Reconceptualizing Dependence Severity in Project MATCH

描述（由申请人提供）：有酒精使用问题的个人代表了一个异质性群体，其变量与分类和治疗有关。如果不能解释这种异质性，预计会影响治疗结局和匹配效应。考虑到这一点，Project MATCH根据酒精类型、酒精严重程度、精神病严重程度和酒精依赖假设了几种治疗匹配关系，但发现客户异质性的影响有限。然而，现有的MATCH项目数据检查可能没有完全表征酒精依赖严重程度的性质，因为这些分析通常将依赖严重程度作为与DSM-IV中所述的诊断策略类似的附加症状计数进行检查。我们建议检查依赖的严重程度作为一个潜在的特质假设有一个特征的发展进程，这种概念化可能会导致一个维度，可能代表一个重要的来源，在治疗反应和结果的方差，直接和其他重要的类型变量的主持人。我们试图确定显着的标志物依赖严重程度在这个假定的发展连续使用项目反应理论（IRT）的技术，并检查这种方法的影响，以严重程度缩放的项目匹配数据方面的治疗和治疗匹配的结果。 具体而言，本项目旨在（1）使用IRT建立理论上可能反映酒精中毒发展过程中里程碑的标度严重性标记;（2）测试跨性别和种族背景的标度连续体的普遍性;和（3）规模项目匹配参与者的基础上，他们的经验适合与（traitedness）和他们的位置（严重性）这一确定的潜在的严重性特质，然后使用这些信息来重新检查治疗效果和匹配的假设，该项目的核心。

DESCRIPTION (provided by applicant): Individuals with alcohol use problems represent a heterogeneous group with respect to variables relevant to classification and treatment. Failure to account for this heterogeneity would be expected to compromise treatment outcome and matching effects. With this in mind, Project MATCH hypothesized several treatment matching relationships based on alcoholic type, alcohol severity, psychiatric severity, and alcohol dependence, but found limited effects of client heterogeneity. However, it is possible that the existing examinations of Project MATCH data have not fully characterized the nature of severity of alcohol dependence, as these analyses have typically examined dependence severity as an additive symptom count similar to the diagnostic strategy represented in the DSM-IV. We propose to examine dependence severity as a latent trait hypothesized to have a characteristic developmental progression, and that this conceptualization may result in a dimension that may represent an important source of variance in treatment response and outcome, both directly and as a moderator of other important typological variables. We seek to identify salient markers of dependence severity on this putative developmental continuum using techniques of Item Response Theory (IRT), and examine the implications of this approach to severity scaling in the Project MATCH data with respect to its effect on treatment and treatment matching outcomes. Specifically, this project seeks to (1) use IRT to establish scaled severity markers that may theoretically reflect milestones in the developmental course of alcoholism; (2) test the generalizability of the scaled continuum across gender and ethnic background; and (3) scale Project MATCH participants based upon their empirical fit with (traitedness) and their placement on (severity) this identified latent severity trait, and then use this information to re-examine the treatment effects and matching hypotheses central to that project.