Outcome Measure
Drug Use Disorders Identification Test
What it measures?
- The Drug Use Disorders Identification Test (DUDIT) is an 11-item self-report assessment measure which helps to identify individuals experiencing drug-related problems within the last year.
- The DUDIT can be used to screen for current use of or dependence on illicit drugs, or abuse of prescription drugs, as according to diagnoses of substance abuse/dependence in the DSM-IV and ICD-10.
- The DUDIT was designed as a parallel to the Alcohol Use Disorders Identification Test (AUDIT; Saunders et al., 1993), which can be used in conjunction with the DUDIT to screen for problems with alcohol.
Who is it for?
* The DUDIT has been used for people 16 years and older (Berman et al., 2005) * While the DUDIT is useful for initial identification of drug-related problems, the instrument developers recommend use of a more in-depth instrument, the DUDIT-E (Berman et al., 2003)
Instrument Quality
- The DUDIT has been found to have good reliability and validity as a clinical or research tool, with strong internal consistency and favourable sensitivity and specificity in regards to identifying drug-related problems in a variety of populations (Hildebrand, 2015)
Structure
- 11 items
- Items 1 to 9 are a 5-point Likert scale, scored from 0 to 4; Items 10 and 11 are a 3-point Likert scale, scored 0, 2 or 4
- Respondents are asked about their behaviours, emotions and social interactions involving drug use over the past year
Scoring instructions
- Sum up the points from each item. The result is the DUDIT score.
| Subscale | Item number |
|---|---|
Full-scale (DUDIT) |
1,2,3,4,5,6,7,8,9,10,11 |
Score Interpretation
What higher scores mean?
- A higher score indicates a higher likelihood of harmful use of drugs or substance dependence. Scores can range between 0 and 44. In a normative population where drug use is assumed to be less common, a DUDIT score of 2 for women and 6 for men can indicate drug-related problems. In a clinical population where drug use is assumed to be more common, a DUDIT score of 25 or more is likely to indicate substance abuse or dependence.
How to assess symptom severity & change?
| Description | Score Range | |
|---|---|---|
| Normal | 0 | |
| Harmful drug use (female) | 2 | |
| Substance Use Disorder | >=25 | Provisional Diagnosis |
| Harmful drug use (male) | 6 | |
| Clinical drug dependence | 25 | |
| Maximum | 44 |
Instrument developers
- Berman, A. H., Bergman, H., Palmstierna, T., & Schlyter, F. (2005). Evaluation of the Drug Use Disorders Identification Test (DUDIT) in Criminal Justice and Detoxification Settings and in a Swedish Population Sample. European Addiction Research, 11(1), 22–31. https://doi.org/10.1159/000081413
Refrences
* Berman, A. H., Bergman, H., Palmstierna, T., & Schlyter, F. (2003). DUDIT: The Drug Use Disorders Identification Test Manual Version 1.0. Karolinska Institute Department of Clinical Neuroscience; 2003. * Berman, A. H., Bergman, H., Palmstierna, T., & Schlyter, F. (2005). Evaluation of the Drug Use Disorders Identification Test (DUDIT) in Criminal Justice and Detoxification Settings and in a Swedish Population Sample. European Addiction Research, 11(1), 22–31. https://doi.org/10.1159/000081413 * Grigg, J., Volpe, I., Tyler, J., Hall, K., McPherson, B., Lubman, D. I., & Manning, V. (2021). Ready2Change: Preliminary effectiveness of a telephone‐delivered intervention program for alcohol, methamphetamine and cannabis use problems. Drug and Alcohol Review. https://doi.org/10.1111/dar.13363 * Hildebrand, M. (2015). The Psychometric Properties of the Drug Use Disorders Identification Test (DUDIT): A Review of Recent Research. Journal of Substance Abuse Treatment, 53, 52–59. https://doi.org/10.1016/j.jsat.2015.01.008
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Severity ranges
The DUDIT Manual (Berman et al., 2003) states that, in a low-prevalence group where drug use is not expected, a DUDIT score of 2 for women and 6 for men indicates probable “risky or harmful drug habits that might be diagnosed as substance abuse/harmful use or dependence”; however, “These numbers are preliminary but can be used as guidelines until more data are available.” It appears as if there has yet to be additional published data with a similarly large normative sample. In a high-prevalence group, where drug use is expected (e.g. prison inmates, rehabilitation programs), a DUDIT score of 25 will indicate drug dependence diagnoses in accordance with DSM-IV and ICD-10: “In our drug user sample the DUDIT accurately predicted dependence on multiple drugs with a cut-off score of 25” (Berman & Palmstierna, 2005). Hildebrand (2015) highlights that selecting an appropriate DUDIT cut-off score depends on the screening purpose, and that it may be up to the clinician’s judgement to interpret the results appropriately.
Provisional diagnosis
A DUDIT score of 25 is indicative of diagnoses of drug dependence from both the International Classification of Diseases, Tenth Revision (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). For the ICD-10 diagnosis of harmful use and dependence syndrome, a score of 25 had sensitivity of 90%, and specificity of 88%; this means using 25 as a cut-off score will capture 90% of people presenting with dependence syndrome, and exclude 88% of people without dependence syndrome. For the DSM-IV diagnosis of substance abuse and dependence, a score of 25 had sensitivity of 90% and specificity of 78% (Berman et al., 2005) Additionally, Hildebrand’s (2015) review of research into the psychometric properties of the DUDIT found sensitivity values generally ranged from .85 to 1.00, and specificity values ranged from .75 to .92, in a variety of populations.
Reliable change and clinically significant improvement
* Berman & Palmstierna (2005) derived T-score equivalents for patient scores on the DUDIT, using a large sample derived from the general Swedish population. In men, a change of 3-points (from 0 to 3) was approximately equal to a change of 1 standard deviation unit. For women, a change of 1 point on the DUDIT (from 0 to 1) roughly equated to a 1 standard deviation unit change.The same authors also evaluated a clinical sample of N = 154 (128 men), drawn from in-patient drug detoxification units, and from prison and probation clients with known drug use. Here, the the mean DUDIT score was 32.2 (SD = 8.0) (Berman et al., 2005). On the basis on the above, we feel an 8-point change on the DUDIT (reflecting 1 standard deviation from the mean in a clinical sample) can be roughly used as a defensible rule of thumb for assessing reliable change. * Wampold et al (2001) conducted a meta-analysis of psychotherapy outcome studies and noted that the average improvement was reflected in an effect size (ES) of .80. Because a change of 1 SD corresponds to an ES of 1.0, and .80 is considered to be a large ES, Wise (2004) concludes that a change of 1 SD is a defensible indicator of clinically significant change. For other research evaluating change on the DUDIT, see Grigg and colleagues (2021), who measured the difference in DUDIT scores for a sample of clients experiencing substance use issues (n = 249, 128 male), before and after a series of telehealth sessions administering a cognitive and behavioural intervention. For clients experiencing problems with methamphetamine, there was a statistically significant mean difference in DUDIT scores of -17.3 (SD = 10.8, 95% CI = -20.9, -13.7). For clients experiencing problems with cannabis, there was a statistically significant mean difference of -15.9 (SD = 12.9, 95% CI = -22.3, -9.6). In this research 73% of methamphetamine users and 55% of cannabis users moved to a healthier DUDIT cutoff range.
Mean
Standard Deviation
Reliability