Reconceptualizing Dependence Severity in Project MATCH

描述（由申请人提供）：与分类和治疗相关的变量方面，有酒精使用问题的个体代表了一个异质群体。如果不能解释这种异质性，预计会影响治疗结果和匹配效果。考虑到这一点，MATCH项目假设了几种基于酒精类型、酒精严重程度、精神严重程度和酒精依赖的治疗匹配关系，但发现客户异质性的影响有限。然而，MATCH项目数据的现有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一种附加症状计数进行检查，类似于DSM-IV中所代表的诊断策略。我们建议将依赖严重程度作为一种潜在的特质来研究，假设其具有特征性的发展进程，并且这种概念化可能导致一个维度，该维度可能代表治疗反应和结果的重要方差来源，既直接也作为其他重要类型变量的调节因子。我们试图利用项目反应理论（IRT）的技术，在这个假定的发展连续体上识别依赖严重程度的显著标记，并研究这种方法对MATCH项目数据中严重程度量表的含义，以及它对治疗和治疗匹配结果的影响。

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.