PSYCHOMETRIC MEASURES OF ADDICTIONS

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PSYCHOMETRIC MEASURES OF ADDICTIONS MENTAL
HEALTH PROBLEMS
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• hundreds of psychometric measures (see ASSESSMENT
  INSTRUMENTS)
• How do they differ?
• Focus
• all addictions, just a certain addiction
• testing treatment readiness? Testing relapse
  risk?
• Screening or assessment (tests can be the primary
  basis of the assessment (e.g., DSM-IV Addiction
  Severity Index), or can serve as screening tool
• Target population
• Length
• Administration format
• Some are filled out by the client, some are
  completed by the clinician
• Some are self-report questions, some are
  interview questions
• Reliability validity

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RELIABILITY

• consistency and stability of the assessment
  results
• 4 types of reliability
• Interrater reliability
• Test-retest
• Alternate form
• Split-half
• The reliability of an assessment procedure or
  test is expressed in terms of a reliability
  coefficient (rxx) that can range from -1.0 to
  1.0.
• Generally need assessment procedures with a
  reliability of at least r gt.80.
• The standard error of measurement (SEM) tells
  you the margin of error to be expected in an
  individuals score due to the unreliability of
  the assessment procedure.

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VALIDITY

• the degree to which the assessment is measuring
  what it is supposed to be measuring
• 4 types of validity
• Content (does the test adequately sample the area
  being assessed).
• Concurrent (Is the test predictive of current
  behaviour)
• Predictive (is the test predictive of future
  behaviour).
• Construct (Does the test correlate with similar
  measures and lack correlation with dissimilar
  measures).
• The validity of an assessment procedure or test
  is expressed in terms of a validity coefficient
  (rxy) that can range from -1.0 to 1.0.
  (correlation between test score and criterion
  measure).
• Generally need assessment procedures with a
  validity of at least r gt.80.
• The standard error of estimate (SEest) tells
  you margin of error to be expected in the
  individuals predicted score in some other area
  of functioning (e.g., IQs predicting school
  grades).

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WHAT IS THEIR UTILITY

• Objectively providing a determination of whether
  problem exists.
• Semi-structured interviews are an excellent way
  of collecting information, however, they dont
  provide any mechanism for objectively weighing
  the information to make a firm determination of
  what the problem is this is left to the
  subjective judgement of the clinician. Scores
  above the threshold level on psychometric tests
  have been reliably shown to correspond to
  clinical judgements of the presence of the
  addiction.
• Information collected in a self-administered
  format tends to be more valid.
• To corroborate information obtained from an
  interview.
• As a therapeutic tool

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HOW TO CHOOSE AMONG THEM

• Best to have
• Broad based instrument that assesses wide range
  of problems
• Instrument with high degree of acceptance in the
  clinical community
• Instrument with high degree of reliability and
  validity

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DSM-IV
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• 4th edition of the Diagnostic and Statistical
  Manual of Mental Disorders
• Created by the American Psychiatric Association
• It is the primarily reference clinicians use to
  define mental disorders and addictions.
• very explicit criteria and contraindicators
• multiaxial
• I-main disorders
• II-Personality Mental Retardation
• III-medical problems
• IV-psychosocial and environmental problems
• V-Highest level of adaptive functioning in
  previous year)
• http//www.behavenet.com/capsules/disorders/dsm4tr
  .htm

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PROBLEMS WITH DSM-IV

• Medical orientation
• Presumes discrete entities
• Presumes that the problem primarily resides with
  you rather than your environment
• once classification occurs, the route or cause
  becomes ignored
• Historically, psychiatric classification has
  reflected societys current moral code, allowing
  society to pathologize
• Historical examples childhood masturbation
  disorder drapetomania homosexuality
• Modern examples pedophilia, bulimia, tobacco
  use
• Once you have pathologized a group of people, it
  is easy to discriminate against them
• expel (ship of fools)
• Institutionalize
• labeling
• Change from being John Smith to being an
  alcoholic
• self-fulfilling prophecy Sane in insane
  places illustrates how the system is
  self-serving

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ADVANTAGES OF DSM-IV

• It is a vehicle for further understanding and
  progress
• Each edition of DSM is an improvement over the
  last
• labels are often beneficial
• some people get great relief from a label
  (connotation changes from being bad to being ill)
• many labels efficiently capture the phenomenon
  and provide valuable new info on cause, treatment
  and prognosis (autism panic attacks,
  Huntingtons Chorea, manic depression)
• cross-cultural manifestations of all major mental
  disorders brain is organ like any other, things
  can and do go wrong

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• even for psychopathology that is continuous,
  identification of the extremes is practical and
  necessary
• can still identify the extremes on a continuum
  (e.g., day vs night)
• real world uses discrete categorizations all the
  time
• eligibility criteria (e.g., social assistance)
• treatment decisions (guilty/innocent by reason
  of insanity receive/not receive treatment)
• classification and categorization are essential
  for communication shorthand
• if everyone created their own system would be
  communication nightmare
• easier than listing all the behaviour/symptoms

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• If you are employing a comprehensive assessment
  procedure that includes mental health screening
  addiction screening detailed analysis of
  presenting problem 3rd party report, and DSM-IV
  then any additional psychometric tests will
  usually be redundant

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OTHER TESTS

• Recommended tests
• Alcohol Use Disorders Identification Test (AUDIT)
• Drug Abuse Screening Test (DAST)
• Canadian Problem Gambling Index (CPGI)
• Tests used by AADAC (adult)
• Alcohol Dependence Scale
• Drug Abuse Screening Test
• South Oaks Gambling Screen
• AADAC Adult Screening Assessment Form
• Tests used by AADAC (adolescent)
• Personal Experience Screening Questionnaire
• Adolescent Problem Severity Index
• Treatment Goals Checklist

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3rd PARTY REPORT
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• spouse, extended family, children, employer,
  friends, physician, probation/parole officer
• Advantages
• More information
• Some tendency for client to report greater
  frequency of use than 3rd party
• Some tendency for 3rd party to report greater
  consequences of use compared to client
• Allows 3rd party to vent
• Creates opportunity to involve 3rd party in
  treatment
• Disadvantages
• Client may not be as forthright
• 3rd party may use this as opportunity to
  punish/embarrass client