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A core criterion for Chronic Fatigue Syndrome (CFS) and Myalgic Encephalomyelitis (ME) is a substantial reduction in functioning from pre-illness levels. Despite its ubiquity in diagnostic criteria, there is considerable debate regarding how to measure this domain. The current study assesses five distinct methods for measuring substantial reductions. The analysis used an international, aggregated dataset of patients (N = 2,368) and controls (N=359) to compare the effectiveness of each method. Four methods involved sophisticated analytic approaches using the Medical Outcomes Survey Short Form-36; the fifth method included a single self-report item on the DePaul Symptom Questionnaire (DSQ). Our main finding was that all methods produced comparable results, though the DSQ item was the most valid in differentiating patients from controls. Having a simple, reliable method to capture a substantial reduction in functioning has considerable advantages for patients and health care workers.

and recovery have focused on the proximal factors immediately preceding or most directly linked to substance use behaviors, and have tended to clinical, linear, and person-centered in nature. When distal causes have been investigated, they used these broader concepts to explain drug and alcohol use more generally, rather than in application to a specific drug-using group (i.e. heroin users). Yet, when using a distal lens, the causes of individual drug use can become more difficult to establish, particularly as one considers such issues as economic inequality and stigma [10]. Further, the research on substance use and, more specifically heroin abuse, has not reduced the number of heroin users, or heroin-related deaths in the United States. Thus, it is possible that a different approach is needed, using a more contextual perspective, to delineate the functions by which individuals sustain abstinence, and multidisciplinary approaches provide researchers with the tools to consolidate contextual theoretical approaches. Theories describe, explain, and predict phenomena. Most frequently, theories are used to describe a phenomenon, and this first effort at description can then be used to explain why the phenomenon occurs, allowing for possible inferential predictions. Good theories also provide guidance about under which circumstances and conditions a given set of propositions apply [11]. In terms of the field of sociology, macro-level theories focus on society-or group-level causes and processes, and this in in contrast to micro-level theories which address individual-level processes [12]. There is a need to incorporate more of these macro-level approaches in the study of heroin addiction. As such, this article aims to assess the usefulness of three established theories in