Severity Of Dependence Scale Score Research Articles

Study protocol: Brief intervention for medication overuse headache - A double-blinded cluster randomised parallel controlled trial in primary care

BackgroundChronic headache (headache ≥ 15 days/month for at least 3 months) affects 2–5% of the general population. Medication overuse contributes to the problem. Medication-overuse headache (MOH) can be identified by using the Severity of Dependence Scale (SDS). A “brief intervention” scheme (BI) has previously been used for detoxification from drug and alcohol overuse in other settings. Short, unstructured, individualised simple information may also be enough to detoxify a large portion of those with MOH. We have adapted the structured (BI) scheme to be used for MOH in primary care.Methods/DesignA double-blinded cluster randomised parallel controlled trial (RCT) of BI vs. business as usual. Intervention will be performed in primary care by GPs trained in BI. Patients with MOH will be identified through a simple screening questionnaire sent to patients on the GPs lists. The BI method involves an approach for identifying patients with high likelihood of MOH using simple questions about headache frequency and the SDS score. Feedback is given to the individual patient on his/her score and consequences this might have regarding the individual risk of medication overuse contributing to their headache. Finally, advice is given regarding measures to be taken, how the patient should proceed and the possible gains for the patient. The participating patients complete a headache diary and receive a clinical interview and neurological examination by a GP experienced in headache diagnostics three months after the intervention. Primary outcomes are number of headache days and number of medication days per month at 3 months. Secondary outcomes include proportions with 25 and 50% improvement at 3 months and maintenance of improvement and quality of life after 12 months.DiscussionThere is a need for evidence-based and cost-effective strategies for treatment of MOH but so far no consensus has been reached regarding an optimal medication withdrawal method. To our knowledge this is the first RCT of structured non-pharmacological MOH treatment in primary care. Results may hold the potential of offering an instrument for treating MOH patients in the general population by GPs.Trial registrationClinicalTrials.gov identifier: NCT01314768

Dependence scores predict prognosis of medication overuse headache: A prospective cohort from the Akershus study of chronic headache

Medication overuse headache (MOH) is a chronic headache that is common in the general population. It has characteristics similar to drug dependence, and detoxification is established as the main treatment. The majority of MOH cases are in contact with general practitioners. Our objective was to investigate whether the Severity of Dependence Scale (SDS) score could be used as predictor for the prognosis of MOH in the general population.In a cross-sectional epidemiological survey, an age- and gender-stratified sample of 30,000 persons 30 to 44 years of age was recruited via a posted questionnaire. Those individuals with self-reported chronic headache (⩾15 days per month) were interviewed by neurological residents at Akershus University Hospital, Oslo. The International Classification of Headache Disorders was used. Those with MOH were re-interviewed by telephone 2 to 3 years after the initial interview. SDS scores and medication information were collected at baseline and follow-up. The main outcomes were SDS scores, termination of MOH and chronic headache from baseline to follow-up. We found the predominant overused analgesics in this sample to be simple analgesics. At follow-up, 65% of participants no longer had medication overuse, and 37% had changed to episodic headache (<15 days per month). The SDS score at baseline successfully predicted improvement for primary MOH, but not secondary MOH. The SDS scores decreased slightly from baseline to follow-up in those who stopped medication overuse, but were still significantly higher than in subjects with chronic headache without medication overuse at baseline. We conclude that the SDS score can predict successful prognosis related to detoxification of primary MOH but not in secondary MOH.

Management of primary chronic headache in the general population: the Akershus study of chronic headache

Primary chronic headaches cause more disability and necessitate high utilisation of health care. Our knowledge is based on selected populations, while information from the general population is largely lacking. An age and gender-stratified cross-sectional epidemiological survey included 30,000 persons aged 30–44 years. Respondents with self-reported chronic headache were interviewed by physicians. The International Classification of Headache Disorders was used. Of all primary chronic headache sufferers, 80% had consulted their general practitioner (GP), of these 19% had also consulted a neurologist and 4% had been hospitalised. Co-occurrence of migraine increased the probability of contact with a physician. A high Severity of Dependence Scale score increased the probability for contact with a physician. Complementary and alternative medicine (CAM) was used by 62%, most often physiotherapy, acupuncture and chiropractic. Contact with a physician increased the probability of use of CAM. Acute headache medications were taken by 87%, while only 3% used prophylactic medication. GPs manage the majority of those with primary chronic headache, 1/5 never consults a physician for their headache, while approximately 1/5 is referred to a neurologist or hospitalised. Acute headache medication was frequently overused, while prophylactic medication was rarely used. Thus, avoidance of acute headache medication overuse and increased use of prophylactic medication may improve the management of primary chronic headaches in the future.

An adapted Severity of Dependence Scale is valid for the detection of medication overuse: the Akershus study of chronic headache

Medication overuse headache is a common subtype of chronic headache involving the overuse of simple analgesics, opioids, ergotamine or triptans or combinations of these medications. Medication overuse may worsen the headache and has been described to have many characteristics similar to addiction. The purpose of this study was to validate and optimize the Severity of Dependence Scale (SDS) for use amongst people with chronic headache. In a cross-sectional epidemiological survey, an age- and gender-stratified sample of 30,000 30- to 44-year-old people were recruited via a posted questionnaire. Those with self-reported chronic headache were interviewed by neurological residents at Akershus University Hospital, Oslo. Headache was classified according to the International Classification of Headache Disorders. Split file methodology was employed for data analysis. Severity of Dependence Scale score in those with and without medication overuse. Severity of Dependence Scale score was a significant predictor of medication overuse amongst chronic headache patients. Medication overuse could be predicted with sensitivity, specificity, positive and negative predictive values of 0.79, 0.84, 0.84 and 0.79, respectively, in men and 0.76, 0.77, 0.73 and 0.79 in women. Linear regression and factor analysis suggested a redundancy for the SDS question 'Do you think your use of your headache medication was out of control?' Removal of this question improved Chronbach's alpha=0.76. The SDS is valid for detecting medication overuse and dependency like behaviour amongst people with chronic headache. The adapted version may be used to identify chronic headache patients who may benefit from detoxification.

Brief intervention for regular ecstasy (MDMA) users: Pilot randomized trial of a Check-up model

The prevalence of ecstasy (MDMA) use has increased significantly in recent years, particularly amongst young people. Despite the existence of a sizable population of regular ecstasy users and emergent evidence of a range of associated harms, including dependence, to date no effective targeted intervention responses have been reported specifically for this group. The aim of this study was to evaluate the efficacy of a single session brief intervention in reducing ecstasy use and related problems among regular ecstasy users. In a randomized controlled trial conducted in Sydney, Australia, 50 adult ecstasy users were assigned to either a single session brief intervention or an assessment-only 3-month delayed treatment control condition. Primary outcome measures were days of ecstasy use and number of DSM-IV dependence symptoms reported. At 3-month follow-up significant differences were found in favour of the intervention group on measures of DSM-IV dependence symptoms reported and Severity of Dependence Scale score. No statistically significant differences were detected on measures of quantity and frequency of use. While abstinence rates differed between groups by a factor of 4 (16% vs. 4%), this difference did not achieve statistical significance. Between group effect sizes at follow-up, all in favour of the intervention group, were moderate on the main outcome measures. The approach is acceptable to participants and merits further evaluation.

The severity of dependence score correlates with medication overuse in persons with secondary chronic headaches. The Akershus study of chronic headache

The objective was to compare the Severity of Dependence Scale (SDS) score and pattern of medication use in persons with secondary chronic headache (⩾15days/month for at least 3months) in a cross-sectional epidemiological survey. A posted questionnaire screened for chronic headache. Neurological residents interviewed those with self-reported chronic headache. The International Classification of Headache Disorders was used. Split file methodology was employed for data analysis. People with secondary chronic headaches were identified in an age and gender stratified sample of 30,000 30–44year olds from the general population. The interviews and examinations were conducted at the Akershus University Hospital, Oslo, Norway. The main outcome measure was the SDS score in those with and without medication overuse. Fifty-five (49%) of the 113 persons with secondary chronic headaches were found to have medication overuse. Fifty-eight percent overused simple analgesics and 31% overused combination analgesics. The SDS score was significantly higher among those with than without medication overuse (5.5 vs. 1.9). The sensitivity, specificity, positive and negative predictive values were 0.82, 0.82, 0.82 and 0.83, respectively. Thus the SDS score correlates with medication overuse, and a high SDS score suggests dependency-like behaviour in persons with secondary chronic headache. The use of SDS score in subjects with frequent pain episodes may contribute to the detection of medication overuse and better management of this group of patients.

Association between Severity of Cannabis Dependence and Depression

Objective. The aim of the current study was to investigate the relationship between self-reported severity of cannabis dependence and symptoms of depression. Method. The lifetime diagnoses of depression and cannabis misuse (abuse and/or dependence) were obtained from 50 participants recruited from the general community, using a self-completed diagnostic interview (CIDI-Auto 2.1). The lifetime severity of cannabis dependence was established using a standard questionnaire, Severity of Dependence Scale (SDS). Results. Of the 19 participants with mental illness diagnoses, 14 (74%) reported depression symptoms. The 14 participants with depression diagnoses had significantly more cannabis misuse diagnoses and significantly higher SDS scores compared to those without mental illness diagnoses (N = 31). SDS scores significantly predicted presence or absence of CIDI depression diagnoses with a 69% overall rate of cor-rect predictions. As SDS scores increased the odds of classification into depressed versus non-depressed groups was 1.3 (95% C.I. 1.02-1.57). Conclusion. The presence of lifetime depression symptoms is associated with higher lifetime severity of cannabis dependence and more lifetime cannabis misuse symptoms in otherwise healthy research vol-unteers.

Gender differences in Health Related Quality of Life of young heroin users.

BackgroundHealth Related Quality of Life (HRQL) of opiate users has been studied in treatment settings, where assistance for drug use was sought. In this study we ascertain factors related to HRQL of young opiate users recruited outside treatment facilities, considering both genders separately.MethodsCurrent opiate users (18-30 y) were recruited in outdoor settings in three Spanish cities (Barcelona, Madrid, Sevilla). Standardised laptop interviews included socio-demographic data, drug use patterns, health related issues, the Severity of Dependence Scale (SDS) and the Nottingham Health Profile (NHP).ResultsA total of 991 subjects (73% males), mean age = 25.7 years were interviewed. The mean global NHP score differed by gender (women: 41.2 (sd:23.8); men:34.1(sd:23.6);p < 0.05). Multivariate analysis was implemented separately by gender, variables independently related with global NHP score, both for males and females, were heroin and cocaine SDS scores. For women, only other drug related variables (alcohol intake and length of cocaine use) were independently associated with their HRQL. HIV+ males who suffered an opiate overdose or had psychiatric care in the last 12 months perceived their health as poorer, while those who had ever been in methadone treatment in the last 12 months perceived it as better. The model with both genders showed all factors for males plus quantity of alcohol and an interaction between gender and HIV status.ConclusionsHeroin users were found to be at a considerable risk of impaired HRQL, even in these young ages. A score approaching severity of dependence was the factor with the strongest relation with it.

The Severity of Dependence Scale detects people with medication overuse: the Akershus study of chronic headache

Objective:To evaluate the Severity of Dependence Scale (SDS) in people with primary chronic headache and analyse the pattern of medication overuse.Design:Cross sectional epidemiological survey. A posted questionnaire screened for chronic...

Severity of Dependence Scale as a Diagnostic Tool for Heroin and Cocaine Dependence

Aims: Our aim was to further assess the Severity of Dependence Scale (SDS) validity and to identify the cut-off score for a DSM-IV diagnosis of heroin and cocaine dependence through a cross-sectional survey in Barcelona, Spain. Methods: The Psychiatric Research Interview for Substance and Mental Disorders (PRISM) was used as the gold standard. 146 young (18–30 years old) heroin users were recruited from outside the healthcare context, 135 of whom were also current cocaine users. SDS scores were correlated to quantity, frequency and length of drug use. Results: The SDS cut-off point at which there was optimal discrimination of a DSM-IV diagnosis presence was found to be 3 (i.e., a score of 3 or more) for heroin dependence and 4 for cocaine dependence. Conclusions: The study gives further support to SDS dimensional properties and to its validity for rapid assessment of current heroin and cocaine dependence.

Severity of drug dependence does not predict changes in drug users’ behaviour over time

This paper examines the power of a measure of drug dependence to predict future changes in drug consumption and related outcomes such as criminality and homelessness. Data from an ongoing, longitudinal, interview study (DORIS) of 1033 new attenders at a range of Scottish drug treatment facilities were analysed, 16 months on from sample recruitment, using forward stepwise logistic regression models. Dependence was measured at baseline and in subsequent interview sweeps using the five-item Severity of Dependence Scale (SDS). In addition to drug consumption measures, a range of non-drug consumption measures were used, including those measuring housing status, employment status and criminality. Respondents’ SDS scores fell significantly over time, and SDS score at 16 months was a significant independent predictor of outcome measures such as reports of acquisitive crimes. However, SDS score at baseline was not an independent predictor of either drug consumption measures at 16 months or non-drug outcomes such as criminality at 16 months. Treatment services are increasingly designed to view drug use as a chronic condition, with dependence as its core property. However, while SDS score functions as a useful outcome measure, puzzlingly, severity of dependence does not predict future drug using careers in these data, the largest longitudinal cohort of Scottish drug users ever studied. Accordingly, the implications of these findings for the conceptualisation of drug use and for services planning and delivery are both unsettling and unclear.

Concurrent validity of cannabis misuse diagnoses on CIDI-Auto 2.1 in low-level cannabis users from the general population

The aim of the current study was to investigate the concurrent validity of cannabis misuse diagnoses (abuse and/or dependence) on the Composite International Diagnostic Interview (CIDI-Auto 2.1) in 50 relatively low-level cannabis users from the general population. Cannabis misuse diagnoses on the CIDI were compared with Severity of Dependence Scale (SDS) scores indicating the level of cannabis dependence. Participants with cannabis misuse diagnoses had significantly higher SDS scores, and significantly more of them (82%) self-reported daily or weekly cannabis use than participants without such diagnoses. The overall agreement between CIDI-Auto diagnoses and SDS scores was 86%. SDS scores were 3.5 times more likely than chance to predict presence of cannabis misuse diagnoses on the CIDI. Therefore it appears that CIDI-Auto 2.1 assigns cannabis misuse diagnoses to relatively low-level cannabis users from the general population in fair agreement with SDS scores and self-reports of cannabis use.

Determining a cut-off on the Severity of Dependence Scale (SDS) for alcohol dependence

Optimal cut-off points on the Severity of Dependence Scale (SDS) indicative of clinically significant dependence have been determined for a range of substance types. This study aims to determine a cut-off point on SDS that discriminates between the presence and absence of a DSM-IV diagnosis of alcohol dependence. A structured interview was administered to 90 alcohol users in Sydney, Australia. Receiver Operating Characteristic curve analysis confirmed the utility of the SDS-alcohol for characterising and diagnosing persons with respect to their alcohol-dependent status to an accuracy of 85%. A SDS score of 3 or above was determined as optimal for characterising alcohol dependence. Evidence is also provided confirming that the SDS-alcohol is a valid, reliable uni-dimensional scale for measuring alcohol dependence. It has been demonstrated that the SDS-alcohol can be used to characterise an individual's alcohol-dependent status. A cut-off value for SDS-alcohol provides additional meaning and value to the scale for clients and clinicians and will enable researchers to characterise the prevalence of alcohol dependence in their target populations.

Combined counseling and bupropion therapy for smoking cessation: identification of outcome predictors

AbstractBecause some smoking‐induced pathologies improve upon discontinuation, strategies have been developed to help smokers quit. The aim of this study was to measure the rate of smokers still abstinent one year after one cycle of a six‐week group counseling given alone or in combination with a seven‐week period of daily administration of bupropion. We also evaluated the predictor validity of nicotine dependence intensity at enrollment, administering both the Fageström Tolerance Questionnaire (FTQ) and the Severity of Dependence Scale (SDS). Visual Analogue Scale (VAS), to measure the intensity of “smoke craving,” was also administered. Two hundred twenty‐nine subjects trying to quit smoking were enrolled. Bupropion therapy was accepted by 110 subjects, but only 50 completed the 7‐week cycle of therapy. Abstinence rates at one year were 68.0 and 56.6%, respectively, in the group that used bupropion for the scheduled 7 weeks and in the group that discontinued bupropion, and 35.3% in the group with counseling therapy alone. SDS (but not FTQ) scores at enrollment, VAS values for craving at the end of the program, and bupropion therapy were the variables selected by Linear Discriminant Analysis to assign subjects to the Smoker or Non‐smoker group, with a global correctness of 70.9%. In conclusion, the efficacy of bupropion largely depends upon its interaction with psychological factors, such as the level of nicotine dependence, craving for nicotine, and the subject's commitment to quit smoking. Drug Dev. Res. 67:271–279, 2006. © 2006 Wiley‐Liss, Inc.

The Severity of Dependence Scale (SDS) in an adolescent population of cannabis users: Reliability, validity and diagnostic cut-off

The Severity of Dependence Scale (SDS) is a five-item scale that has been reported to be a reliable and valid screening instrument for dependence and a measure of dependence severity in adults across several substance classes. To date no data have been reported on its performance in a population of adolescent cannabis users. The current study assessed the psychometric properties of the SDS in a community sample of 14–18-year-old adolescent cannabis users ( n = 100). Internal consistency ( α = 0.83) and test–retest coefficients (ICC = 0.88) were high and a principal components analysis of the scale found all items to load on a single factor. Total SDS score correlated significantly with frequency of cannabis use and number of DSM-IV dependence criteria met, indicating good concurrent validity. Receiver Operating Characteristic curve analysis was used to determine the most appropriate SDS cut-off score for use as an indicator of cannabis dependence, with optimal discrimination at an SDS score of 4. These findings indicate that the SDS is a reliable and valid measure of severity of cannabis dependence among adolescents, has high diagnostic utility, and that an SDS score of 4 may be indicative of cannabis dependence.

A preliminary investigation into the relationship between anabolic-androgenic steroid use and the symptoms of reverse anorexia in both current and ex-users.

To establish whether the symptoms of reverse anorexia continue with the cessation of anabolic-androgenic steroid (AAS) use in male body builders. To determine whether current and ex-AAS-using body builders score higher on the modified (for reverse anorexia) eating disorders inventory (EDI) than both non-AAS-using body builders and regular aerobic exercisers. A random sample of regular aerobic exercisers, current, ex-, and non-AAS-using body builders were recruited from four local gyms and a syringe exchange in the Merseyside area. A total of 137 male subjects with an average age of 29 years (range 17-49 years) were recruited. Fifty subjects were classed as aerobic exercisers, 39 subjects were classed as non-AAS-using body builders, 29 subjects were current AAS users and 19 subjects were ex-AAS users. All subjects undertook an anonymous questionnaire consisting of the modified EDI, the severity of dependence scale (SDS) for both exercising and AAS use, and questions about body weight, dieting, and substance use. AAS-using bodybuilders were striving towards an exaggerated mesomorphic physique. Both current and ex-AAS users had higher scores on all sections of the EDI than both groups of non-AAS users. There was a significant positive correlation between the SDS scores for AAS and scores on the EDI for current AAS users. AAS use, but not body building per se, was associated with increased symptoms of reverse anorexia, and this symptomatology was higher in those who had higher scores on the SDS for AAS. It remains to be determined whether symptoms of reverse anorexia are either a cause or an effect of AAS use.

PREDICTIVE FACTORS OF PERSISTING ILLICIT DRUG USE IN HOSPITALIZED HEROIN ADDICTS

The efficacy of methadone treatment in reducing the rate of positive urinalyses for opiates has been repeatedly assessed in outpatient intravenous heroin users (IHUs), but not in IHUs hospitalized for coexisting diseases. The aim of the present study, performed on 83 IHUs, was to assess the rate of drug-free urinalyses for addictive drugs over a 13-day period of hospitalization. The rate of drug-free urinalyses was then related to the intensity of withdrawal symptoms, the level of dependence (as measured by the severity of dependence scale (SDS)) and of heroin craving (as measured by a visual analogical scale, (VAS)), assessed on admission and on days 4, 7, 10, and 13. All but nine patients received methadone upon hospitalization. The results show that positive urinalyses for morphine and/or cocaine dropped over the period of observation from 67 to 7%. On admission, patients who persisted in the illicit use of heroin did not differ significantly from the rest in terms of abstinence scores or daily methadone dose, but scored higher at the SDS and yielded urinalyses which all tested positive for morphine and/or cocaine. In conclusion, in the hospital setting low methadone doses (32.5 mg per die on average) induce a drug-free condition in the majority of patients and high SDS scores associated with positive urinalysis for morphine and/or cocaine are predictive of persistent drug abuse during hospitalization.

Dual dependence: assessment of dependence upon alcohol and illicit drugs, and the relationship of alcohol dependence among drug misusers to patterns of drinking, illicit drug use and health problems.

The study investigates severity of alcohol dependence among drug misusers. Specifically, it investigates the inter-relationship of alcohol and drug dependence and associations with alcohol consumption, drug consumption and substance-related problems. The sample comprised 735 people seeking treatment for drug misuse problems, who were current (last 90 days) drinkers. Data were collected by structured face-to-face interviews. Dependence upon illicit drugs and upon alcohol was measured by the Severity of Dependence Scale (SDS). Three groups of drinkers were identified: non-alcohol-dependent drug misusers (63%); low-dependence (19%); and high-dependence (18%). Many drug misusers were drinking excessively and alcohol dependence was related to patterns of alcohol and drug consumption. High-dependence drinkers were more likely to drink extra-strength beer; they were less frequent users of heroin and crack cocaine but more frequent users of benzodiazepines, amphetamines and cocaine powder; they reported more psychological and physical health problems. The SDS was found to have good reliability and validity as a measure of alcohol dependence. SDS scores for alcohol and drug dependence were unrelated. Alcohol use is an important and under-rated problem in the treatment of drug misusers. A comprehensive assessment of alcohol use among drug misusers should include separate assessments of alcohol consumption, alcohol-related problems and severity of alcohol dependence.

Validity and reliability of the Severity of Dependence Scale (SDS) in a Brazilian sample of drug users.

The Severity of Dependence Scale (SDS) is a short, five-item scale which provides a measure of degree of dependence upon different drugs. The present study explores the validity and reliability of a Portuguese version of the instrument with a sample of 374 Brazilian drug users. Concurrent validity of the SDS was assessed in relation to reported quantity of drugs used and to DSM-IV dependence items, and test-retest reliability was assessed with a subsample of 42 subjects. The SDS total scores for powder cocaine, crack cocaine, cannabis and alcohol were significantly and highly positively correlated with severity of dependence as measured by DSM-IV, and with the estimated quantity of drugs used in the last month. Test-retest coefficients were high for all drugs studied. Principal components analysis showed that the SDS scores lie on a single dimension with the exception of crack cocaine where scores lie on a single dimension for treatment attenders and on two dimensions for community samples. The results indicate that the Portuguese version of the SDS is a valid research tool for measuring severity of dependence upon powder cocaine (snorted), crack cocaine (smoked), cannabis and alcohol.

Event-related potential indices of auditory selective attention in dependent amphetamine users

Background: The aim of the present study was to further investigate a previously reported attention-related impairment in dependent amphetamine users using event-related potential (ERP) indices of selective attention. Methods: ERPs were recorded during an auditory selective attention task (SAT) that involved detecting infrequent long-duration target tones presented among short-duration tones that varied in location (left vs. right ear) and pitch (low vs. high). Amphetamine users ( n = 19) were divided into two groups, high dependence ( n = 10) and low dependence ( n = 10), based on amphetamine Severity of Dependence Scale scores, and compared to an age-matched control group ( n = 9). Results: The high-dependence group showed slowed reaction time and reduced early processing negativity and peak N1 amplitude to location-relevant nontarget stimuli. Poor performance on the SAT was highly correlated with deficits in early processing, which were also related to poor performance on the Wechsler Memory Scale Attention/Concentration index. Conclusions: It is suggested that severely dependent users suffer an inability to selectively enhance the sensory processing of relevant auditory information. This may produce poor automatic preferential processing of relevant information and increase load on limited attentional resources.