Abuse and dependence on prescription opioids in adults: a mixture categorical and dimensional approach to diagnostic classification.
Abstract
For the emerging DSM-V, it has been recommended that dimensional and categorical methods
be used simultaneously in diagnostic classification; however, little is known about
this combined approach for abuse and dependence.Using data (n=37 708) from the 2007
National Survey on Drug Use and Health (NSDUH), DSM-IV criteria for prescription opioid
abuse and dependence among non-prescribed opioid users (n=3037) were examined using
factor analysis (FA), latent class analysis (LCA, categorical), item response theory
(IRT, dimensional), and factor mixture (hybrid) approaches.A two-class factor mixture
model (FMM) combining features of categorical latent classes and dimensional IRT estimates
empirically fitted more parsimoniously to abuse and dependence criteria data than
models from FA, LCA and IRT procedures respectively. This mixture model included a
severely affected group (7%) with a comparatively moderate to high probability (0.32-0.88)
of endorsing all abuse and dependence criteria items, and a less severely affected
group (93%) with a low probability (0.003-0.16) of endorsing all criteria. The two
empirically defined groups differed significantly in the pattern of non-prescribed
opioid use, co-morbid major depression, and substance abuse treatment use.A factor
mixture model integrating categorical and dimensional features of classification fits
better to DSM-IV criteria for prescription opioid abuse and dependence in adults than
a categorical or dimensional approach. Research is needed to examine the utility of
this mixture classification for substance use disorders and treatment response.
Type
Journal articleSubject
HumansOpioid-Related Disorders
Severity of Illness Index
Prevalence
Factor Analysis, Statistical
Logistic Models
Chi-Square Distribution
Diagnostic and Statistical Manual of Mental Disorders
Adolescent
Adult
United States
Female
Male
Prescription Drugs
Young Adult
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https://hdl.handle.net/10161/19993Published Version (Please cite this version)
10.1017/S0033291710000954Publication Info
Wu, L-T; Woody, GE; Yang, C; Pan, J-J; & Blazer, DG (2011). Abuse and dependence on prescription opioids in adults: a mixture categorical and
dimensional approach to diagnostic classification. Psychological medicine, 41(3). pp. 653-664. 10.1017/S0033291710000954. Retrieved from https://hdl.handle.net/10161/19993.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Daniel German Blazer
J. P. Gibbons Distinguished Professor Emeritus of Psychiatry
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
Li-Tzy Wu
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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