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The Severity of Dependence Scale (SDS) in An Adolescent Population of Cannabis Users: Reliability, Validity and Diagnostic Cut Off
The Severity of Dependence Scale (SDS) in An Adolescent Population of Cannabis Users: Reliability, Validity and Diagnostic Cut Off
The Severity of Dependence Scale (SDS) in An Adolescent Population of Cannabis Users: Reliability, Validity and Diagnostic Cut Off
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Cannabis use and brief intervention with young people View project
Systematic Literature Review and Meta Analysis of Medication Error-Related Harms in Paediatrics View project
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Abstract
The Severity of Dependence Scale (SDS) is a five-item scale that has been reported to be a reliable and valid screening instrument for dependence
and a measure of dependence severity in adults across several substance classes. To date no data have been reported on its performance in a population
of adolescent cannabis users. The current study assessed the psychometric properties of the SDS in a community sample of 14–18-year-old adolescent
cannabis users (n = 100). Internal consistency (α = 0.83) and test–retest coefficients (ICC = 0.88) were high and a principal components analysis of
the scale found all items to load on a single factor. Total SDS score correlated significantly with frequency of cannabis use and number of DSM-IV
dependence criteria met, indicating good concurrent validity. Receiver Operating Characteristic curve analysis was used to determine the most
appropriate SDS cut-off score for use as an indicator of cannabis dependence, with optimal discrimination at an SDS score of 4. These findings
indicate that the SDS is a reliable and valid measure of severity of cannabis dependence among adolescents, has high diagnostic utility, and that
an SDS score of 4 may be indicative of cannabis dependence.
© 2005 Elsevier Ireland Ltd. All rights reserved.
1. Introduction dence among young people (AIHW, 2005; Coffey et al., 2002)
it is important to have valid and reliable instruments for screen-
The Severity of Dependence Scale (SDS) was originally ing, assessment and outcome measurement appropriate to this
developed to provide a brief, easily administered measure of population.
the psychological aspects of dependence experienced by users It is not necessarily the case that adult assessment instru-
of various types of illicit drugs (Gossop et al., 1995). The SDS is ments can be generalised to an adolescent population. Different
a measure of compulsive use; its five items relate to an individ- developmental stages, patterns of use, family and peer issues,
ual’s preoccupation and anxieties about their own drug taking, problem recognition and level of self-insight may influence an
and feelings of impaired control over their drug use. instrument’s psychometric properties (Winters, 2003; Leccese
The psychometric properties of the SDS have been well and Waldron, 1994). The aims of the current study were to
established in adult populations of illicit drug and alcohol users assess the reliability and validity of the SDS within a popu-
(Gossop et al., 1995, 1997, 2002; Ferri et al., 2000), and empir- lation of young cannabis users, and determine the optimal SDS
ically derived cut-off scores indicative of substance dependence cut-off score indicative of a DSM-IV diagnosis of cannabis
have been reported for amphetamine, cocaine, benzodiazepine dependence.
and cannabis use in adults (Topp and Mattick, 1997; Kaye and
Darke, 2002; De La Cuevas et al., 2000; Swift et al., 1998). 2. Method
To date, however, no data have been reported on the perfor-
mance of the SDS in a population of adolescent cannabis users. 2.1. Participants
Given the high prevalence of cannabis use and cannabis depen-
A convenience sample of 100 young people was recruited.
To meet inclusion criteria participants were required to be aged
∗ Corresponding author. Tel.: +61 2 93850260; fax: +61 2 93850222. 14–18 years, and to have used cannabis at least once in the past
E-mail address: g.martin@unsw.edu.au (G. Martin). 90 days. Although using a sample of convenience, recruitment
0376-8716/$ – see front matter © 2005 Elsevier Ireland Ltd. All rights reserved.
doi:10.1016/j.drugalcdep.2005.10.014
G. Martin et al. / Drug and Alcohol Dependence 83 (2006) 90–93 91
processes ensured that it was stratified with regard to age, gender, test–retest reliability via the intraclass correlation coefficient
and frequency of cannabis use. Participants were recruited from (ICC) of total SDS score at time 1 and time 2, and individual
tertiary education institutions and local youth centres. Further item ICCs between the two time points. A Receiver Operat-
recruitment came via word-of-mouth, fliers, and advertisement ing Characteristic (ROC) analysis was used to determine the
on community radio. optimal SDS cut-off score for distinguishing between cannabis
dependence and non-dependence. This analysis compared the
2.2. Materials performance of the SDS against the “gold standard” measure
of DSM-IV cannabis dependence obtained from the CIDI. The
Participants completed two interviews approximately 1 week ROC curve demonstrates the relationship between sensitivity
apart. During both interviews the SDS was administered for the (the proportion of true positives) and specificity (proportion of
period of the last 3 months. true-negatives) across the full range of SDS values. Chi-square
The SDS items adapted for cannabis are: values were obtained for each score to determine which provided
the best balance between sensitivity and specificity, as indicated
1. Did you ever think your use of cannabis was out of control? by the largest χ2 -value.
2. Did the prospect of missing a smoke make you very anxious
or worried? 3. Results
3. Did you worry about your use of cannabis?
4. Did you wish you could stop? 3.1. Participants
5. How difficult would you find it to stop or go without
cannabis? Participants were 100 young people aged 14–18 with a mean
age of 16.1 years (S.D. 1.1). The sample was almost evenly
Each item is scored on a four-point scale: for items 1, 2, 4 divided by gender with 46% females. The majority (95%) were
(0 = never or almost never; 1 = sometimes; 2 = often; 3 = always non-indigenous Australians. The mean age of first cannabis use
or nearly always), item 3 (0 = not at all; 1 = a little; 2 = quite a lot; was 13.7 years (S.D. 1.4; range 10–18). Frequency of use varied
3 = a great deal) and item 5 (0 = not difficult; 1 = quite difficult; widely with 31% of the sample reporting daily use; 35% report-
2 = very difficult; 3 = impossible). Item scores are added to give ing more than weekly but less than daily use; 8% reporting less
a total SDS score, which can range from 0 to 15. The first inter- than weekly but more than monthly use; and 25% using less than
view also included questions relating to participant demographic monthly. The mean number of days on which cannabis was used
information, quantity and frequency of cannabis use, age of initi- in the past 90 days was 33.7 (S.D. 33.4; range 1–90).
ation of cannabis use, and other drug use. DSM-IV diagnoses of Just under half of the sample (45%) met DSM-IV criteria for
cannabis abuse and dependence were obtained using the Com- cannabis dependence. The total sample mean number of depen-
posite International Diagnostic Interview (CIDI) (World Health dence symptoms was 2.8 (S.D. 2.4; range 0–7).
Organisation, 1997). The second interview involved a repeat The range of number of dependence symptoms was: 23%
administration of the SDS. reported no symptoms; 32% reported one to two symptoms;
25% reported three to five symptoms; and 20% reported six or
2.3. Procedure seven symptoms. Of the total sample, 14% met cannabis abuse
criteria and 18% reported one or two dependence symptoms
Ethical approval to conduct the study was granted by the but did not report any abuse symptoms, leaving them “diagnos-
University of New South Wales Human Research Ethics Com- tic orphans” (Deas et al., 2005). Mean Severity of Dependence
mittee. A waiver of parental consent was obtained to ensure Scale score was 3.4 (S.D. 3.7; range 0–15) with a median of 2.
participant confidentiality. At the initial interview participants The distribution of SDS scores was positively skewed with 21%
provided written informed consent. Interviewers were two social of participants scoring zero.
science graduates trained in the use of the CIDI and the current
protocol. The two interviews were conducted a mean of 6.85 3.2. Reliability
(S.D. 1.93; range 5–14) days apart, in most cases by the same
interviewer. On completion of the second interview participants The internal consistency of the SDS was good with a Cron-
were given two movie vouchers. bach’s alpha of 0.83. Test–retest reliability (as measured by
intraclass correlation coefficient) between time 1 and time 2
2.4. Data analysis for total SDS score was 0.88. Individual items ICCs compared
between the two time points ranged from 0.69 to 0.85 (see
The analyses were performed using SPSS for Windows (Ver- Table 1).
sion 12.0.1). Means are reported for normally distributed contin-
uous data, and categorical variables are described in percentages. 3.3. Validity
The data from the first administration of the SDS were anal-
ysed by principal components analysis (PCA) to assess the The construct validity of the scale was assessed by principal
dimensionality and construct validity of the scale. Internal con- components analysis. As expected, the PCA of the five SDS
sistency of the scale was assessed by Chronbach’s alpha; and items revealed a single factor, which accounted for 60% of the
92 G. Martin et al. / Drug and Alcohol Dependence 83 (2006) 90–93
Table 1 Table 2
Severity of Dependence Scale: principal components analysis factor loadings Sensitivity, specificity and χ2 -values of the SDS at each cut-off point when
and test–retest intraclass correlation coefficients discriminating between adolescent cannabis users with and without DSM-IV
cannabis dependence diagnoses
Item Factor loading Intraclass correlation
coefficient SDS score Sensitivity (%) Specificity (%) Chi-square