In psychiatry, the Diagnostic and Statistical Manual of Mental Disorders (DSM) is the standard classification system used by clinicians to diagnose disorders. The DSM provides criteria sets that are quantifiable and directly observable measures or symptoms associated with each disorder. For classification, a minimum number of criteria must be observed and once this threshold is met, a disorder is considered to be present. For some disorders, a dimensional classification is also provided by the DSM where severity of disorder increases as the number of criteria observed increases (i.e., None, Mild, Moderate and Severe). While the criteria sets provided by the DSM are the primary assessment mechanisms used by clinicians in psychiatric disease classification, some criteria sets may have too many items making them problematic and/or inefficient in clinical and research settings. In addition, psychiatric disorders are inherently latent constructs without any direct visual or biological observation available which makes validation of psychiatric diagnoses difficult. The present dissertation proposes and applies two empirical statistical methods to address lengthy criteria sets and validation of diagnoses. The first proposal is a data-driven method packaged as a SAS Macro that systematically identifies subsets of criteria and associated cut-offs (i.e., diagnostic short-forms) that yield diagnoses as similar as possible as using the full criteria set. The motivating example is alcohol use disorder (AUD) which is a type of substance use disorder (SUD) in the DSM-5. A diagnosis of AUD is made when two or more of the 11 possible criteria associated with it are observed. Relying on data from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III), the new methodology identifies diagnostic short-forms for AUD by: (1) maximizing the association between the sum scores of all 11 criteria with newly constructed subscales from subsets of criteria, (2) optimizing the similarity of AUD prevalence between the current DSM-5 rule and newly constructed diagnostic short-forms, (3) maximizing sensitivity and specificity of the short-forms against the current DSM-5 rule, and (4) minimizing differences in the accuracy of the short-form across chosen covariates. The second method introduces external validators of disorder into the process of identifying and validating short-forms. Each step in the first methodology uses some type of comparison (i.e., maximizing correlation, sensitivity, specificity) with the current DSM rule assuming the DSM is the best diagnostic target to use. However, the method does not itself assess the validity of the criteria-based definition but instead relies on the validity of the original diagnosis. For the second methodology, we no longer assume the validity of the current DSM rule and instead introduce the use of external validators (antecedent, concurrent, and predictive) as the target when identifying short-forms. Application of the method is again AUD and the NESARC III is used as the data source. Rather than use the binary yes/no diagnosis, we use the dimensional classification framework provided by the DSM to identify and validate subsets and associated severity cut-offs (i.e., dimensional short-forms) in a systematic way. Using each external validator separately in the process could prove difficult in determining a consensus across the validators. Instead, our methodology offers a way to combine these external validators into a singular summary measure using factor analysis that derives the external composite validator (ECV). Using NESARC-III and following principles of convergent validity, we identify dimensional short-forms that most relate to the ECV in theoretically justified ways. Specifically, we obtain nested subsets of the original criteria set that (1) maximize the association between ECV and newly constructed subscales from subsets of criteria and (2) obtain associated severity cut-offs that maximally discriminate on ECV based on R-Squared. Substance use disorders in the DSM-5 include alcohol use disorder (AUD), nicotine use disorder (NUD) and drug use disorders (DUDs). Each of these substances is associated with a single underlying SUD construct with the same 11 diagnostic criteria used across each substance and the same diagnostic classifications. Cannabis and non-medical prescription opioids are two examples of DUDs and both have recently been identified as major public health priorities. Due to their diagnostic similarity to AUD in the DSM-5, these substances were ideal to also test our methodologies. Using data from the NESARC on criteria for cannabis use disorder (CUD) and opioid use disorder (OUD), we forward applied the diagnostic short-forms that accurately replicated AUD and also applied the methods to each substance separately. Overall, the new methodology was able to identify shorter criteria sets for AUD, CUD, and OUD that yielded highly accurate diagnosis compared to the current DSM (i.e., high sensitivity and specificity). Specifically, excluding criteria “Neglected major roles to use” and/or “Activities given up to use” created no marked change in ability to diagnose or measure severity the same way as DSM-5. When applying the method for identifying the most valid dimensional short-forms using external validators, different severity cut-points compared to the current DSM-5 were found and different cut-points were found across AUD, OUD, and CUD. There were dimensional short-forms with as few as 7 criteria for AUD, CUD and OUD that demonstrated the same or better level of validity as using all 11 criteria. We discuss the implications of these findings and propose recommendations for future DSM revisions. Lastly, we review limitations and future extensions of each of our proposed methodologies.

The Substance Abuse Subtle Screening Inventory was constructed to screen for substance abuse patterns despite non-admittance of respondents. Predictive validity studies of the SASSI are limited, and are not available for probationers. Participants were 147 male and 54 female probationers mandated to treatment. Overall differences among SASSI scales were significant for treatment compliance and outcome. Higher SASSI scales were found among those probationers who were compliant/successful. Individual scales were not significantly different, however, a trend was revealed; those respondents who scored higher tended to comply/succeed in treatment. The SASSI alone accurately classified 59.7% of respondents. In summary, the SASSI's use in predicting treatment outcome is limited and should be employed with concomitant data.

Research in the field of dual diagnosis (the coexistence of symptoms indicative of a substance abuse problem and a mental health problem) has expanded immensely over the past 15 years. Unfortunately, much of the existing literature available on this topic is limited to adult populations. The researcher explored the rate of dual diagnosis in the adolescent population by conducting a secondary data analysis of the Canadian Incidence Study of Child Abuse and Neglect (CIS-2003; Trocme et al., 2005). The rate of having one or more substance abuse problems in the CIS-2003 was 8.8% and the rate of having one or more mental health problems was 23.6%. Dual diagnosis was found to be under-reported in the child welfare system in Canada. Results of the secondary data analysis indicate that 4.4% of the total sample of adolescents aged between 10 and 15 years old had symptoms indicative of a dual diagnosis over the 3 month study period (n=4381). By providing a profile of child and caregiver characteristics and risk factors associated with dual diagnosis, clinicians from all realms can become better equipped to understand these issues. In the future, Social Workers and other professionals can work collaboratively on identification of DD and improving outcomes for youth and families affected by symptoms of a dual diagnosis.

No description available.

The accurate evaluation of substance use is a critical component of forensic assessment due to the well-established link between drug use sentencing issues and risk of recidivism. Due to limited resources and chronic time constraints, practitioners typically rely only on self-report measures to assess substance use (SU) patterns. As these measures directly inquire about SU patterns, they remain vulnerable to response distortion. This can lead to ineffective treatment recommendations made to the Court and misuse of resources. The present study investigated the utility of the PAI and SASSI-3 in identifying SU patterns in offenders mandated to a long-term treatment facility. As a second major component, offenders were examined post-release to identify predictors for poor treatment outcomes. Results found the direct questioning approach best identified SU patterns in the present sample. In addition, while statistically significant differences in treatment outcomes were not observed between offenders who endorsed a more severe course of their SU problem versus those who endorsed a much less problematic pattern of use, they were trending in the expected direction. Specifically, offenders who used "hard" drugs regularly (e.g., cocaine, heroin), had more negative consequences directly related to their use (e.g., more arrests, prior treatment), and had a more complex clinical presentation (e.g., endorsing more personality pathology) did have worse outcomes by follow up. Methodological and statistical limitations are discussed in depth, and future directions to improve on this study and clarify these relationships are emphasized.

Thesis (MPH.) -- University of Limpopo, 2021 / PURPOSE OR OBJECTIVE: The purpose of this study was to investigate factors that contribute to the relapse of substance abusers post rehabilitation at South African National Council On Alcoholism And Drug Dependence (SANCA) Polokwane. METHOD: A quantitative research method or approach, and a descriptive research design were employed respectively to conduct the study. Data was collected using group-administered questionnaires / surveys amongst substance abusers who relapsed post rehabilitation at the SANCA, and a total number of sixty-one (61) respondents at the centre responded to the questionnaires. FINDINGS: Findings revealed that personal factors that predisposed the relapse of substance abusers post rehabilitation include lack of coping mechanism; less committed and motivated towards staying clean or sober; having a craving for drugs; challenged with too many triggers; lack of believe in themselves; thinking they could deal with their emotions by using drugs; thinking they could be able to control my use; community members still look down on them for using drugs; peer pressure from peer group; easily influenced by others; significant relationship in their lives ending; social group still abusing drugs; finding it difficult to avoid social gathering; lack of financial support; feeling lonely and being bored. Findings also indicated that substance abuser receive sufficient support from their family. On the contrary, however, findings further show that respondents have indicated that they receive poor from their friends, community members, peers and the rehabilitation centre attended. CONCLUSION: The study successfully identified, and discussed diverse causes or factors that contribute or influence relapse amongst substance abusers post rehabilitation at SANCA, as listed above. Furthermore, also assessing the availability of social support systems post rehabilitation.

Thesis (MA)--Stellenbosch University, 2005. / ENGLISH ABSTRACT: During the researcher's work at the South African National Council for Alcohol and Drug Dependence (SANCA), based at the Paarl-office, it was obvious that adolescent substance abuse was growing into a huge governmental concern. During the first half of 2004 the average age of patients at drug rehabilitation centres who used crystal methamphetamine (streetname: "tik-tik") as their primary substance of abuse were between the ages of 15-19 years. Crystal methamphetamine is the latest drug that has taken the Western Cape by storm. It is obvious that the root of the problem is not being addressed since the number of adolescents abusing drugs seems to increase rather than decrease. The goal and aims of the study focuses on the factors contributing to adolescent substance abuse, parenting styles and -roles that contribute to adolescent substance abuse, and providing guidelines to social workers regarding the role of the family in the prevention of adolescent substance abuse. Adolescents have to deal with the new changes that occur, together with aspects such as, peer pressure, negative self-image, irresponsibility by the community and parents, poor parent-child relationships as well as socio-cultural variables that often lead tot substance abuse. Parents were found to be the role-models for their children and their parents' values, attitudes and behaviour regarding alcohol and/or drugs influence the values, attitudes and behaviour of their children. Therefore it seems that parents are primarily responsible for the prevention of adolescent substance abuse and the research study aims at providing facilitation skills on prevention strategies to social workers in order to successfully starting prevention of adolescent substance abuse. The quality of a family-system seems to have an important influence on adolescents in their growing up years, since adolescents experience a variety of changes and have to learn how to handle and accept these changes. During the literature study it was found that a negative family environment and negative experiences contribute to negative behaviour of adolescents, because the family is the primary unit where children learn their values, attitudes and processes that regulate their actions throughout their lives. A paradigm shift should be facilitated by social workers on maintaining healthy family relationships regarding the prevention of adolescent substance abuse. Supportive family-centred services therefore provide the best in adolescents' positive development, as well as identifying the most important needs of adolescents. / AFRIKAANSE OPSOMMING: Die navorser was gedurende die navorsingstudie as 'n maatskaplike werker by Die Suid Afrikaanse Nasionale Raad vir Alkohol en Dwelmafhanklikheid (SANRA) te Paarl aangestel. Na aanleiding van die werkslading kon die navorser tot die gevolgtrekking kom dat adolessente se middelemisbruik groot bekommernis vir die staat beteken. Gedurende die eerste helfte van 2004 was die gemiddelde ouderdom van pasiënte in dwelmrehabilitasiesentrums wie crystal methamphetime (straat naam: "tik-tik") as hul primêre middel van misbruik aangedui het, tussen die ouderdomme van 15-19 jaar. Na aanleiding van statistieke is dit duidelik dat die kern van die probleem nie aangespreek word nie, aangesien die hoeveelheid adolessente wie middele misbruik toeneem anders as om af te neem. Die doel en doelstellings van die studie fokus op die faktore wat bydra tot adolessente se middelemisbruik, ouerskapstyle en -rolle wat bydra tot adolessente se middelemisbruik, en die bied van riglyne aan maatskaplike werkers rakende die rol van die gesin tot die voorkoming van adolessente se middelemisbruik. Adolessente moet leer om die nuwe veranderinge in hullewens te hanteer, tesame met aspekte soos groepsdruk, negatiewe selfbeeld, onverantwoordelikheid deur die gemeenskap, swak ouer-kind verhoudings en sosio-kulturele veranderlikes wat telkens tot middelemisbruik bydra. Daar is gevind dat ouers die rolmodelle vir hul adolessente moet wees en dat ouerlike waardes, houdings en gedrag rakende alkohol en/of dwelms die waardes, houdings en gedrag van hul adolessente beïnvloed. Daarom blyk dit dat die primêre verantwoordelikheid op die ouers berus tot die voorkoming van adolessente se middelemisbruik en die navorsingstudie poog om die fasilitering van voorkomingstrategieë aan maatskaplike werkers te bied ten einde die voorkoming van adolessente se middiemisbruik aan te spreek. Die kwaliteit van die gesinsisteem het 'n belangrike invloed op adolessente in hul grootwordjare, aangesien adolessente 'n verskeidenheid veranderinge ervaar en moet leer hoe om die veranderinge te hanteer en te aanvaar. Gedurende die literatuurstudie is bevind dat 'n negatiewe gesinsomgewing en negatiewe ervarings bydra tot negatiewe gedrag van adolessente, omdat die gesin die primêre eenheid is waar adolessente hul waardes, houdings en prosesse aanleer wat hul aksies gedurende hullewens reguleer. 'n Paradigmaverskuiwing moet vervolgens deur maatskaplike werkers gefasiliteer word tot die handhawing van gesonde gesinsverhoudings ten opsigte van adolessente se middelemisbruik. Ondersteunende gesinsgesentreerde dienste bied vervolgens die beste opsie vir adolessente se positiewe ontwikkeling, sowel as om die mees belangrikste behoeftes van adolessente te identifiseer.

This study examined an important, yet underreported, area of family service agency assessments, the failure to adequately screen for substance abuse issues. A self-report screening instrument was used to accurately determine substance abuse frequency rates, instead of using the current clinician-directed questioning. New agency clients were randomly assigned to either the experimental group (self-report) or the control group (clinician-directed) to determine if assessment accuracy improved.

Using both qualitative and quantitative research designs, this study focused on the knowledge of Children Protective Services (CPS) social workers for identifying Alcohol and Other Drugs (AOD) risk factors in their clients, and the impact that these AOD issues have on the child welfare system in San Bernardino County, California.