Development and Initial Evaluation of the Psychometric Properties of an Ecstasy Craving Questionnaire
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DEVELOPMENT AND INITIAL EVALUATION OF THE PSYCHOMETRIC PROPERTIES OF AN ECSTASY CRAVING QUESTIONNAIRE Alan Kooi Davis A Thesis Submitted to the Graduate College of Bowling Green State University in partial fulfillment of the requirements for the degree of MASTER OF ARTS August 2012 Committee: Harold Rosenberg, Advisor Robert Carels John Tisak © 2012 Alan Kooi Davis All Rights Reserved iii ABSTRACT Harold Rosenberg, Advisor Numerous questionnaires have been published to assess craving for a wide variety of drugs, but no such instrument has been developed to assess craving for MDMA/ecstasy. Therefore, this study was designed to develop and evaluate the psychometric properties of such a questionnaire. First, I developed a pool of 19 potential items by modifying questions from other instruments assessing craving for other substances and writing new items that applied specifically to MDMA/Ecstasy. Next, using three websites (bluelight.ru, pillreports.com, facebook.com), I recruited 217 regular users of MDMA/ecstasy to complete a series of ecstasy- related questionnaires. Following an initial rating of their agreement with 19 craving items, participants watched one of two 3-minute cue-exposure videos: (a) dancing plus music at a club/rave with interspersed photos of ecstasy pills or (b) marching band on a football field and music with interspersed photos of peanuts. Following cue-exposure, subjects re-rated their agreement with the same 19 items, and completed questionnaires to assess their motivations for using ecstasy, refusal self-efficacy, obsessive/harmonious engagement in ecstasy use, drug/alcohol use and problems, and demographic information. Based on a conceptualization of craving that emphasized current desire, intention to consume and loss of control, I eliminated 11 potential items that appeared redundant or assessed outcome expectancies to yield the final 8- item version of the Ecstasy Craving Questionnaire-Current Craving (ECQ-CC). None of these 8 items were “unbalanced” (i.e., 80+% agreed or disagreed) nor were any pairs of the 8 items highly inter-correlated (r > 0.70). Internal reliability consistency across the 8 items was high (α = 0.93). The criterion validity of the ECQ-CC was supported by significant positive correlations iv of craving scores with motives for use, number of problems related to drug use, frequency of ecstasy use, and levels of obsessive/harmonious engagement in ecstasy use. I also found a significant negative correlation with self-efficacy to refuse ecstasy. As one element of construct validity, I also found a statistically significant interaction between time (pre vs. post cue exposure) x condition (rave/pills video vs. band/peanuts video), F(1, 215) = 5.276, p = .023. I plan to conduct further testing with different samples of drug takers to evaluate the generalizability of these initial findings. v ACKNOWLEDGMENTS I would like to thank Dr. Harold Rosenberg for his encouragement and assistance in the development, execution, and completion of this project. I am certain that my success is directly related to his direction and thoughtful concern for my training in psychological research. Additionally, I would not have been able to pursue my academic goals without the love and support of Randy and Kathy Davis, remarkable parents that continue to support my life in extraordinary ways. Lastly, I am fortunate to have been influenced by family and friends who have believed in me far longer than I have believed in myself. Without your love and support I would not be where I am today, thank you. vi TABLE OF CONTENTS Page INTRODUCTION ................................................................................................................. 1 Assessment of the subjective experience of craving .................................................. 8 METHOD ....…………………………………………………………………… 14 Measures ............................................................................................................ 14 Recruitment and procedure ........................................................................................ 18 Participant Characteristics ......................................................................................... 19 RESULTS ............................................................................................................ 21 Elimination of items on the ECQ-19 ......................................................................... 21 Principal Components Analysis of the ECQ-CC ....................................................... 22 Elements of construct validity of the ECQ-CC .......................................................... 23 Elements of criterion validity of the ECQ-CC ........................................................... 23 DISCUSSION ....................................................................................................................... 26 REFERENCES ...................................................................................................................... 32 APPENDIX A. Ecstasy Craving Questionnaire ................................................................... 53 APPENDIX B. Ecstasy Refusal Self-Efficacy Questionnaire .............................................. 54 APPENDIX C. Ecstasy Harmonious and Obsessive Passion Scale ..................................... 55 APPENDIX D. Motives for Ecstasy Use Questionnaire ...................................................... 56 APPENDIX E. Drug Abuse Screening Test - 10 .................................................................. 57 APPENDIX F. Alcohol Use Disorders Identification Test - Consumption.......................... 58 APPENDIX G. Substance Use History Questionnaire ......................................................... 59 APPENDIX H. Background Questionnaire and Ecstasy Use History .................................. 60 vii APPENDIX I. Informed Consent Document ........................................................................ 61 APPENDIX J. Cue Exposure Active – Still images ............................................................. 63 APPENDIX K. Cue Exposure Control – Still images .......................................................... 65 APPENDIX L. Drug Craving Reduction Script ................................................................... 67 viii LIST OF TABLES Table Page 1 Demographic characteristics of participants .............................................................. 40 2 Ecstasy use and drug and alcohol related problems ................................................... 42 3 Other substance use .................................................................................................... 43 4 Assessment of unbalanced items on the ECQ-19 ...................................................... 44 5 Intercorrelation matrix of items on the ECQ-19 ........................................................ 45 6 Principal components analysis of the ECQ-19 .......................................................... 46 7 Principal components analysis of the ECQ-CC ......................................................... 47 8 Means (and standard deviations) for analysis of variance (Time x Condition) ......... 48 9 Motives for ecstasy use, passionate engagement in ecstasy use, and self-efficacy to refuse ecstasy in various situations ............................................. 49 10 Correlations among post ECQ-CC scores and other ecstasy measures ..................... 50 ix LIST OF FIGURES Figure Page 1 Flow chart of study procedure ................................................................................... 51 2 Estimated marginal means of the ECQ-CC: Time x Condition ................................ 52 1 INTRODUCTION MDMA (+/- 3, 4-methylenedioxymethamphetamine), also known as Ecstasy, is a popular psychoactive substance taken orally by young adults in clubs or at dance parties, primarily for its euphoric and energizing effects. Ecstasy is a monoaminergic agonist that both promotes the release and inhibits the reuptake of serotonin in the brain (Green, Cross, & Goodwin, 1995; Rudnick & Wall, 1992; Schmidt, 1987). According to Meyer, Mayerhofer, Kovar, & Schmidt (2002), MDMA and its homologue MDE (3,4-methlyenedioxy-ethylamphetamine) are “substituted amphetamines with ‘entactogenic’ properties.” These entactogenic properties include reduced anxiety, increased openness to communication with others, and lowered defensiveness (Nichols, 1986). This novel classification (entactogen) has been proposed to distinguish these drugs from hallucinogens and stimulants (Morgan, 2000); however, chemically, entactogens are similar to both mescaline and amphetamine. The U.S. Army conducted research on ecstasy following the end of World War II, but it was not until 1976 that it was used as an adjunct to psychotherapy with individuals who had difficulty being disclosive (Maxwell, 2005). Although MDMA first became popular as a recreational drug in the 1970s, ecstasy has been a schedule I drug in the United States since 1985, meaning that the U.S. government considers it to have a high potential for abuse and no accepted medical uses (Maxwell, 2005). Initially, the drug was used mostly by Caucasian “club goers,” but use later spread to other ethnic minority groups, such as African Americans and Hispanics and to non-club settings (Koesters, Rogers, & Rajasingham, 2002; Maxwell, 2005). More recently, results from prevalence surveys (Johnston, O'Malley, Backman, & Schulenberg, 2007; Substance Abuse and Mental Health Services Administration