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Treatment Process

COMPARISON ::: Universal Dependence Scales
scale characteristics and quality framework scores


Dependence is at the heart of addiction - it is a psychological disorder and is itself a mental health problem which can easily be mistaken for other common problems such as anxiety or depression. Measuring dependence is key to deciding how strong a person's addiction has become and what help is going to work best. Universal scales can be applied to most substances and are valid for most cultural and socio-economic groupings. Dependence scores change quite quickly but may then persist despite sustained abstinence. In a simple head to head the Leeds Dependence Questionnaire (LDQ) comes out as the best scale to use in routine practice and for research. The other three scales were designed for a different purpose and have different strengths - read the 'Points to Consider' for each scale.

LDQ :: Leeds Dependence Questionnaire designed for routine clinical practice and research

The LDQ was developed for use as a treatment outcome measure in routine clinical practice. It has been used as an outcome measure in major research studies. The LDQ measures the construct dependence as described in ICD11 by the World Health Organisation. The LDQ provides comprehensive coverage of the elements of ICD11 dependence:  Q1: preoccupation  Q2: salience  Q3: inability to control use Q4: planning Q5: maximising effect  Q6: stereotyped pattern of use  Q7: loss of control  Q8: importance of effect  Q9: relief of withdrawal symptoms  Q10: global coping. Timeframe :: The last 30days. Scoring :: All items are scored 0-1-2-3 giving a maximum of 30. Up to two unanswered items can be pro-rated by allocating the mean score for the valid responses. Completion time :: <3minutes. Cut-off score :: The scale developers recommend using dependence as a continuous data variable, however, cut-offs suggested: low dependence <10; moderate dependence 11-20; severe dependence >=21. Clinically significant change :: The reliable change score is >=4 and functional population scores are male <10 female <5.


SDS :: Severity of Dependence Scale  designed for research - especially screening for dependence

The SDS was designed as a brief way of assessing dependence on illicit drugs. It is universal in that any drug or group can be inserted as the reference point. The SDS is a five item scale specifically concerned with the individual's feelings of impaired control over their own drug taking and with their preoccupation and anxieties about drug taking. The SDS provides partial coverage of the elements of ICD10 dependence:  Q1: loss of control Q2: craving Q3: concern Q4: desire to stop Q5: difficulty stopping. Timeframe :: The last 12 months - the authors advise the timeframe can be varied. Scoring :: Each of the items is scored on a four-point scale; 0=never/almost never  1=sometimes  2=often  3=always/nearly always (for Q1-4) and 0=not difficult  1=quite difficult  2=very difficult  3=impossible (for Q5). Completion time :: <1minute. Cut-off score :: Suggested cut-offs for dependence range from >=3 to >=6 depending on the drug. The scale could be used as a continuous scale, grading severity of dependence, though this has not been recommended by the scale authors. 


SDSQ :: Substance Dependence Screening Questionnaire designed for screening for dependence in general populations

The SDSQ is an 11 item scale; there are two filter questions, Q8 & Q10, and one, Q1 with five parts, about consumption; the eight scored items screen for dependence by DSM4 criteria:  Q2: tolerance  Q3: withdrawal  Q4: loss of control  Q5: attempts at reduction  Q6: time seeking and recovering  Q7: salience  Q9: salience  Q11: salience. Timeframe :: Unspecified - 'ever' is implied. Scoring :: The first item establishes the quantity and frequency of use of the primary substance of misuse. Two items, Q8 & Q10, ask about health problems and 'set up' the subsequent questions Q9 & Q11. Responses to the remaining eight dependence items are in Yes/No format - max score 8. Completion time :: Unspecified but brief. Cut-off score :: The cut off score to distinguish people with and without DSM dependence criteria is a total score >=3 on items 2-7, 9 & 11. The sensitivity and specificity of the scale for detecting dependence are very high. 


SDSS :: Substance Dependence Severity Scale  designed for detailed rater assessment of dependence

The SDSS is a semi-structured clinical interview consisting of substance specific severity scales with items keyed to every criterion of DSM-IV dependence and abuse. Ratings are repeated for each substance of interest. For substances having a withdrawal syndrome there are 11 items and for those without withdrawal 8 items. As the scale is rater scored there is scope for flexibility - raters need to be trained. Timeframe :: The last 30days. Scoring :: For each substance there are 11 items (if there is a withdrawal syndrome) 8 items (if no withdrawal). SDSS scores frequency, 0-7, and severity of symptoms, 0-5, for each item and for each substance. Completion time :: The completion time is very variable depending on the number of drugs and the depth of drug involvement but is of the order 25-45minutes. which cover DSM4 criteria for dependence. Cut-off score :: A dependence diagnosis is met when three or more symptoms are coded >=2. The scale also produces a much more sophisticated set of scores: each item is divided into 'typical' and 'worst' categories for frequency and severity creating four scores for each substance.