Magazine article Clinical Psychiatry News

Screening Tool Predicts Substance Dependence in Teens

Magazine article Clinical Psychiatry News

Screening Tool Predicts Substance Dependence in Teens

Article excerpt

EXPERT ANALYSIS FROM THE ECNP CONGRESS

VIENNA -- The creation of a simple risk score that accurately predicts which adolescents in the general population will develop persistent substance dependence as adults was one of the highlights of 2016 in addiction medicine, Wim van den Brink, MD, said at the annual congress of the European College of Neuropsychopharmacology.

"These predictors are not very difficult to assess. Clinicians will be interested to know that the positive predictive value of the screen is threefold greater than the persistent prevalence rate," noted Dr. van den Brink, professor of psychiatry and addiction at the University of Amsterdam and director of the Amsterdam Institute for Addiction Research.

This work by investigators from New Zealand opens the door to selective prevention of adult addiction disorders through interventions addressing some of the newly identified risk factors in childhood and adolescence, although how best to proceed remains unresolved, he added.

The researchers developed "a universal screening tool" by working backward in an analysis of a representative group of 1,037 individuals born in Dunedin, New Zealand, in 1972-1973 and prospectively followed to age 38 years, with a 95% study retention rate. Participants were assessed for dependence on alcohol, tobacco, cannabis, or hard drugs at ages 21, 26, 32, and 38.

Persistent substance dependence in adulthood, defined as dependence at a minimum of three of the assessments, was present in 19% of subjects.

The investigators found that the presence in childhood or adolescence of any four of nine risk factors had an area under the curve of 80% for persistent substance dependence as an adult. The sensitivity was 43%, with a 93% specificity. The positive predictive value was 60%, and the negative predictive value was 87% (Psychol Med. 2016 Mar;46[4]:877-89).

The nine risk factors are low family socioeconomic status, a family history of substance dependence, childhood depression, childhood conduct disorder, early exposure to substances, adolescent frequent alcohol use, adolescent frequent cannabis use, male gender, and adolescent frequent tobacco use. …

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