Drug Use Disorders Identification Test Extended – DUDIT-E

Abstract

The Drug Use Disorders Identification Test Extended – DUDIT-E is a comprehensive, self-report screening instrument developed to identify individuals with potential drug use disorders and assess their readiness for change. Extending the scope of the original DUDIT, the DUDIT-E incorporates detailed sections on the frequency of use across various substance categories, the perceived positive and negative consequences associated with drug use, and a critical component measuring the individual’s motivation to seek or engage in substance abuse treatment. Published in 2007, this instrument is designed to provide clinicians and researchers with a robust tool for both diagnostic screening and treatment planning, particularly within clinical or correctional settings.

Keywords

DUDIT-E, Drug Use Disorders, Substance Abuse, Screening Instrument, Motivational Index, Psychometrics, Self-Report, Addiction.

Authors

Anne H. Berman, Hans Bergman, Tom Palmstierna, Frans Schlyter.

Purpose

The primary purpose of the DUDIT-E is threefold: first, to accurately screen for the severity and potential presence of drug use disorders, building upon the established methodology of the original DUDIT; second, to gather detailed information regarding the pattern of use for a wide range of illicit and prescription substances; and third, to assess the respondent’s ambivalence, concerns, and readiness to change their drug use behavior. This third aspect is particularly crucial, as the inclusion of a comprehensive Motivational Index helps guide subsequent clinical interventions, aligning with motivational interviewing principles.

The instrument is specifically designed to be easily administered and scored, making it suitable for use in diverse clinical environments, including primary care, psychiatric services, and forensic settings, where rapid and reliable identification of substance use problems is necessary. The extended format allows for a deeper exploration of the functional aspects of drug use (both rewards and harms), which is invaluable for developing personalized treatment strategies.

Construct

The DUDIT-E measures a multi-faceted construct rooted in the diagnostic criteria for substance use disorders (as outlined in systems like the DSM and ICD) while integrating principles of the Transtheoretical Model of Change. The construct can be broadly divided into three core domains:

1. Frequency and Severity of Use: This domain assesses the pattern and quantity of use across ten different substance categories, contributing to a basic severity score.

2. Consequences of Use: This includes two sub-dimensions: perceived positive reinforcement (e.g., feeling relaxed, increased creativity) and negative consequences (e.g., legal issues, health deterioration, relational problems).

3. Readiness to Change (Motivational Index): This domain captures the individual’s current stage of change, including enjoyment of use, worry, desire for help, perceived difficulty of change, and efforts to prevent relapse. This aspect is key to the “Extended” nature of the DUDIT-E.

By combining these elements, the DUDIT-E provides a holistic view of the individual’s relationship with drugs, moving beyond simple identification to assessing clinical need and potential responsiveness to intervention.

Validity

The validity of the DUDIT-E, as documented in the foundational 2007 study by Berman et al., was rigorously examined. The instrument demonstrated strong concurrent validity, correlating significantly with established measures of drug dependence and related psychiatric distress. Furthermore, the DUDIT-E showed high levels of criterion validity, successfully differentiating between individuals diagnosed with drug dependence and non-dependent users in clinical populations.

The inclusion of separate sections detailing positive and negative consequences, alongside the motivational items, enhances its content validity, ensuring that the scale covers the full spectrum of behaviors and attitudes associated with problematic drug use, not just physiological dependence symptoms. The scale’s ability to predict treatment engagement, stemming from the Motivational Index, further supports its predictive validity in clinical settings.

Reliability

Psychometric evaluation confirms the high reliability of the DUDIT-E. The scale exhibits excellent internal consistency, particularly across the items measuring negative consequences and the core drug use frequency items. The 2007 validation study reported Cronbach’s alpha values indicating strong coherence among the scale items, confirming that they measure a unified underlying construct of drug use severity and associated problems.

While specific test-retest reliability data are often contextual, the structure of the DUDIT-E, utilizing clear frequency and consequence measures, suggests adequate stability over short periods, making it a reliable tool for initial screening and brief follow-up assessments. The reliability of the DUDIT-E ensures that scoring differences primarily reflect true variations in drug use behavior or motivational state, rather than measurement error.

Factor Analysis

Factor analysis performed on the DUDIT-E typically reveals a multi-dimensional structure, reflecting the instrument’s design. Unlike simpler screening tools that often yield a single factor of severity, the DUDIT-E structure separates core use patterns from psychological and motivational factors. Studies generally support the distinction between factors related to dependency symptoms (frequency and consequence items, similar to the original DUDIT) and the distinct factors forming the Motivational Index.

Specifically, the motivational items often load onto factors representing stages of change, such as “Precontemplation/Contemplation” (enjoyment, lack of worry) and “Preparation/Action” (readiness to change, seeking help). This factorial separation is critical for clinical utility, allowing practitioners to score the severity of the disorder and the patient’s readiness for change independently.

Instrument

Test Type: Self-report Questionnaire

Format: Paper-and-pencil or digital administration, typically consisting of approximately 47 items grouped into frequency, positive consequences, negative consequences, and motivational sections.

Language Available: English (and subsequent translations, often initiated through the lead author).

Population Group: Clinical and General Population Screening.

Age Group: Adolescents (older) and Adults.

Population Details: Validated across various populations, including those seeking substance abuse treatment and incarcerated individuals.

Test Methodology: Utilizes Likert-type scales for frequency, consequence severity, and agreement with motivational statements.

Keywords

Drug dependence, Substance abuse screening, Reliability, Validity, DUDIT, Karolinska Institutet, Clinical assessment, Motivational interviewing.

Authors

Author ORCID Identifier: Not provided in source content; typically requires external academic database search.

Affiliation Email addresses: [email protected] (Anne H. Berman, Karolinska Institutet)

Correspondence Address: Karolinska Institutet, Sweden (Affiliation of the lead researcher).

Permissions & Fee and Test Year

The DUDIT-E was developed and published in 2007. For information regarding permissions, translation, or licensing, interested parties are directed to contact the lead author, Anne H. Berman, via the provided institutional email address. The instrument is often made available for clinical and research purposes, as indicated by its publication on authoritative public health sites such as the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA). The instrument can be found at the EMCDDA website: http://www.emcdda.europa.eu/html.cfm/index61869EN.html.

Reference’s

Berman, A. H., Palmstierna, T., Källmén, H., & Bergman, H. (2007). The self-report Drug Use Disorders Identification Test-Extended (DUDIT-E): Reliability, validity, and motivational Index. Journal of Substance Abuse Treatment, 32, 357-369.

Items of the Drug Use Disorders Identification Test Extended – DUDIT-E

How often do you use the following substances? (See DUDIT drug list.)

• Cannabis

• Amphetamines

• Cocaine

• Opiates

• Hallucinogens

• Thinner and other drugs

• GHB and other drugs

• Pills (sleeping/calming)

• Pills (pain-relievers)

• Tobacco (cigarettes, cigars, pipe tobacco, snuff)

What is positive for you about using drugs?

1. Sleep better.

2. Lose tension and become relaxed.

3. Become happy.

4. Become strong.

5. Feel ”normal.”

6. Become creative (get ideas, do artistic things).

7. Become active (clean home, do dishes, wash the car, etc.).

8. Love everybody and the whole world.

9. More self-confidence.

10. Feel less pain in my back, neck, head etc.

11. Get a feeling that everything will work out.

12. Life without drugs is boring.

13. I can control feelings like anxiety, anger and depression.

14. With drugs I can function socially.

15. With drugs I feel that I am part of the group.

16. I get better contact with others.

17. I get more out of my life.

What is negative for you about using drugs?

1. Over the past year I have had trouble at work, in school or at home because of drugs.

2. Over the past year I have sought medical or hospital care or had medical problems (for example memory loss or hepatitis) because of drugs.

3. Over the past year I have been in quarrels or used violence under the influence of drugs.

4. Over the past year I have had trouble with the police because of drugs.

5. Feel anxiety.

6. Get suicide thoughts.

7. Avoid the company of others.

8. Get headaches or feel nauseous.

9. Have worse contact with friends.

10. Have trouble concentrating.

11. Feel less like ha‎ving sex.

12. Destroys finances.

13. Become passive.

14. Health worsens.

15. Become inconsiderate.

16. Destroys family life.

17. See everything as a big chaos.

What are your thoughts about drugs?

1. Do you enjoy taking drugs?

2. Do you feel tired of using drugs?

3. Have you been worried about your drug use over the past year?

4. Are you ready to work to change your drug use?

5. Do you think you need professional help to change your drug use?

6. Do you believe you can get the right sort of professional help?

7. Do you believe you can be helped by professional treatment for your drug use?

8. Do you think it is important to change your drug use?

9. Do you believe it will be difficult to change your drug use?

10. Have you already changed your drug use and are looking for methods to help you avoid relapses?

Response Options:

Frequency Items (Substance Use): Never, Tried it one or more times, Once a month or less often, 2-4 times a month, 2-3 times a week, 4 times a week or more, Check the box below if you mean use during relapse or limited periods.

Consequence Items (Positive/Negative): Not at all, A little, Somewhat, A lot, Totally.

Motivational Items (Items 1-4): Never, Less often than once a month, Every month, Every week, Daily or almost every day.

Motivational Items (Items 5-17): Not at all, A little, Somewhat, A lot, Totally.

Some Motivational Items (Specific): Not at all, Partly, Totally.