Drug Use Disorder Identification Test – Extended (DUDIT-E)

Abstract

The Drug Use Disorder Identification Test – Extension (DUDIT-E) is a comprehensive self-report assessment tool comprising 54 items, developed as an extension of the original 11-item DUDIT. It is crucial to understand that the DUDIT-E serves as an assessment measure, not a definitive diagnostic instrument. The theoretical foundation of the scale posits that drug use is a behavioural choice reflecting positive outcome expectancies regarding substance consumption. Furthermore, for active users, this choice is often perceived not as a reflection of low self-efficacy, but rather as an adequate and self-efficacious response to underlying existential needs. A key focus of the DUDIT-E is the measurement of motivation, which is widely recognized as a critical premise for successful change in substance use treatment settings.

Keywords

Drug Use Disorder Identification Test, DUDIT-E, Substance Use Disorder, Assessment Tool, Motivation, Treatment Readiness, Psychometrics, Outcome Expectancies

Authors

Arif H. Berman, Torkel Palmstierna, Håkan Källmén, Håkan Bergman

Purpose

The primary purpose of the DUDIT-E is to provide a detailed, comprehensive assessment of drug use patterns and associated psychological aspects, moving beyond simple screening provided by shorter instruments like the original DUDIT. The 54 items are structured to gather information across four distinct domains, providing clinicians with a nuanced profile of the individual’s relationship with substances.

A significant focus of the DUDIT-E is the measurement of treatment readiness and motivational aspects regarding change. By quantifying an individual’s thoughts and concerns about their substance use, the tool helps gauge their level of commitment to therapeutic intervention. This motivational data is highly valuable in tailoring treatment plans, as motivation is a cornerstone concept in effective substance use treatment (Sletteng et al., 2011).

Construct

The DUDIT-E is designed to measure the complex construct of problematic drug use behavior, framed within a model emphasizing behavioral choice and subjective utility. The core theoretical premise is that substance use reflects positive outcome expectancies; users choose to engage in drug use because they anticipate positive effects or outcomes.

The scale encompasses four specific subscales or sections that together define the user’s drug use profile:

• Frequency of drug use.
• Positive aspects of drug use (e.g., perceived benefits or rewards).
• Negative aspects of drug use (e.g., perceived harm or consequences).
• Treatment readiness and aspects of motivation.

The scale specifically covers a wide range of substances, including cannabis, amphetamines, cocaine, opiates, hallucinogens, thinner and other drugs, GHB, sleeping/calming pills, pain relievers, and tobacco.

Validity

The DUDIT-E has demonstrated strong evidence of validity through extensive psychometric testing across diverse national and clinical settings, including studies conducted in Sweden, Norway, and Hungary. Research has utilized various populations, such as prison inmates and psychiatric inpatients, demonstrating the tool’s applicability in challenging environments.

However, specific limitations regarding validity have been identified, particularly concerning testing environments. Studies have predominantly occurred in detoxification settings and criminal justice environments. In these contexts, there is a risk of social desirability bias, where respondents may feel pressure to express negative attitudes toward continued drug use if doing so offers potential benefits, such as favorable sentencing or job security. This environmental pressure may lead to invalid scores (Matuszka et al., 2014). Future research is required to confirm the tool’s validity in outpatient addiction treatment settings, especially among underrepresented groups such as female drug users and young drug users.

Reliability

Reliability analyses of the DUDIT-E have consistently indicated robust psychometric properties. The scale exhibits good internal consistency, suggesting that items within the subscales measure the same underlying construct effectively. High intraclass correlations further confirm good test-retest reliability, indicating stability of scores over time.

Specific metrics reported in the literature support these findings (Berman et al., 2007). The Cronbach’s Alpha values for the subscales range from 0.73 to 0.93. For the online administration version, all subscales reported a Cronbach’s Alpha value greater than 0.73, further attesting to the scale’s reliability across different delivery methods.

Factor Analysis

Although the source content does not provide specific statistical details of the factor analysis (e.g., factor loadings or variance explained), the structure of the DUDIT-E is explicitly defined by four distinct conceptual sections, suggesting a multi-factor model. This structure implies that confirmatory or exploratory factor analysis confirmed the separation of items into the following four domains:

• Factor 1: Frequency and Pattern of Drug Use.
• Factor 2: Positive Reinforcement/Outcome Expectancies (Positive Aspects).
• Factor 3: Negative Consequences/Harm (Negative Aspects).
• Factor 4: Change Readiness and Motivation.

The robust reliability of the individual subscales (as indicated by high Cronbach’s Alpha values) supports the conceptual independence and internal cohesion of these four factors.

Instrument

Test Type: Self-report assessment tool (not diagnostic).

Format: 54 items divided into four sections. Available in paper format and online.

Language Available: Internationally appropriate; available in multiple languages. Procedures exist for translation and adaptation if a specific language copy is unavailable.

Population Group: Clinical populations (inpatients, detoxification patients) and forensic populations (prison inmates, criminal justice settings).

Age Group: Primarily adults, but psychometric studies have focused on young drug users (Matuszka et al., 2014).

Population Details: Initial studies showed a preponderance of male participants. Researchers recommend future studies focus on female drug users and young drug users in outpatient settings to broaden generalizability.

Test Methodology: Utilizes self-reporting to assess behavioral choices, outcome expectancies, and stages of change/motivation regarding substance use. The tool aims to capture the individual’s perceived benefits and harms associated with drug use.

Keywords

Self-Report, Behavioral Choice, Internal Consistency, Cronbach’s Alpha, Social Desirability, Criminal Justice, Detoxification Settings, Narcotic Use

Authors

Author ORCID Identifier: Not specified.

Affiliation Email addresses: Not specified; likely affiliated with the Karolinska Institutet or relevant psychiatric institutions at the time of publication (Berman et al., 2007).

Correspondence Address: Requires direct contact with the corresponding author of the foundational validation papers (e.g., Arif H. Berman).

Permissions & Fee and Test Year

Test Year: 2007 (Year of primary validation and publication of the DUDIT-E scale details).

Permissions and Fees: Information regarding current licensing, permissions, and administration fees requires consultation with the original authors or the publishing body of the scale. The tool’s international availability suggests broad, though potentially licensed, use.

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(4), 357-369.

Matuszka, B., Bácskai, E., Berman, A. H., Czobor, P., Sinadinovic, K., & Gerevich, J. (2014). Psychometric characteristics of the drug use disorders identification test (DUDIT) and the drug use disorders identification test-extended (DUDIT-E) among young drug users in Hungary. International journal of behavioral medicine, 21(3), 547-555.

Sletteng, R., Harnang, A. K., Hoxmark, E., Aslaksen, P. M., Friborg, O., & Wynn, R. (2011). A Psychometric Study of the Drug Use Disorders Identification Test—Extended in a Norwegian Sample. Psychological reports, 109(2), 663-674.

Items of the Drug Use Disorder Identification Test – Extension (DUDIT-E)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

The DUDIT-E contains 54 items across four sections. Example questions related to the Treatment Readiness section include:

• “have you been worried about your drug use…?”
• “are you ready to work to change your drug use?”