1. Assessment of risky cannabis use and related consequences
Chair: Hugo López Pelayo, Spain
− Definitions of risky and problematic cannabis use: a systematic review.
Cristina Casajuana, Spain
− Assessment of cannabis use disorders: a systematic review of screening and diagnostic instruments.
Hugo López-Pelayo, Spain
− Standard Joint Unit as a tool for assessing risky cannabis use.
Antoni Gual, Spain
− Weighting the evidence: a systematic review on long-term neurocognitive effects of cannabis use in abstinent adolescents and adults.
Florian Ganzer, Germany
− Discussant: Mercè Balcells, Spain

2. López-Pelayo H, Batalla A, Balcells MM, Colom J, Gual A
Assessment of cannabis use disorders: a systematic review of screening and diagnostic instruments
López-Pelayo H, Batalla A, Balcells MM, Colom J, Gual A

3. There is no conflict of interest related to this presentation

4. Menu Introduction Method: systematic review Results
Conclusions & Next Steps

5. Menu Introduction Method: systematic review Results
Conclusions & Next Steps

6. Cannabis related problems are not just Cannabis Dependence or Addiction
Addiction: “A set of physiological, behavioral and cognitive manifestations in which the consumption of cannabis acquires the highest priority for the individual, even greater than any other type of behavior of those which had the highest value in the past ” (WHO ICD-10)

7. Cannabis related problems are not just Cannabis Dependence or Addiction
Hazardous Use: “A pattern of substance use that increases the risk of harmful consequences for the user. Some would limit the consequences to physical and mental health (as in harmful use); some would also include social consequences. In contrast to harmful use, hazardous use refers to patterns of use that are of public health significance despite the absence of any current disorder in the individual user” (WHO)”
e.g. Hazardous alcohol use: 60 g of alcohol/day for a man and 40 g/day for a woman
Gual A, López-Pelayo H, Reynolds J and Anderson P (2016) Editorial: Brief Interventions for Risky Drinkers. Front. Psychiatry 7:42. doi: /fpsyt

8. Cannabis related problems are not just Cannabis Dependence or Addiction
Cardiovascular disorders including myocardial infarction
Educational attainment
Cognitive impairment and psychiatric disorders: psychosis, anxiety and affective
Chronic
Bronchitis
&
Respiratory Cancers
The adverse health effects of chronic cannabis use. Wayne Hall and Louisa Degenhardt Drug Test. Analysis 2014, 6, 39–45

9. Why should we use screening and diagnostic instruments?
Early identification allows early intervention in early stage of the problem = Identify hazardous users

10. Which characteristics are important for a screening and diagnostic instrument?
Reliability
Validity
Adaptability to different consumption patterns
Applicability to daily practice
Shortness
Clarity
Usability in different settings and population
Reliability in statistics and psychometrics is the overall consistency of a measure.[1] A measure is said to have a high reliability if it produces similar results under consistent conditions. "It is the characteristic of a set of test scores that relates to the amount of random error from the measurement process that might be embedded in the scores. Scores that are highly reliable are accurate, reproducible, and consistent from one testing occasion to another. That is, if the testing process were repeated with a group of test takers, essentially the same results would be obtained. Various kinds of reliability coefficients, with values ranging between 0.00 (much error) and 1.00 (no error), are usually used to indicate the amount of error in the scores.“
Inter-rater reliability assesses the degree of agreement between two or more raters in their appraisals.
Test-retest reliability assesses the degree to which test scores are consistent from one test administration to the next. Measurements are gathered from a single rater who uses the same methods or instruments and the same testing conditions.[4] This includes intra-rater reliability.
Inter-method reliability assesses the degree to which test scores are consistent when there is a variation in the methods or instruments used. This allows inter-rater reliability to be ruled out. When dealing with forms, it may be termed parallel-forms reliability.[5]
Internal consistency reliability, assesses the consistency of results across items within a test.[5]
the degree to which evidence and theory support the interpretations of test scores" ("as entailed by proposed uses of tests").[2]
It is generally accepted that the concept of scientific validity addresses the nature of reality and as such is an epistemological and philosophical issue as well as a question of measurement. The use of the term in logic is narrower, relating to the truth of inferences made from premises.
Validity is important because it can help determine what types of tests to use, and help to make sure researchers are using methods that are not only ethical, and cost-effective, but also a method that truly measures the idea or construct in question.
Piontek D, Kraus L, Klempova D (2008). Short scales to assess cannabis-related problems: a review of psychometric
properties. Substance Abuse Treatment Prevention and Policy 3, 25.
Tiet QQ, Finney JW, Moos RH (2008). Screening psychiatric patients for illicit drug use disorders and problems. Clinical
Psychology Review 28, 578–591.

11. One example of a good instrument for AUD
From Hazardous Use through Quantity and Frequency
To Dependence or Abuse through signs and symptoms

12. Menu Introduction Method: systematic review Results
Conclusions & Next Steps

13. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart detailing study selection

14. Menu Introduction Method: systematic review Results
Conclusions & Next Steps

15. Good psychometric properties Many instruments
reliability and validity
Good psychometric properties
Many instruments
6 specified scales for CUD
4 scales for SUD (including cannabis)
7 structured interviews
8 tools to quantify consumption and other methods
López-Pelayo H, Batalla A, Balcells MM, Colom J, Gual A, (2014). Assessment of cannabis use disorders: a systematic review of screening and diagnostic instruments. Psychol. Med. 1–13.

16. Good psychometric properties Many instruments
6 specified scales for CUD
4 scales for SUD (including cannabis)
7 structured interviews
8 tools to quantify consumption and other methods
Cannabis Problem Questionnaire (CPQ)
Cannabis Abuse Screening Test (CAST)
Cannabis Use Disorder Identification Test (CUDIT)
Marijuana Screening Inventory (MSI-X)
Marijuana Problem Scale (MPS)
Risk and Consequences Questionnaire-Marijuana (RCQ-M)
López-Pelayo H, Batalla A, Balcells MM, Colom J, Gual A, (2014). Assessment of cannabis use disorders: a systematic review of screening and diagnostic instruments. Psychol. Med. 1–13.

17. Good psychometric properties Many instruments
6 specified scales for CUD
4 scales for SUD (including cannabis)
7 structured interviews
8 tools to quantify consumption and other methods
Alcohol, Smoking and Substance Involvement Screening Test (ASSIST)
Severity Dependence Scale (SDS)
Drug Use Disorder Identification Test (DUDIT)
Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT)
López-Pelayo H, Batalla A, Balcells MM, Colom J, Gual A, (2014). Assessment of cannabis use disorders: a systematic review of screening and diagnostic instruments. Psychol. Med. 1–13.

18. Good psychometric properties Many instruments
6 specified scales for CUD
4 scales for SUD (including cannabis)
7 structured interviews
8 tools to quantify consumption and other methods
Child and Adolescent Psychiatric Assessment (CAPA-C)
Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A)
Drug Use History Form (DUHF)
Psychiatric Research Interview for Substance and Mental Disorders (PRISM)
MINI
AUDADIS
SCID
López-Pelayo H, Batalla A, Balcells MM, Colom J, Gual A, (2014). Assessment of cannabis use disorders: a systematic review of screening and diagnostic instruments. Psychol. Med. 1–13.

19. Good psychometric properties Many instruments
6 specified scales for CUD
4 scales for SUD (including cannabis)
7 structured interviews
8 tools to quantify consumption and other methods
TLFB
López-Pelayo H, Batalla A, Balcells MM, Colom J, Gual A, (2014). Assessment of cannabis use disorders: a systematic review of screening and diagnostic instruments. Psychol. Med. 1–13.

20. Limitations Too long e.g. MSI-X 31 items or CPQ-A 21 items
Not appropriate timeframe
e.g. too short < 12 months
Limited data for different population:
Gender
Age (adolescents/elderly)
Psychiatric patients
Partial data about validity
sometimes only internal validity
sometimes only external validity
In scientific research, internal validity is the extent to which a causal conclusion based on a study is warranted, which is determined by the degree to which a study minimizes systematic error (or 'bias'). It contrasts with external validity, the degree to which it is warranted to generalize results to other contexts.

21. Limitations
Gold standard: abuse or dependence. No data for at-risk or low validity in this population.
Regular, risky and hazardous use worked as synonyms
Do not consider quantity (dose and potency) and frequency

22. Menu Introduction Method: systematic review Results
Conclusions & Next Steps

23. Conclusions
Current instruments are not useful for early identification of hazardous users (quantity/frequency are lacking)
Several dimensions of cannabis related problems are not assessed:
Cognitive impairment
Social/Educational impairment
Respiratory or cardiovascular consequences

24. Next Steps for early identification & intervention
We need instruments also based on hazardous cannabis use
Hazardous cannabis use should be based on frequency and quantity and related to the consequences of the consumption pattern in all dimensions (physical, psychological and social)