Meta‐analysis of self‐reported substance use compared with laboratory substance assay in general adult mental health settings

Abstract

An accurate assessment of substance use is necessary to make a correct psychiatric diagnosis and to provide appropriate treatment. This study uses meta-analysis to establish the strength of the association between self-reported substance use and the results of laboratory substance assay including the testing for specific substances and screening for any substance use in psychiatric hospitals and in community mental health settings. A systematic search for published studies was supplemented by additional data required for meta-analysis provided by several researchers in this field. Using random-effects meta-analysis, we calculated the pooled estimate of the odds ratio of a positive substance assay in patients reporting use or non-use of substances and estimated the sensitivity, specificity, positive predictive value and negative predictive value. Twenty-six studies met the inclusion criteria. Very strong associations were found between self-reported use and positive tests for cannabis [N = 11 studies, odds ratio (OR) = 22.3; 95% confidence interval (CI) = 10.1-49.1], amphetamines (N = 8, OR = 26.6; 95% CI = 7.9-88.9), cocaine (N = 8, OR = 39.7; 95% CI = 16.2-97.2) and opiates (N = 7, OR = 83.5; 95% CI = 26.7-260.7). Strong associations were found between self-reported use of any substance and positive substance screening (N = 15, OR = 7.2, 95% CI = 3.6-14.1) and tests for alcohol use (N = 5, OR = 8.5; 95% CI = 2.5-28.4). Screening for any substance use had a sensitivity of 61% and a specificity of 66%. Testing for individual substances was specific but lacked sensitivity. Screening has the potential to detect clinically relevant substances that would not be reported by the patient, whereas testing for a specific substance has little advantage over self-report. The sensitivity of the substance assay might be improved by obtaining a sample at the earliest opportunity. Consideration should be given to the increased use of substance screening in general adult mental health settings because it could improve the accuracy of psychiatric diagnosis and increase the likelihood of patients receiving treatment for substance use disorders.

Practice effects on the modified Concept Shifting Task (mCST): A convenient assessment for treatment effects on prefrontal cognitive function

“…Typically, in clinical research, a large number of studies located for a purpose of meta-analysis (for instance, N >2000) is drastically reduced to N < 10 mainly due to the inability to extract adequate information from such sources. Thus, it is not uncommon to perform meta-analysis on as few as five primary studies [for example, see [13]]. Secondly, even though not reported here, the results of the fixed-effect meta-analysis conducted on the current five studies produced the same results as the random-effects model in terms of similar mean weighted effect sizes, 95%CI s and p -values.…”

Developing an Integrated Violence Prevention for Men and Women in Treatment for Substance Use Disorders

“…Data collected in this trial relied on retrospective self-report, which may be subject to recall and demand biases, although prior work supports the reliability and validity of patients’ self-reports of substance use (Chermack, Roll, et al, 2000; Large et al, 2012). The inclusion criteria used for this pilot may have been too liberal (e.g., past-year violence), resulting in a floor effect (~50% of the sample did not report violence in the 6 months prior to baseline) and insufficient power to detect intervention effects over a relatively short follow-up period.…”

Distal and proximal factors associated with aggression towards partners and non-partners among patients in substance abuse treatment

“…Moreover, evidence suggests that individuals in SUD treatment may provide more accurate reporting of aggression than community-based, representative, or forensic samples (Panuzio et al, 2006). There is also evidence to support the accuracy of self-reported substance use in research studies and among those new to SUD treatment (Chermack, Roll, et al, 2000; Chermack, Singer, & Beresford, 1998; Darke, 1998; Desmarais, Van Dorn, Sellers, Young, & Swartz, 2012; Large et al, 2012). Fifth, this study did not include comprehensive measures of psychological disorders (e.g.…”