Use of item response theory and latent class analysis to link poly-substance use disorders with addiction severity, HIV risk, and quality of life among opioid-dependent patients in the Clinical Trials Network.
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BACKGROUND:This study applied item response theory (IRT) and latent class analysis (LCA) procedures to examine the dimensionality and heterogeneity of comorbid substance use disorders (SUDs) and explored their utility for standard clinical assessments, including the Addiction Severity Index (ASI), HIV Risk Behavior Scale (HRBS), and SF-36 quality-of-life measures. METHODS:The sample included 343 opioid-dependent patients enrolled in two national multisite studies of the U.S. National Drug Abuse Treatment Clinical Trials Network (CTN001-002). Patients were recruited from inpatient and outpatient addiction treatment settings at 12 programs. Data were analyzed by factor analysis, IRT, LCA, and latent regression procedures. RESULTS:A two-class LCA model fit dichotomous SUD data empirically better than one-parameter and two-parameter IRT models. LCA distinguished 10% of severe comorbid opioid-dependent individuals who had high rates of all SUDs examined-especially amphetamine and sedative abuse/dependence-from the remaining 90% who had SUDs other than amphetamine and sedative abuse/dependence (entropy=0.99). Item-level results from both one-parameter and two-parameter IRT models also found that amphetamine and sedative abuse/dependence tapped the more severe end of the latent poly-SUD trait. Regardless of whether SUDs were defined as a continuous trait or categorically, individuals characterized by a high level of poly-SUD demonstrated more psychiatric problems and HIV risk behaviors. CONCLUSIONS:A combined application of categorical and dimensional latent approaches may improve the understanding of comorbid SUDs and their associations with other clinical indicators. Abuse of sedatives and methamphetamine may serve as a useful marker for identifying subsets of opioid-dependent individuals with needs for more intensive interventions.
Severity of Illness Index
Quality of Life
Published Version (Please cite this version)10.1016/j.drugalcdep.2011.03.018
Publication InfoWu, Li-Tzy; Ling, Walter; Burchett, Bruce; Blazer, Dan G; Yang, Chongming; Pan, Jeng-Jong; ... Woody, George E (2011). Use of item response theory and latent class analysis to link poly-substance use disorders with addiction severity, HIV risk, and quality of life among opioid-dependent patients in the Clinical Trials Network. Drug and alcohol dependence, 118(2-3). pp. 186-193. 10.1016/j.drugalcdep.2011.03.018. Retrieved from https://hdl.handle.net/10161/19984.
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Professor of Psychiatry and Behavioral Sciences
I am currently semi-retired. Most of my recent work has been focused on roles with the National Academy of Medicine (former Institute of Medicine). I have chaired three committees during the past four years, one on the mental health and substance use workforce, one on cognitive aging, and one on hearing loss in adults. I currently also chair the Board on the Health of Select Populations for the National Academies. In the past I have been PI on a number of research
Assistant Professor in Psychiatry and Behavioral Sciences
This author no longer has a Scholars@Duke profile, so the information shown here reflects their Duke status at the time this item was deposited.
Professor in Population Health Sciences
Areas of expertise: Health Measurement and Health Services Research
Professor in Psychiatry and Behavioral Sciences
Education/Training: Pre- and post-doctoral training in mental health service research, psychiatric epidemiology (NIMH T32), and addiction epidemiology (NIDA T32) from Johns Hopkins University School of Public Health (Maryland); Fellow of the NIH Summer Institute on the Design and Conduct of Randomized Clinical Trials.Director: Duke Community Based Substance Use Disorder Research Program.Research interests: COVID-19, Opioid misuse, Opioid overdose, Opioid use disorder
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