The most important reason for assessing and measuring addiction, as with any other problem, is to answer the question “Is it getting better?” People with addiction problems, their families and friends, the people who offer professional help and the people who pay for the services all want to know. Here are some key events in the development of a new website RESULT4ADDICTION.
The nature of dependence
In 1976 a seminal publication by Edwards & Gross proposed that addiction problems are best seen as a dependence syndrome and related problems. A debate on the nature of dependence followed: is it a physical or psychological state or are there elements of both as suggested by the syndrome? The Severity of Alcohol Dependence Questionnaire was the first scale designed to measure dependence. It was heavily weighted towards measuring withdrawal symptoms, and, therefore, was proxy for heavy drinking. The Severity of Alcohol Dependence Data was developed better to reflect the psychological elements of dependence. The Leeds Dependence Questionnaire superseded all of these and is a universal measure of substance dependence as a psychological condition – it is now the measure of dependence preferred by RESULT4ADDICTION.
Measuring Addiction
Dependence might be the essence of addiction but it is not its only component nor is it the most visible. The most obvious aspect of addiction is substance use itself but this is very difficult to summarise in a single measure – there are many substances of misuse, some illicit some on prescription, there are different routes of use, and variable patterns of use in terms of both quantity and frequency. Substance use screening tools typically give sufficient information for initial assessment (see here and here).
Addiction is also about Quality of Life measurement. There are many scales to choose from. In developing RESULT4ADDICTION certain criteria, which later were formalised as a Quality Framework, were adopted: universality, brevity, good psychometrics being key. When these criteria are applied the choice is limited and, rather than a Quality of Life measure, it was decided that two scales, the Social Satisfaction Questionnaire and the Clinical Outcomes in Routine Evaluation, best capture the psychosocial components of addiction.
The concept of recovery was coined by the 12 Step movement and taken up in mainstream UK policy in 2013, signaling a move away from harm reduction. The nature of recovery has been well described by the 12 Step movement. A number of rating scales, which are in effect also general assessment tools, have been developed of which the Addiction Recovery Questionnaire best meets RESULT4ADDICTION criteria.
Categories of Measurement
Different stakeholders want different things from measuring addiction outcomes. RESULT4ADDICTION suggests using a mix of measures across three categories:
Generic – measuring health
Dimension – measuring addiction
Condition specific – measuring dependence and other conditions
A Consensus Group laying the foundations of RESULT4ADDICTION
In 2011 an expert group was convened to update on the state of the art of addiction outcome measurement. A preliminary set of measures suitable for the range of addiction problems was identified and evaluated by applying Quality Framework criteria. It was clear that few scales achieved a high standard of validation according to the Quality Framework and the meaning of scores on most scales needed elucidating.
The full report can be found here
RESULT4ADDICTION is the product of development work undertaken since the Consensus Group report. The centrepiece of the website is self-assessment of addiction, recovery, and mental health problems using the best scales currently available. People with an addiction problem, or just worried, can test themselves and share the results with a practitioner or can use the results to support self-directed change and they can see pictograms of how good treatment is likely to be. Practitioners and researchers can dig deeper to find the evidence underpinning scales and their psychometric properties and compare a selection of scales measuring different aspects of addiction.
https://www.result4addiction.net/
Other linked material is available on the SSA website:
Perspectives in outcome measurement for addiction interventions [2016]
Measuring recovery [2015]
Payment by results [2012]
References
1. Edwards G & Gross M (1976) Alcohol dependence: provisional description of a clinical syndrome. British Medical Journal 1:1058-1061
2. Stockwell TR, Hodgson RJ, Edwards G, Taylor C, and Rankin H (1979) The Development of a Questionnaire to Measure Severity of Alcohol Dependence. British Journal of Addiction 74:79-87
3. Raistrick D, Dunbar G & Davidson R (1983) Development of a Questionnaire to Measure Alcohol Dependence. British Journal of Addiction 78: 89-95
4. Raistrick DS, Bradshaw J, Tober GW, Weiner J, Allison J & Healey C (1994) Development of the Leeds Dependence Questionnaire. Addiction 89:563-572
5. Tober GW (2000) The nature and measurement of change in substance dependence, University of Leeds, PhD Thesis
6. Fairhurst CM, Böhnke JR, Gabe R, Croudace TJ, Tober GW, Raistrick D (2014) Factor analysis of treatment outcomes from a UK specialist addiction service: relationship between the Leeds Dependence Questionnaire, Social Satisfaction Questionnaire and CORE-10. Drug and Alcohol Review 33: 643-650
7. Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. (1998) The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. Archives of Internal Medicine 158:1789
8. Berman AH, Bergman H, Palmstierna T, Schlyter F. (2005) Evaluation of the Drug Use Disorders Identification Test (DUDIT) in criminal justice and detoxification settings and in a Swedish population sample. European Addiction Research 11:22-31
9. Raistrick D, Tober G, Heather N and Clark J (2007) Validation of the Social Satisfaction Questionnaire for outcome evaluation in substance use disorders. Psychiatric Bulletin 31: 333-336
10. Barkham M, Bewick B, Mullin T, Gilbody S, Connell J, Cahill J, Mellor-Clark J, Richards D, Unsworth G and Evans C. (2013) The CORE-10: A short measure of psychological distress for routine use in the psychological therapies. Counselling and Psychotherapy Research 13:3-13
11. Betty Ford Institute. (2007). What is recovery? A working definition from the Betty Ford Institute. The Betty Ford Institute Consensus Panel. Journal of Substance Abuse Treatment 33:221–228
12. Iveson-Brown K & Raistrick D. (2016) A brief Addiction Recovery Questionnaire derived from the views of service users and concerned others. Drugs: Education, Prevention and Policy 23:41-7
13. Fitzpatrick, R., Davey, C., Buxton, M.J., and Jones, D.R. (1998) Evaluating patient-based outcome measures for use in clinical trials. Health Technology Assessment 2(14)
The opinions expressed in this commentary reflect the views of the author(s) and do not necessarily represent the opinions or official positions of the Society for the Study of Addiction.