The Addiction Behaviors Checklist: Validation of a New ... - Westat

Vol. 32 No. 4 October 2006 Addiction Behaviors Checklist347differences in PDUQ scores between participantswho received mean scores of 3 or greateron the ABC across the first 4e5 months andthose with mean scores below 3. Mean PDUQscores were higher for those participants witha mean ABC score greater than or equal to 3(mean ¼ 11.77, SD ¼ 3.99) than those withmean ABC scores less than 3 (mean ¼ 8.52,SD ¼ 4.05, t(86) ¼ 2.97, P ¼ 0.004). A similart-test was performed comparing participantswho received any ABC score greater than orequal to 3 over the first 4e5 months with thosewho consistently had scores less than 3 duringthis period. Mean PDUQ scores were againhigher for those participants who had at leastone ABC score greater than or equal to 3(mean ¼ 10.17, SD ¼ 4.35) than those who consistentlyhad scores less than 3 (mean ¼ 8.02,SD ¼ 3.80, t(86) ¼ 2.46, P ¼ 0.016).Trends Over Final Four Visits of StudyOver the course of the one-year data collectionfollow-up period, 38 participants had theiropioid medication prescriptions discontinueddue to objective misuse criteria establishedwithin the clinic setting. These objective criteriaincluded receiving a ‘‘bad’’ urine toxicologyscreen (e.g., positive urine findings of drugs ofabuse, numerous occurrences of absence ofprescribed medications within urine toxicologyscreens) or refusing to comply with themedication contract used within the clinic(e.g., failing to submit to random pill counts,repeatedly deviating from prescribed opioidmedication schedule). It should be notedthat the clinic used a sophisticated urinescreening methodology, including high-performanceliquid chromatography of all samples,which was both sensitive and specific for individualopioid compounds. Given the initial developmentof the ABC, participants did nothave their opioid medications discontinueddue to elevated scores on the ABC, but wereonly discontinued from their medicationsdue to the previously mentioned objectivemeasures of opioid misuse. Of these 38 participants,11 participants had their opioid medicationsdiscontinued due to alcohol or illicitsubstance abuse, 21 due to noncompliancewith prescribed medications, and 6 due tononcompliance with clinic procedures.It might be expected that objective signs ofopioid misuse and opioid prescriptiondiscontinuation would be preceded by an increasingtrend in misuse behaviors. To examinethis, the ABC scores were analyzed forthe final three to four visits for each patient.Comparisons were made between those participantswho were dropped from the study forone of the above-mentioned offenses vs. thoseparticipants who either completed the study orhad to drop out of the study for nonproblematicreasons (i.e., need for surgery, movedout of town). It should be noted that the lastvisit in this data set could either be the participant’scompletion of the one-year follow-upvisits or the point at which the patient wasdropped from the study, due to either problemsin opioid use or other reasons. Fig. 2 displaysa graphical representation of the trendsseen between the mean ABC scores for thesetwo groups in the last four visits of the study.As can be seen in Fig. 2, the ABC mean scoregradually increased, approaching a totalmean score of 3, as the participants nearedthe final visit in which they were droppeddue to problematic opioid medication use.ABC mean scores for participants who eithercompleted the study or were dropped due tononproblematic reasons tended to remainfairly stable around a mean score of about1.2e1.3. Based on t-test analysis, equalMean ABC Score3.02.52.01.51.00.50.03 Visits PriorCompleted or Non-problematic dropDropped due to a problem2 Visits Prior1 Visit Prior*Final Visit* P < 0.05 for scores at final visitFig. 2. Comparison of mean ABC scores over thefinal four visits in the study (n ¼ 136). Participantswho were discontinued due to opioid misuse problem(e.g., problem displayed in urine toxicology,noncompliance with clinic procedures) displayedan elevated ABC score (P < 0.05) at final visit ascompared to participants who completed or discontinuedthe study due to nonproblematic reasons(i.e., need for surgery).