New test for drug and alcohol addiction focuses solely on time of heaviest use

A new survey can quickly test for addiction to cocaine, heroin and alcohol simply by asking about the time in the person’s life when he or she was drinking or using these substances the most, according to a study by Rockefeller University researchers.

In the five-minute survey, only three answers influence the patient’s score: the duration of the heaviest period of use, the frequency of use during that time, and the amount typically consumed at one sitting during that time.

While most other brief tests for drug or alcohol addiction ask about the negative consequences of substance abuse, such as neglect of work or family responsibilities, the Rockefeller University survey is the first to focus solely on the intensity of alcohol or substance use, an important contributor to addiction.

During relatively heavy substance abuse, the brain may undergo key changes that lead to and strengthen the addiction, said Scott Kellogg, Ph.D., clinical psychologist at The Rockefeller University, and first author of the study published in the latest issue of the journal Drug and Alcohol Dependence.

“A growing body of evidence is showing that as a person becomes addicted, fundamental physiological changes take place in that person’s brain, and that in research animals an intense enough period of heavy exposure to drugs or alcohol will cause such changes,” Kellogg explained. “That’s why asking about exposure is so important in trying to gauge addiction.”

Although the survey was developed as a research tool, emergency rooms and clinics may eventually use it to test for addiction, Kellogg said, because it takes a different approach than other brief tests, and therefore could spot a subset of addicted people missed by the other tests.

“This scale identifies a history of addiction at least as well as other brief tests that already exist,” Kellogg said. “And we hope researchers and clinicians will find it a welcome addition to their collection of addiction tests.”

Brief addiction tests mainly serve as screening tools, and they cannot give an official diagnosis of addiction, he said. If a brief test suggests that a person is or has been addicted, the doctor or clinician would want to follow-up with a clinical evaluation before making a formal diagnosis of drug or alcohol dependence.

Kellogg is part of the research team in the university’s Laboratory of Biology of Addictive Diseases, which is headed by Mary Jeanne Kreek, M.D., who is also a Senior Physician at The Rockefeller University Hospital. Kreek’s lab has spent more than three decades studying how drugs and alcohol affect the brain at the molecular and cellular level.

The new survey, called the Kreek-McHugh-Schluger-Kellogg (KMSK) scale, asks six to eight questions about the individual’s heaviest period of use of four different substances: alcohol, tobacco, cocaine, and heroin/opiates.

To study the effectiveness of the scale, Kellogg, Kreek, and their colleagues compared it with the SCID-1, the lengthy and labor-intensive “gold standard” test that psychiatric and addiction researchers use to make formal diagnoses. They recruited 100 volunteers, both with and without alcohol and substance use histories, and gave each of them the SCID-1 and the KMSK scale for all four substances.

The results showed that the KMSK scale was very accurate at predicting whether or not an individual had been addicted to either heroin/opiates or cocaine, Kellogg said. The screen could detect 100 percent of the heroin/opiate addicts, and 97 percent of the cocaine addicts. These results are as good as, or better than other brief tests already in use, he said.

For alcohol, the KMSK scale could detect 90 percent of people who met the formal diagnosis of alcohol addiction. However, the alcohol test was slightly more likely than the other two to give a false positive result, meaning it sometimes identified a person as an alcoholic when the individual did not meet the formal criteria, Kellogg said.

The higher rate of “false positives” is probably caused by the complexity of alcoholism, rather than any problem with the design of the test, Kellogg explained. Many factors besides exposure may affect a person’s risk of alcoholism, including genetic background, abuse of other substances, and psychiatric or psychological problems.

“From a clinical perspective, having an occasional false positive result is not a terrible thing. In this case, it means that we have uncovered individuals with histories of high levels of alcohol use who did not experience major negative consequences of their drinking. However, they are at risk of developing them in the future, so one would want to counsel these drinkers about reducing or eliminating their alcohol use,” he noted.

The KMSK scale may prove helpful to clinicians and other scientists who study addiction, especially those who focus on the link between exposure to drugs or alcohol and dependence, Kellogg said. It may also aid research on other diseases. “It could be used in studies of other conditions where drug or alcohol use can be a factor, such as heart disease,” he said.

Kellogg and his colleagues are planning to create similar tests for barbiturates (sleeping pills), benzodiazepines (sedatives), and marijuana. “We’re especially interested in developing a scale for marijuana, because we have less evidence about how different levels of use relate to addiction,” Kellogg said. “We’re also interested to discover whether a high or low score on the KMSK scale can predict an addicted individual’s response to treatment,” he said.

Co-authors on the study included Clinical Scholar Pauline McHugh; research nurse Kathy Bell; physician-scientist James Schluger, M.D.; research nurse Rosemary Schluger; molecular biologist K. Steven LaForge; and experimental psychologist Ann Ho, Ph.D.

The study was supported by a P-60 Center grant and other grants from the National Institute on Drug Abuse and the NIH Center for Research Resources.

>Founded by John D. Rockefeller in 1901, The Rockefeller University was this nation’s first biomedical research university. Today it is internationally renowned for research and graduate education in the biomedical sciences, chemistry, bioinformatics and physics. A total of 22 scientists associated with the university have received the Nobel Prize in medicine and physiology or chemistry, 18 Rockefeller scientists have received Lasker Awards, five have been named MacArthur Fellows, and 11 have garnered the National Medal of Science. More than a third of the current faculty are elected members of the National Academy of Sciences.