Biomedical subjects
Publications and source records attributed to Elizabeth C Gates.
We developed and pilot tested a 2-session motivational interviewing intervention for substance use among 14- to 18-year-old medical patients. Recruitment and retention were more challenging than anticipated. A substantial number of completers reduced their use of substances and risk of driving after drinking during the 3-month follow-up period.
BACKGROUND: Adolescent substance abuse is a serious problem for which effective interventions are needed. To conduct trials of new therapies, investigators need reliable means of identifying potential participants and of measuring outcomes. The objective of this study was to determine the 1-week test-retest reliability of the CRAFFT screening test and of the timeline follow-back (TLFB) calendar method for measuring alcohol, cannabis, and other drug use. METHODS: Ninety-three 12- to 18-year-old patients presenting for routine medical care to three urban adolescent clinics were administered the CRAFFT screen in both lifetime and past-year versions and a 90-day TLFB. Both measures were completed on the day of the clinic visit and again 1 week later. We computed kappa coefficients and the intraclass correlation coefficient (ICC) for the CRAFFT and computed the ICC separately for TLFB self-reports of alcohol and cannabis. RESULTS: For the CRAFFT, kappa for individual items ranged from 0.31 to 0.86, and the ICC was 0.93 (95% confidence interval, 0.90-0.95). However, the total score of the lifetime CRAFFT at time 2 was significantly lower than at time 1; there was no difference in time 1 and time 2 total scores for the past-year version. The ICCs for past-90-days TLFB variables were as follows: drinking days, 0.92; drinks per occasion, 0.87; cannabis days, 0.83; and joints per occasion, 0.76. Past-30-day and past-60-day intervals compared favorably to past-90-day intervals. CONCLUSIONS: The CRAFFT screen is a reliable means of screening adolescents for substance abuse, although we recommend using the past-year version. The TLFB is a reliable method of quantifying adolescents' alcohol and cannabis use at intervals of 30, 60, or 90 days.
BACKGROUND: Adolescents should be screened for alcohol misuse as part of routine care. The objective of this study was to compare the criterion validity of the Alcohol Use Disorders Identification Test (AUDIT), the Problem Oriented Screening Instrument for Teenagers substance use/abuse scale (POSIT), and the CAGE and CRAFFT questions among adolescents. METHODS: Fourteen- to 18-year-old patients arriving for routine healthcare at a large, hospital-based adolescent clinic completed the four screens and the criterion standard Adolescent Diagnostic Interview, which yields DSM-IV diagnoses of alcohol abuse and dependence. Receiver operating characteristic (ROC) curves were plotted to determine optimal cut-points. Areas under the ROC curves of the four screens were compared, and sensitivities and specificities were calculated. RESULTS: Participants' past 12-month alcohol diagnostic classifications were as follows: no use (58.6%), nonproblem use (13.0%), problem use (20.8%), abuse (5.4%), and dependence (2.2%). Optimal cut-points associated with problem use or higher were 2 for AUDIT, 1 for POSIT, 1 for CAGE, and 1 for CRAFFT. ROC curve area of the CAGE was significantly lower compared with areas of all other screens. Sensitivities (95% confidence intervals) were AUDIT 0.88 (0.83-0.93), POSIT 0.84 (0.79-0.90), CAGE 0.37 (0.29-0.44), and CRAFFT 0.92 (0.88-0.96); specificities were AUDIT 0.81 (0.77-0.85), POSIT 0.89 (0.86-0.92), CAGE 0.96 (0.94-0.98), and CRAFFT 0.64 (0.59-0.69). CONCLUSIONS: The AUDIT, POSIT, and CRAFFT have acceptable sensitivity for identifying alcohol problems or disorders in this age group. The CAGE is not recommended for use among adolescents.