Semi-Structured Assessment For Drug Dependence And Alcoholism Research Articles

Associations between methamphetamine and alcohol use disorder, suicidal ideation, and lowered quality of life in methamphetamine users

Aim: There is a strong comorbidity between methamphetamine (MA) and alcohol use whereby MA use may contribute to increased alcohol consumption. This study aims to determine the associations between alcohol drinking and MA-associated behaviors among MA users in relation to mood disorders, suicidal ideation, and health-related quality of life (HR-QoL). Methods: Substance use characteristics were obtained in 106 participants with MA use at a substance abuse treatment center by using the Severity of Dependence Scale (SDS) and the Thai version of the Semi-Structured Assessment for Drug Dependence and Alcoholism (SSADDA). Current alcohol drinking behaviors were estimated using the Substance Outcomes Profile (SOP), which was developed and translated from the Treatment Outcomes Profile, by computing the number of alcohol units x days per month of alcohol use. The Mini-International Neuropsychiatric Interview (M.I.N.I.) was used to estimate lifetime histories of mood disorders and substance abuse and current suicidal ideation. Results: Current suicidal ideation in MA users is to a large extent predicted by the severity of current alcohol and MA use, female gender, and a lifetime history of mood disorders (major depression, dysthymia, and hypo-mania). Moreover, a lifetime history of mood disorders is positively associated with the severity of MA, but not with alcohol use. Partial least squares (PLS) path modeling shows that lowered HR-QoL in MA users is predicted by the SDS score and alcohol dosing (both inversely) and that lifetime diagnoses of mood disorders and MA use (both inversely) and alcohol dependence (positively) have significant effects on HR-QoL which are completely mediated via the SDS score. Conclusions: In MA users, the severity of dependence, and MA and/or alcohol use exert adverse effects on current suicidal ideation and HR-QoL. Mechanistic explanations are given which may explain the inverse associations between the severity of MA and alcohol use in MA abusers.

Clinical and behavioral correlates in adult methamphetamine users with childhood exposure to household drug and alcohol use

Aims: To describe and compare methamphetamine (MA) users with and without a family history of alcohol or drug () use in the household.
 Design: A total of 1144 Thai-speaking MA users in Thailand were recruited for a cohort study. Cross-sectional baseline data were analyzed according to their exposure to FAOD use (FAOD+/FAOD-). The Semi-Structured Assessment for Drug Dependence and Alcoholism (SSADDA) was utilized to collect baseline socio-demographic information and variables known to be associated with the impact of FAOD use.
 Findings: FAOD+ participants had lower average years of education (p<0.01), fewer average months of employment in the past year (p<0.01) and reported higher rates of self-harm experience (p<0.001), gambling (p=0.018) and antisocial personality disorder (p=0.015). FAOD+ participants had more severe clinical, adverse consequences. FAOD+ significantly predicted episodes of lifetime MA use (R2 =0.004, p=0.032), the largest number of drinks ever had in a 24-hour period (R2 =0.01, p=0.001), paranoid experiences ([OR]=1.090, p=0.004), alcohol dependence ([OR]=1.112, p=0.001) and antisocial personality disorder ([OR]=1.139, p=0.015). FAOD+ participants who were exposed to alcohol only were more likely to report a significantly higher number of drinks ever had in a 24-hour periods (p<0.005). Similarly, FAOD+ participants who were exposed to MA use only were significantly more likely to report more frequent use of MA (p<0.005).
 Conclusions: FAOD+ participants were characterized by a generally more severe clinical presentation than FAOD- participants. Moreover, we show the specificity of drug type mattered, with family exposure of alcohol and MA associated with greater subsequent use of the respective drugs.

Leukocyte telomere length is not shortened in methamphetamine dependence or methamphetamine-induced psychosis but is increased following traumatic events

Objective This study aims to examine the effects of methamphetamine (MA) use and dependence and MA withdrawal symptoms on the telomere length and whether shortening of the latter is associated with MA-induced psychosis (MIP). Methods This study included 185 MA-abuse, 118 MA-dependent, and 67 MIP patients, diagnosed using DSM-IV criteria. The Semi-structured Assessment for Drug Dependence and Alcoholism (SSADDA) questionnaire was employed to collect MA-related data. MIP was confirmed using the Methamphetamine Experience Questionnaire (MEQ). The leukocyte telomere length was measured using real-time polymerase chain reaction measuring the Telomere/Single gene ratio (T/S ratio). Data were analysed using multivariate statistical analyses. Results There were no significant associations between the T/S ratio and severity of MA-use, MIP, and MA withdrawal symptoms. MIP was significantly predicted by alcohol dependence, antisocial personality disorder, and MA-use severity. There were significantly positive associations between the T/S ratio and previous traumatic and life-threatening events. The T/S ratio was not affected by alcohol and nicotine dependence. Alcohol and nicotine dependence, antisocial personality disorder, and severity of MA use increased risk of MA withdrawal symptoms. Conclusion MIP and MA-use severity are not associated with leukocyte telomere length, but previous traumatic and life-threatening events are associated with increased telomere length.

Reliability and validity of DSM-IV and DSM-5 methamphetamine use disorder diagnoses using the Chinese Version of the Semi-Structured Assessment for Drug Dependence and Alcoholism (SSADDA)

BackgroundThe Semi-structured Assessment for Drug Dependence and Alcoholism (SSADDA) was developed to assess substance-use disorders and other psychiatric traits. We translated the SSADDA into Chinese and evaluated its inter-rater reliability and concurrent validity in diagnosing DSM-IV methamphetamine (MA) dependence and DSM-5 MA-use disorder (MUD). MethodsThe sample comprised 231 participants who were interviewed using the Chinese SSADDA and the Mini-International Neuropsychiatric Interview (Chinese MINI) for concurrent validation. Of the 231 participants, 191 were interviewed by two different interviewers two weeks apart. We evaluated the inter-rater reliability and concurrent validity of the diagnoses using percent agreement and Cohen's kappa coefficient (κ). Cohen’s linear weighted kappa was used to assess the reliability of DSM-5 MUD severity. ResultsIt showed good inter-rater reliability and no significant differences among the DSM-5 MUD (κ = 0.71), DSM-IV MA abuse or dependence (κ = 0.72), and the DSM-IV diagnoses of MA dependence (κ = 0.66) and abuse (κ = 0.68) tested separately. The weighted kappa was 0.67 across the three DSM-5 MUD severity levels. The reliability of each individual diagnostic criterion for DSM-5 MUD ranged from fair to excellent (κ = 0.41–0.80), except for “repeated attempts to quit/control use” (κ = 0.38). The concurrent validity based on MINI-derived diagnoses ranged from good to excellent (κ = 0.65–0.78). ConclusionsThis study shows that the Chinese version of SSADDA has good reliability and validity among Chinese MA users.

Diagnostic Reliability and Validity of the Semi-Structured Assessment for Drug Dependence and Alcoholism (SSADDA) Chinese Version

The Semi-Structured Assessment for Drug Dependence and Alcoholism (SSADDA) is a polydiagnostic instrument for substance use and psychiatric disorders. We translated the SSADDA English version into Chinese (SSADDA-Chinese) and report here our examination of the diagnostic reliability and validity of DSM-IV substance dependence (SD) diagnoses in a Mandarin-speaking sample in Taiwan. We recruited 125 subjects who underwent an assessment of lifetime SD diagnoses using both the SSADDA-Chinese and the Structured Clinical Interview for DSM-IV, Clinician Version (SCID-Chinese). Thirty-one subjects were retested with the SSADDA-Chinese. Cohen’s κ statistic, which measures chance-corrected agreement, was used to measure the test-retest reliability and concurrent validity of the individual SD diagnoses. There was a high degree of concordance between SD diagnoses made using the SSADDA-Chinese and the SCID-Chinese, including those for dependence on alcohol (κ = 0.83), ketamine (κ = 0.97), methamphetamine (κ = 0.93), and opioids (κ = 0.95). The test-retest reliability of dependence diagnoses for ketamine (κ = 0.95), methamphetamine (κ = 0.80), and opioids (κ = 1.00) obtained using the SSADDA-Chinese was excellent, while that for alcohol dependence (κ = 0.63) and nicotine dependence (κ = 0.65) was good. We conclude that the SSADDA-Chinese is a reliable and valid instrument for the diagnosis of major SD traits in Mandarin-speaking populations.

A regulatory variant of CHRM3 is associated with cannabis-induced hallucinations in European Americans

Cannabis, the most widely used illicit drug, can induce hallucinations. Our understanding of the biology of cannabis-induced hallucinations (Ca-HL) is limited. We used the Semi-Structured Assessment for Drug Dependence and Alcoholism (SSADDA) to identify cannabis-induced hallucinations (Ca-HL) among long-term cannabis users (used cannabis ≥1 year and ≥100 times). A genome-wide association study (GWAS) was conducted by analyzing European Americans (EAs) and African Americans (AAs) in Yale-Penn 1 and 2 cohorts individually, then meta-analyzing the two cohorts within population. In the meta-analysis of Yale-Penn EAs (n = 1917), one genome-wide significant (GWS) signal emerged at the CHRM3 locus, represented by rs115455482 (P = 1.66 × 10−10), rs74722579 (P = 2.81 × 10−9), and rs1938228 (P = 1.57 × 10−8); signals were GWS in Yale-Penn 1 EAs (n = 1092) and nominally significant in Yale-Penn 2 EAs (n = 825). Two SNPs, rs115455482 and rs74722579, were available from the Collaborative Study on the Genetics of Alcoholism data (COGA; 3630 long-term cannabis users). The signals did not replicate, but when meta-analyzing Yale-Penn and COGA EAs, the two SNPs’ association signals were increased (meta-P-values 1.32 × 10−10 and 2.60 × 10−9, respectively; n = 4291). There were no significant findings in AAs, but in the AA meta-analysis (n = 3624), nominal significance was seen for rs74722579. The rs115455482*T risk allele was associated with lower CHRM3 expression in the thalamus. CHRM3 was co-expressed with three psychosis risk genes (GABAG2, CHRNA4, and HRH3) in the thalamus and other human brain tissues and mouse GABAergic neurons. This work provides strong evidence for the association of CHRM3 with Ca-HL and provides insight into the potential involvement of thalamus for this trait.

Genomewide Association Study of Alcohol Dependence and Related Traits in a Thai Population.

Alcohol use (both quantity and dependence) is moderately heritable, and genomewide association studies (GWAS) have identified risk genes in European, African, and Asian populations. The most reproducibly identified risk genes affect alcohol metabolism. Well-known functional variants at the gene encoding alcohol dehydrogenase B and other alcohol dehydrogenases affect risk in European and African ancestry populations. Similarly, variants mapped to these same genes and a well-known null variant that maps to the gene that encodes aldehyde dehydrogenase 2 (ALDH2) also affect risk in various Asian populations. In this study, we completed the first GWAS for 3 traits related to alcohol use in a Thai population recruited initially for studies of methamphetamine dependence. All subjects were evaluated with the Thai version of the Semi-Structured Assessment for Drug Dependence and Alcoholism (SSADDA). A total of 1,045 subjects were available for analysis. Three traits were analyzed: flushing, maximum number of alcoholic beverages consumed in any lifetime 24-hour period ("MAXDRINKS"), and DSM-IV alcohol dependence criterion count. We also conducted a pleiotropy analysis with major depression, the only other psychiatric trait where summary statistics from a large-scale Asian-population GWAS are available. All 3 traits showed genomewide significant association with variants near ALDH2, with significance ranging from 2.01×10-14 (for flushing; lead single nucleotide polymorphism (SNP) PTPN11* rs143894582) to pmeta =5.80×10-10 (for alcohol dependence criterion count; lead SNP rs149212747). These lead SNPs flank rs671 and span a region of over a megabase, illustrating the need for prior biological information in identifying the actual effect SNP, rs671. We also identified significant pleiotropy between major depression and flushing. These results are consistent with prior findings in Asian populations and add new information regarding alcohol use-depression pleiotropy.

Ancestry-specific and sex-specific risk alleles identified in a genome-wide gene-by-alcohol dependence interaction study of risky sexual behaviors.

We previously mapped loci for the genome-wide association studies (GWAS) and genome-wide gene-by-alcohol dependence interaction (GW-GxAD) analyses of risky sexual behaviors (RSB). This study extends those findings by analyzing the ancestry- and sex-specific AD-stratified effects on RSB. We examined the concordance of findings for the AD-stratified GWAS and the GW-GxAD analysis of RSB, with concordance defined as genome-wide significance in one analysis and at least nominal significance in the second analysis. A total of 2,173 African-American (AA) and 1,751 European-American (EA) subjects were investigated. Information regarding RSB (lifetime experiences of unprotected sex and multiple sexual partners) and DSM-IV diagnosis of lifetime AD were derived from the Semi-Structured Assessment for Drug Dependence and Alcoholism (SSADDA). In our ancestry- and sex-specific analyses, we identified four independent genome-wide significant (GWS) loci (p < 5*10-8 ) and one suggestive locus (p < 6*10-8 ). In men, we observed a GWS signal in FAM162A (rs2002594, p = 4.96*10-8 ). In women, there was a suggestive locus in PLGRKT (rs3824435, p = 5.52*10-8 ). In AAs, there was a GWS signal in GRK5 (rs1316543, p = 1.25*10-9 ). In AA men, we observed an intergenic GWS signal (rs12898370, p = 4.49*10-8 ) near LINGO1. In EA men, there was a GWS signal in CCSER1 (rs62313897; p = 7.93*10-10 ). The loci identified in this GWAS implicate molecular mechanisms related to psychiatric illness and personality features, suggesting that the interplay between AD and RSB is mediated by alleles associated with behavioral traits.

T45 - Genetic Factor Common To Schizophrenia And Hiv Infection Is Associated With Risky Sexual Behavior

Background The relationship between schizophrenia (SZ) and human immunodeficiency virus (HIV) infection is complicated epidemiologically and genetically. Although observational studies have described their co-occurrence and their joint relationship with risky sexual behavior (RSB), their genetic correlations are not well studied. Methods We performed an extensive search for genetic factors common to SZ and HIV using publically accessible summary statistics from genome-wide association studies of HIV infection and schizophrenia. To study the relationship of these disorders with risky sexual behavior (RSB), 2379 European Americans were genotyped and assessed for RSB score using the Semi-Structured Assessment for Drug Dependence and Alcoholism (SSADDA). Genetic relationships between traits were analyzed in three ways: linkage disequilibrium (LD) score regression to estimate genetic correlation; GPA (Genetic analysis incorporating Pleiotropy and Annotation) to test pleiotropy and identify pleiotropic loci; and polygenic risk scores (PRS) for SZ and HIV to predict RSB using linear regression. Bipolar disorder, height and body mass index (BMI) were tested as negative controls. Results We found that SZ and HIV have a positive genetic correlation, which is highly significant both with (cor=0.2, p=0.001) and without (cor=0.17, p=0.002) inclusion of the MHC region. Consistently, our pleiotropy analysis (p=5.31E-28) showed that a majority of the shared genetic variants have the same effect direction (shared-effect pleiotropic SNPs), meaning that the same allele tends to increase or decrease the risk of both SZ and HIV. Pleiotropic SNPs that influence schizophrenia and HIV infection with the same effect direction (shared) were enriched for chromatin assembly (p=1.3E-9) nucleosome organization (p=4.4E-9), and protein-DNA complex assembly (p=1.8E-8). SNPs with opposite effect directions (antagonistic) were enriched for the regulation of synaptic transmission (p=8.2E-6) and neurotransmitter transport (p=5.5E-5), neuronal differentiation (p=3.8E-5), and the regulation of nerve impulse transmission (p=2.4E-5). SZ PRS computed with antagonistically pleiotropic SNPs significantly predicted RSB score (p=0.019), but SZ PRS based on either shared pleiotropic SNPs or all SNPs did not predict RSB. Discussion The epidemiologic correlation between schizophrenia and HIV can partly be explained by overlapping genetic risk factors, which are related to risky sexual behavior. These findings call for further study of these SNP sets, and when available, using genetic risk scores from them to test other phenotypes that could yield important insights into these very serious disorders and behaviors associated with them.

Inter-observer reliability of DSM-5 substance use disorders

AimsAlthough studies have examined the impact of changes made in DSM-5 on the estimated prevalence of substance use disorder (SUD) diagnoses, there is limited evidence concerning the reliability of DSM-5 SUDs. We evaluated the inter-observer reliability of four DSM-5 SUDs in a sample in which we had previously evaluated the reliability of DSM-IV diagnoses, allowing us to compare the two systems. Methods: Two different interviewers each assessed 173 subjects over a 2-week period using the Semi-Structured Assessment for Drug Dependence and Alcoholism (SSADDA). Using the percent agreement and kappa (κ) coefficient, we examined the reliability of DSM-5 lifetime alcohol, opioid, cocaine, and cannabis use disorders, which we compared to that of SSADDA-derived DSM-IV SUD diagnoses. We also assessed the effect of additional lifetime SUD and lifetime mood or anxiety disorder diagnoses on the reliability of the DSM-5 SUD diagnoses. Results: Reliability was good to excellent for the four disorders, with κ values ranging from 0.65 to 0.94. Agreement was consistently lower for SUDs of mild severity than for moderate or severe disorders. DSM-5 SUD diagnoses showed greater reliability than DSM-IV diagnoses of abuse or dependence or dependence only. Co-occurring SUD and lifetime mood or anxiety disorders exerted a modest effect on the reliability of the DSM-5 SUD diagnoses. Conclusions: For alcohol, opioid, cocaine and cannabis use disorders, DSM-5 criteria and diagnoses are at least as reliable as those of DSM-IV.

Clinical features of methamphetamine-induced paranoia and preliminary genetic association withDBH-1021C→T in a Thai treatment cohort

To explore the clinical features of methamphetamine-induced paranoia (MIP) and associations between MIP and a genetic polymorphism in dopamine β-hydroxylase (DBH-1021C→T). Retrospective analysis of clinical presentation and genetic association by χ(2) test and logistic regression analysis. A Thai substance abuse treatment center. A total of 727 methamphetamine-dependent (MD) individuals. Clinical: Semi-Structured Assessment for Drug Dependence and Alcoholism (SSADDA) and the Methamphetamine Experience Questionnaire (MEQ). Genetic: DBH-1021C→T. Forty per cent of individuals (289 of 727; 39.8%) with MD had MIP. Within-binge latency to MIP onset occurred more rapidly in the most recent compared with initial MIP episode (P = 0.02), despite unchanging intake (P = 0.89). Individuals with MIP were significantly less likely to carry lower (TT/CT) compared with higher (CC) activity genotypes (34.3 versus 43.3%; χ(2) 1 = 5, P = 0.03). DBH effects were confirmed [odds ratio (OR) = 0.7, P = 0.04] after controlling for associated clinical variables (MD severity, OR = 3.4, P < 0.001; antisocial personality disorder, OR = 2.2, P < 0.001; alcohol dependence, OR = 1.4, P = 0.05; and nicotine dependence, OR = 1.4, P = 0.06). TT/CT carriers were more likely to initiate cigarette smoking (OR = 3.9, P = 0.003) and probably less likely to be dependent on alcohol (OR = 0.6, P = 0.05). Among methamphetamine-dependent individuals, paranoia appears to occur increasingly rapidly in the course of a session of methamphetamine use. Severity of methamphetamine dependence and antisocial personality disorder predicts methamphetamine-induced paranoia. The genetic polymorphism in dopamine β-hydroxylase is associated with methamphetamine-induced paranoia and influences smoking initiation.

Polymorphism of COMT Val158Met is associated with inhalant use and dependence: a Thai substance dependence treatment cohort

Background: Inhalants are abused by adolescents worldwide, but genetic markers of inhalant use or dependence are poorly understood. Objective: We assessed the frequency and association of a functional polymorphism in the gene encoding catechol-O-methyltransferase (COMT Val158Met) in inhalant-dependent (ID) subjects and inhalant users (IU). Methods: Demographic and diagnostic data were collected by interviewing 456 Thai-speaking methamphetamine (MA) users by using the Semi-Structured Assessment for Drug Dependence and Alcoholism (SSADDA). COMT Val158Met (rs4680) genotyping was acquired by restriction fragment length polymorphism. Individuals with ID or IU were compared with non-ID or non-IU by using a test. After that, factors associated with ID or IU were analyzed by logistic regression. Blood samples from 217 healthy blood donors were used as controls for ID and IU in the allele frequency comparison. Deviation from Hardy–Weinberg Equilibrium Expectations (HWEE) was also tested. Results: Out of 456 MA users, deviation from HWEE was observed in IU but not in ID, non-ID or from the total sample. The “Met” allele was significantly associated with ID (p = 0.02) and IU (p = 0.002) among MA users, but not in allele frequency comparisons when compared to the healthy control group (p > 0.1). With respect to logistic regression analysis, homo or heterozygosity for the “Met” allele, male sex, younger age, lower level of education, a major depressive episode (MDE), and alcohol dependence were associated with ID. Analyses of IU vs. non-IU yielded the same results except for age and MDE. In addition, individuals with MA-induced paranoia (MIP) were more likely to have used inhalants at least once in their lifetime compared to those without. Conclusion: COMT 158Met, male sex, younger age, lower level of education, MDE, MIP, and alcohol dependence increased risk for inhalant use and/or dependence. Keywords: COMT, inhalant, methamphetamine, Thai, Val158Met

Polymorphism of COMT Val158Met is associated with inhalant use and dependence: a Thai substance dependence treatment cohort

Background: Inhalants are abused by adolescents worldwide, but genetic markers of inhalant use or dependence are poorly understood. Objective: We assessed the frequency and association of a functional polymorphism in the gene encoding catechol-O-methyltransferase (COMT Val158Met) in inhalant-dependent (ID) subjects and inhalant users (IU). Methods: Demographic and diagnostic data were collected by interviewing 456 Thai-speaking methamphetamine (MA) users by using the Semi-Structured Assessment for Drug Dependence and Alcoholism (SSADDA). COMT Val158Met (rs4680) genotyping was acquired by restriction fragment length polymorphism. Individuals with ID or IU were compared with non-ID or non-IU by using a test. After that, factors associated with ID or IU were analyzed by logistic regression. Blood samples from 217 healthy blood donors were used as controls for ID and IU in the allele frequency comparison. Deviation from Hardy–Weinberg Equilibrium Expectations (HWEE) was also tested. Results: Out of 456 MA users, deviation from HWEE was observed in IU but not in ID, non-ID or from the total sample. The “Met” allele was significantly associated with ID (p = 0.02) and IU (p = 0.002) among MA users, but not in allele frequency comparisons when compared to the healthy control group (p > 0.1). With respect to logistic regression analysis, homo or heterozygosity for the “Met” allele, male sex, younger age, lower level of education, a major depressive episode (MDE), and alcohol dependence were associated with ID. Analyses of IU vs. non-IU yielded the same results except for age and MDE. In addition, individuals with MA-induced paranoia (MIP) were more likely to have used inhalants at least once in their lifetime compared to those without. Conclusion: COMT 158Met, male sex, younger age, lower level of education, MDE, MIP, and alcohol dependence increased risk for inhalant use and/or dependence. Keywords: COMT, inhalant, methamphetamine, Thai, Val158Met

Empirically derived subtypes of opioid use and related behaviors

To identify and validate homogeneous subtypes of opioid use and related behaviors. Family-based and case-control genetic studies of opioid and/or cocaine dependence. Clinical and general community samples from Connecticut, Massachusetts, Pennsylvania and South Carolina. A total of 4061 individuals (2003 individuals from 835 families and 2058 unrelated individuals) recruited to participate in genetic studies. The computer-assisted Semi-Structured Assessment for Drug Dependence and Alcoholism (SSADDA) was used to assess participants' demographics, medical history, substance use behaviors and disorders and other psychiatric disorders. Five homogeneous subtypes were identified, which differed on opioid-related measures, demographics and prevalence rates of substance use and psychiatric disorders. Heritability estimates for the two most severely affected subtypes exceeded 0.60. An empirical approach based on opioid use and related behaviors can yield homogeneous subtypes that could be of value in gene finding for opioid dependence.

Inter-rater reliability and concurrent validity of DSM-IV opioid dependence in a Hmong isolate using the Thai version of the Semi-Structured Assessment for Drug Dependence and Alcoholism (SSADDA)

Because isolated populations offer relative genetic and environmental homogeneity, they are important resources for mapping genes for complex traits. Reliable and valid phenotypic characterization of the disease in the population studied is essential. We examined diagnostic reliability and concurrent validity of DSM-IV opioid dependence (OD) in a Hmong population in Thailand with historically high rates of opium (and heroin) use. 578 Thai-speaking Hmong individuals were assessed for lifetime OD, using Thai versions of both the Semi-Structured Assessment for Drug Dependence and Alcoholism (Thai SSADDA) and the Mini-Neuropsychiatric Interview (Thai MINI; adapted for lifetime diagnoses). In a subsample of 123 individuals, two raters interviewed each subject independently within a 2-week period. Chance-corrected agreement on the OD diagnosis was assessed between raters and instruments. Results showed excellent agreement for the DSM-IV diagnosis of OD both for the SSADDA ( κ = 0.97) and MINI ( κ = 1.00) and between the SSADDA and MINI ( κ = 0.97). Consistent with reliability assessments of English versions, our data demonstrate high reliability for Thai versions of the SSADDA and MINI in the diagnosis of OD. The high concordance between instruments supports the concurrent validity of the diagnosis. Either interview provides reliable, valid OD diagnoses in Thai-speaking Hmong individuals.

Adolescent cannabis use increases risk for cocaine-induced paranoia

Cannabis can produce and/or exacerbate psychotic symptoms in vulnerable individuals. Early exposure to cannabis, particularly in combination with genetic factors, increases the risk of a subsequent, primary, psychotic disorder. Because paranoia is a common feature of stimulant abuse and cocaine-dependent individuals frequently endorse a history of cannabis abuse, we examined whether early cannabis exposure, in conjunction with polymorphic variation in the catechol-O-methyl transferase gene ( COMT Val158Met), influences the risk for cocaine-induced paranoia (CIP). Methods Cannabis-use history was obtained in 1140 cocaine-dependent individuals from a family-based (affected sibling pair) study using the Semi-Structured Assessment for Drug Dependence and Alcoholism (SSADDA). Logistic regression and generalized estimating equations’ analyses were used to examine the role of adolescent-onset cannabis use (≤15 years of age) on CIP risk, both controlling for previously implicated CIP risk factors and familial relationships, and considering potential interactions with COMT Val158Met genotype. Results Cocaine-dependent individuals who endorsed CIP had significantly higher rates of adolescent-onset cannabis use than those without CIP (62.2% vs. 50.2%; χ 2 = 15.2, df = 1, p < 0.0001), a finding that remained after controlling for sibling correlations and other risk factors. There were no effects of COMT genotype or genotype by early cannabis onset interactions. A modest (OR = 1.4) and nearly significant ( p = 0.053) effect of CIP status in probands on CIP status in siblings was also noted. Conclusions Adolescent-onset cannabis use increases the risk of CIP in cocaine-dependent individuals. COMT genotype and its interaction with early cannabis exposure did not emerge as significant predictors of CIP. In addition, trait vulnerability to CIP may also be familial in nature.

Sources of Unreliability in the Diagnosis of Substance Dependence

The Semi-Structured Assessment for Drug Dependence and Alcoholism (SSADDA) yields Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnoses for a variety of psychiatric disorders, including alcohol and drug dependence. Using generalizability theory, we sought to ascertain the sources of unreliability for DSM-IV substance-dependence diagnoses and their criterion counts. Two hundred ninety-three subjects (52.2% women) were interviewed twice over a 2-week period, and a generalizability coefficient and an index of dependability (with confidence intervals) were calculated for each dependence category. Overall, there were good-to-excellent reliabilities for the more common diagnoses and criterion counts, including tobacco, alcohol, cocaine, and opioid dependence. The reliabilities were not as good for marijuana dependence and the less common diagnoses of stimulant, sedative, and other drug dependence. There was greater variability between interviewers (inter-rater reliability) than occasions (test-retest reliability). However, for most diagnoses, the subject by occasion variability was larger than the subject by interviewer variability, indicative of greater consistency in the contribution by interviewers to the ordering of subjects than in the contribution by subjects themselves between the two interviews. These results are consistent with prior findings that the SSADDA yields reliable diagnoses and criterion counts for the more prevalent substance-dependence diagnoses. The present analysis extends these findings by showing that the greatest source of unreliability was the subjects' report. This underscores the need for efforts to increase the reliability of substance-dependence diagnoses (and by extension other self-reported phenotypic features) by enhancing the consistency of the information provided by the subjects interviewed.

Risk factors for methamphetamine-induced paranoia and latency of symptom onset in a Thai drug treatment cohort.

Background: Methamphetamine (MA) produces a range of psychotic experiences, ranging from a sub-syndromal symptom to a full-scale psychosis. While the characteristics of and risk factors for MA-psychosis have been studied extensively, MA-induced paranoia (MIP) has received only limited attention. Methods: Demographic, diagnostic, and drug use variables were assessed in 96 experienced MA-users from a Thai drug treatment center using the Semi-Structured Assessment for Drug Dependence and Alcoholism (SSADDA) and the Methamphetamine Experienced Questionnaire (MEQ). Individuals with and without MIP were compared. Latency of the initial symptom onset was also examined. Results: Ninety-six subjects participated in the study including 44 (46%) endorsed MIP. Individuals with MIP were dependent on MA more severely than those without the trait (p=0.02). Subjects with MIP were also more likely to use solvents (p=0.03), be dependent on alcohol (p=0.048), and attempt suicide (p=0.04) than those without. Individuals with short latency to a first MIP episode (i.e., within two years of their first use of MA) did not differ from those with prolonged latency (> 3 years) with respect to MA use at symptom onset. However, they reported lower lifetime use (p=0.007), heaviest period use (p=0.008) and past-year MA use (p=0.04) than those with later onset. Conclusion: Severe dependence on MA, solvent use, alcohol dependence, and suicide attempts were associated with MIP. Though the vulnerability to MIP was associated with greater dependence severity as a group, those who experience MIP earlier in the course of their dependence reported less MA use than those in whom symptoms arose later. This suggests a subgroup of individuals that are intrinsically more vulnerable to the MA effects (e.g., habit forming and psychotic effects) and in whom MIP’s subjectively aversive effects may lead to reduced MIP use over the course of their MA dependence.

Comorbid Psychiatric Diagnoses and Their Association with Cocaine‐Induced Psychosis in Cocaine‐Dependent Subjects

Comorbidity between drug abuse and mental illness is very common, but the association of such comorbidity with specific responses to drugs of abuse remains obscure. The current study examined the relationship between the presence of non-psychotic Axis I psychiatric diagnoses and the frequency and severity of cocaine-induced psychosis. We interviewed 243 unrelated cocaine-dependent adults [37% European American (EA), 52.3% African American (AA); 58.8% male] using the Semi-Structured Assessment for Drug Dependence and Alcoholism (SSADDA) to establish DSM-IV diagnoses, and two instruments for the identification of cocaine-induced paranoia, the Cocaine Experience Questionnaire (CEQ) and the Scale for Assessment of Positive Symptoms for Cocaine-Induced Psychosis (SAPS-CIP). Comorbid substance use and psychiatric disorders were common in this cocaine-dependent sample. Ninety percent of subjects met criteria for substance use disorders other than cocaine dependence; common non-substance-use disorders included antisocial personality disorder (ASPD), adult ASPD, major depression, and attention deficit-hyperactivity disorder (ADHD). Comorbid opioid dependence was more common in EA subjects than in AA participants. After correction for multiple comparisons, a lifetime diagnosis of ADHD was associated with the categorical presence of CIP (p = 0.007), as well as significantly more severe CIP symptoms. Comorbid substance use and psychiatric disorders are very common among individuals with cocaine dependence. Comorbid ADHD increases the odds of an individual endorsing CIP, suggesting some common basis for these phenomena.

Reliability of DSM-IV diagnostic criteria using the semi-structured assessment for drug dependence and alcoholism (SSADDA)

The semi-structured assessment for drug dependence and alcoholism (SSADDA) yields reliable DSM-IV diagnoses for a variety of psychiatric disorders, including alcohol and drug dependence. This study examines the reliability of individual DSM-IV criteria for lifetime substance dependence diagnoses and the impact of those criteria on diagnostic reliability. Methods Two hundred ninety-three subjects (52.2% women; 38.2% African American, 46.8% European American, 7.5% Hispanic) were interviewed twice over a 2-week period to examine the inter-rater reliability ( n = 173) or test–retest reliability ( n = 120) of the SSADDA. Cohen's κ-statistic and its confidence interval were used to assess the reliability of individual diagnostic criteria. Results Overall, the inter-rater reliability estimates were excellent for individual DSM-IV criteria for nicotine and opioid dependence; good for alcohol and cocaine dependence, and fair for dependence on cannabis, sedatives and stimulants. The impact of any individual criterion on diagnostic reliability was minimal, consistent with the notion that the DSM-IV diagnosis of substance dependence measures an underlying construct that is relatively consistent across specific groups of substances. Conclusions These results, combined with results from a study of the SSADDA's diagnostic reliability [Pierucci-Lagha, A., Gelernter, J., Feinn, R., Cubells, J.F., Pearson, D., Pollastri, A., Farrer, L., Kranzler, H.R., 2005. Diagnostic reliability of the semi-structured assessment for drug dependence and alcoholism (SSADDA). Drug Alcohol Depend. 80, 303–312], show that the instrument can be used reliably to assess substance dependence.