An Application of Item Response Theory Analysis to Alcohol, Cannabis, and Cocaine Criteria in DSM-IV.

Abstract

Item response theory (IRT) is supplanting classical test theory as the basis for measures development. This study demonstrated the utility of IRT for evaluating DSM-IV diagnostic criteria. Data on alcohol, cannabis, and cocaine symptoms from 372 adult clinical participants interviewed with the Composite International Diagnostic Interview--Expanded Substance Abuse Module (CIDI-SAM) were analyzed with Mplus (B. Muthen & L. Muthen, 1998) and MULTILOG (D. Thissen, 1991) software. Tolerance and legal problems criteria were dropped because of poor fit with a unidimensional model. Item response curves, test information curves, and testing of variously constrained models suggested that DSM-IV criteria in the CIDI-SAM discriminate between only impaired and less impaired cases and may not be useful to scale case severity. IRT can be used to study the construct validity of DSM-IV diagnoses and to identify diagnostic criteria with poor performance.

The role of alcohol consumption in future classifications of alcohol use disorders

“…Neglect of roles, activities given up, and legal problems were among the most severe criteria, a result consistent with previous studies whether conducted at the item (Kahler and Strong, 2006) or criterion (Langenbucher et al 2004;Proudfoot et al 2006;) level. Psychological/physical problems, social/interpersonal problems, and time spent criteria were also in the severe range of the observed continuum in this study, consistent with items tapping similar constructs in the studies by Krueger et al (2004) and Kahler and Strong (2006), but at variance with findings reported by Langenbucher et al (2004) that showed psychological/physical problems to be the least severe criterion, with the remaining criteria overlapping in the middle range of the observed severity continuum. Similar to prior research in this area, the quit/control, larger/longer, and hazardous use criteria were among the least severe (Krueger et al 2004;Kahler and Strong, 2006).…”

“…Also consistent with prior research (Krueger et al 2004;Langenbucher et al 2004;Proudfoot et al 2006;Kahler and Strong, 2006;Saha et al 2006), the larger/longer dependence criterion was shown to have excellent discrimination and low severity. Taken together, these results suggest that the larger/longer criterion may represent a high-risk drinking pattern that serves as a bridging criterion linking the less severe end of the alcohol use disorder continuum with the more severe end.…”

“…Consistent with prior research (Langenbucher et al 2004;Proudfoot et al 2006;Saha et al 2006), the abuse and dependence criteria tapped the more severe range of the underlying continuum. Also consistent with prior research (Krueger et al 2004;Langenbucher et al 2004;Proudfoot et al 2006;Kahler and Strong, 2006;Saha et al 2006), the larger/longer dependence criterion was shown to have excellent discrimination and low severity.…”

Cigarette smoking and the lifetime alcohol involvement continuum

“…Three of the abuse symptoms (hazardous use, interference with work or home, and social problems) appeared to be effective in making discriminations among the mild to moderate range of alcohol problem severity in this sample. However, as has been shown in other item response analyses of DSM-IV AUD criteria (Kahler and Strong, 2006;Krueger et al, 2004;Langenbucher et al, 2004;Proudfoot et al, 2006), abuse symptoms were not consistently less severe than dependence symptoms. Among the dependence symptoms, the larger/longer criterion appeared to be a particularly effective item for discriminating between those with heavy drinking and no AUD symptoms and those with at least some AUD symptoms.…”

Psychometric properties of DSM assessments of illicit drug abuse and dependence: results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)

“…Furthermore, they have produced inconsistent results, with some studies supporting the coherence of dependence (Hasin et al 1988;Morgenstern et al 1994 ;Feingold & Rounsaville, 1995 ;Nelson et al 1999 ;Swift et al 2001;Langenbucher et al 2004) while others have identified multiple factors underlying dependence criteria (e.g. Kosten et al 1987).…”