Effektivität von Screeningverfahren zur Identifizierung von Medikamentenabhängigkeit: Vergleich der Severity of Dependence Scale (SDS) und des Kurzfragebogens zu Medikamentenmissbrauch (KMM)

Objective Misuse and dependence on prescription drugs are prevalent disorders that are not adequately addressed by the addiction treatment system. Measures for early detection of these disorders might improve provision of services, however, validation studies on screening measures are scarce. Methods In a pro-active and unselected sample of 6,042 inpatients from 2 general hospitals in Luebeck, Germany, a screening was carried out using the short questionnaire on drug addiction and abuse (KMM) and the Severity of Dependence Scale. A standardized clinical diagnosis of drug-related disorders was carried out in screening-positive patients (n=226, 55,3% response rate) and in a randomized sub-sample of 334 screening-negative patients. Optimal cut-off values were identified for both screening tools and the clinical validity was investigated by means of ROC curves. Results Of 226 screening-positive patients, whose consumption of addictive medication according to the Anatomical Therapeutic Classification could be verified, 98 were diagnosed with a drug-related disorder. In the sub-sample of screening-negative patients, corresponding disorders were found in 2 patients. Both screening methods showed good sensitivity and specificity. Mere questionnaire data without checking the medication taken led to high rates of false positive results. Conclusions Prescription drug-related disorders can be identified economically and validly by questionnaire procedures if the type of medication is validated in a second step, followed by a clinical diagnostic procedure. The validity of screening procedures for prescription drug-related disorders without case-specific clinical validation is limited.