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Author List:
Wu S
Naliboff B
Schieffer B
Shekelle P
Bolus R
Objectives:
To develop a valid and reliable psychometric instrument that measures addictive behaviors related to use of prescription opiate medications in chronic pain populations.
Methods:
This study examined 135 veterans (mean age = 53, range 25-65, 93.33% male) in a VA Chronic Pain Clinic who had generally stable pain conditions and were receiving long-term opiate medication treatment. Veterans were followed over the course of one year and were assessed on a monthly basis using the newly developed Addiction Behaviors Checklist (ABC). The ABC is a brief (20-item) interview assessment of problematic behaviors related to prescription opiate medications. Items are focused on observable behaviors during the visit (e.g. appeared sedated or confused) or between visits (e.g. refilled medications early). Concurrent and predictive validity of the ABC was determined by comparing the ABC with an experienced clinician’s global judgment and a previously validated assessment, the Prescription Drug Use Questionnaire (PDUQ). Additionally, interrater reliability for the ABC was determined for 22 subjects rated separately by two independent clinicians.
Results:
Correlation of the ABC total score for independent raters was .96 (p<.01) indicating excellent interrater reliability. T-test results indicated that ABC mean scores were significantly different, (p<.01), between problematic users and non-problematic users as defined by a rater’s global decision of problematic use per patient. Additionally, the ABC showed good concurrent validity, as indicated by Pearson’s r of 0.45 (p<0.01) between mean ABC scores and the PDUQ total score taken at the same visit. The ABC also showed good predictive validity, as indicated by Pearson’s r of 0.48 (p<0.01) between ABC mean scores across the first 4 months as compared with the PDUQ score at 8 months into the study.
Implications:
Initial psychometric results are presented regarding the Addiction Behaviors Checklist. This screening instrument shows good concurrent validity, predictive validity, and interrater reliability for distinguishing between problematic and non-problematic users.
Impacts:
The development of screening instruments, such as the ABC, strongly enhances providers’ abilities in treating patients with chronic pain conditions. Such instruments are important for providers to be able to provide appropriate treatment for pain problems while giving necessary attention to the potential for addiction to opiate medications.
