong psychometric properties. The limitations and implications of this study are noted. This study was supported by an SBIR grant.

Illustration of a statistical process control approach to regional prescription opioid abuse surveillance.

OBJECTIVE: To investigate and illustrate the use of statistical process control (SPC) for prospective monitoring and detection of regional changes in prescription opioid abuse rates. METHODS: A demonstration project was conducted by applying several types of SPC charts to Louisiana TANF (Temporary Assistance for Needy Families) applicant self-reported opioid illicit use data collected during 21 months. These charts were constructed and examined for signals of abuse rate changes both at the aggregate statewide level and for each state region (parish) separately. RESULTS: SPC identified increases in opioid illicit use in 2 parishes and subsequent decreases in both regions. These fluctuations were not as apparent when the data were examined using traditional bar graphs and summary tables. The remaining parishes exhibited stable abuse rates with no statistically significant changes over time. CONCLUSIONS: These results illustrate proof of concept for monitoring prescription drug abuse regionally via statistical control charts and the potential of this approach for real-time prospective surveillance for abuse rate changes.

The effect of computer-mediated administration on self-disclosure of problems on the addiction severity index.

OBJECTIVES: People tend to disclose more personal information when communication is mediated through the use of a computer. This study was conducted to examine the impact of this phenomenon on the way respondents answer questions during computer-mediated, self-administration of the Addiction Severity Index (ASI) called the Addiction Severity Index-Multimedia Version((R)) (ASI-MV((R))). METHODS: A sample of 142 clients in substance abuse treatment was administered the ASI via an interviewer and the computerized ASI-MV((R)), three to five days apart in a counterbalanced order. Seven composite scores were compared between the two test administrations using paired t-tests. Post hoc analyses examined interviewer effects. RESULTS: Comparisons of composite scores for each of the domains between the face-to-face administered and computer-mediated, self-administered ASI revealed that significantly greater problem severity was reported by clients in five of the seven domains during administration of the computer-mediated, self-administered version compared to the trained interviewer version. Item analyses identified certain items as responsible for significant differences, especially those asking clients to rate need for treatment. All items that were significantly different between the two modes of administration revealed greater problem severity reported on the ASI-MV((R)) as compared to the interview administered assessment. Post hoc analyses yielded significant interviewer effects on four of the five domains where differences were observed. CONCLUSIONS: These data support a growing literature documenting a tendency for respondents to be more self-disclosing in a computer-mediated format over a face-to-face interview. Differences in interviewer skill in establishing rapport may account for these observations.

Validation of the Spanish Addiction Severity Index Multimedia Version (S-ASI-MV).

This study aimed to develop and test the reliability and validity of a Spanish adaptation of the ASI-MV, a computer administered version of the Addiction Severity Index, called the S-ASI-MV. Participants were 185 native Spanish-speaking adult clients from substance abuse treatment facilities serving Spanish-speaking clients in Florida, New Mexico, California, and Puerto Rico. Participants were administered the S-ASI-MV as well as Spanish versions of the general health subscale of the SF-36, the work and family unit subscales of the Social Adjustment Scale Self-Report, the Michigan Alcohol Screening Test, the alcohol and drug subscales of the Personality Assessment Inventory, and the Hopkins Symptom Checklist-90. Three-to-five-day test-retest reliability was examined along with criterion validity, convergent/discriminant validity, and factorial validity. Measurement invariance between the English and Spanish versions of the ASI-MV was also examined. The S-ASI-MV demonstrated good test-retest reliability (ICCs for composite scores between .59 and .93), criterion validity (rs for composite scores between .66 and .87), and convergent/discriminant validity. Factorial validity and measurement invariance were demonstrated. These results compared favorably with those reported for the original interviewer version of the ASI and the English version of the ASI-MV.