Validation and normalization of the youth risk-taking behavior assessment scale in an Iranian sample of substance abusers undergoing methadone maintenance treatment

Abstract

Risk-taking (RT) behaviors play a key role in addiction and drug-related disorders. It is necessary to assess RT among young people, as they represent a key demographic vulnerable to drug and alcohol abuse. The aim of the present study was to validate and normalize the 18-item scale assessing youth RT behavior (RT-18) in a sample of substance abusers undergoing methadone maintenance treatment (MMT). In the present study, we employed a descriptive design and aimed to validate the RT-18 scale. The statistical population of the research included all substance-abusing (dependent) patients under MMT in Rasht, northern Iran. Using consecutive sampling, 220 patients were selected from three addiction treatment clinics and provided informed and voluntary consent to answer the RT-18 scale and the brief substance craving scale (BSCS). The test-retest reliability of the RT-18 scale was 0.74. Cronbach’s alpha coefficient of RT-18, RT, and risk assessment (RA) subscales were 0.70, 0.88, and 0.55, respectively. Confirmatory factor analysis indicated that the modified two-factor structure for abusers under MMT provided a good model fit (β2/degree of freedom = 2.74; weighted root mean square residual = 0.897; Tucker-Lewis index = 0.915; comparative fit index = 0.91; root mean square error of approximation = 0.061). The total RT-18 score was significantly correlated with BSCS scores (r = 0.26; p<0.01), but explained only a small proportion of variance (F [1,218] = 6.34; p=0.013). The results of the present study indicate that the Persian version of the RT-18 scale has acceptable reliability coefficients and may be used reliably in outpatient addiction treatment settings to assess RT behavior. However, the reliability coefficient of the RA subscale was low, and the total RT-18 score displayed limited predictive value for substance craving scores.

Keywords

Substance abuse / Risk-taking behavior / Validation / Normalization

Acknowledgments

The authors would like to thank all members of the addiction treatment centers (“Mehr Addiction Treatment Clinic”, “Rah-e Sabz Addiction Treatment Clinic”, and “Behavioral Disorders Center” [ChomarSara-Rasht]) for their assistance in this study.

Funding

None.

Conflict of interest

The authors declare that they have no competing interests.

Author contributions

Conceptualization: Sajjad Rezaei, Iraj Shakerinia

Formal analysis: Sajjad Rezaei

Investigation: Sajjad Rezaei, Yasaman Larijani

Methodology: Sajjad Rezaei

Writing-original draft: Yasaman Larijani, Khadijeh Rezaei

Writing-review & editing: Iraj Shakerinia, Yasaman Larijani, Khadijeh Rezaei

Ethics approval and consent to participate

All study procedures were in compliance with the ethical guidelines of the Declaration of Helsinki (2013). All participants provided informed consent, confirming their satisfaction with participating in this research.

Consent for publication

The participants gave informed consent to publish their data in this study.

Availability of data

The data that support the findings of this study are available on request from the corresponding author.

References

[1] Bozarth MA. Drug addiction as a psychobiological process. In: Addiction Controversies. United States: CRC Press; 2023. p. 112-134.

[2] American Psychiatric Association.Diagnostic and statistical manual of mental disorders. In: Text Revision. 5th ed. Washington, DC: American Psychiatric Association; 2022. doi: 10.1176/appi.books.9780890425787

[3] Takahashi TT, Ornello R, Quatrosi G, et al. Medication overuse and drug addiction: A narrative review from addiction perspective. J Headache Pain. 2021; 22(1):32. doi: 10.1186/s10194-021-01224-8

[4] Lebni JY, Toghroli R, Abbas J, et al. A study of internet addiction and its effects on mental health: A study based on Iranian university students. J Educ Health Promot. 2020;9:205. doi: 10.4103/jehp.jehp_148_20

[5] Babor TF, McRee BG, Kassebaum PA, Grimaldi PL, Ahmed K, Bray J. Screening, brief intervention, and referral to treatment (SBIRT): Toward a public health approach to the management of substance abuse. Subst Abus. 2007; 28(3):7-30. doi: 10.1300/J465v28n03_03

[6] Liu Y, Van Den Wildenberg WP, De Graaf Y, et al. Is (poly-) substance use associated with impaired inhibitory control? A mega-analysis controlling for confounders. Neurosci Biobehav Rev. 2019; 105:288-304. doi: 10.1016/j.neubiorev.2019.07.006

[7] Rieser NM, Shaul L, Blankers M, Koeter MW, Schippers GM, Goudriaan AE. The predictive value of impulsivity and risk-taking measures for substance use in substance dependent offenders. Front Behav Neurosci. 2019;13:192. doi: 10.3389/fnbeh.2019.00192

[8] Adomeit H. Soviet risk-taking and crisis behaviour. In: A Theoretical and Empirical Analysis. United Kingdom: Taylor & Francis; 2022. doi: 10.4324/9781003320326

[9] Johnson SJ, Benson S, Scholey A, Alford C, Verster JC. Risk-taking behavior and the consumption of alcohol mixed with energy drink among Australian, Dutch and UK students. Int J Environ Res Public Health. 2021;18:5315. doi: 10.3390/ijerph18105315

[10] Suljević D, Šiljak A, Fočak M. Different outcomes of methadone maintenance therapy in rehabilitated and relapsed drug addicts: Significance of liver and renal biomarkers. Drug Chem Toxicol. 2022; 45(1):470-475. doi: 10.1080/01480545.2020.1722157

[11] Almasi A, Hajimoradi B, Mohammadi M. Follow-up study of drug use, depression, and anxiety reduction and quality of life in addicts on methadone maintenance therapy. Jundishapur J Health Sci. 2019; 11(3):e86427. doi: 10.5812/jjhs.86427

[12] Soni U, Sharma R, Sharma M, et al. Impulsivity and risk-taking behavior in school-going adolescents. Cureus. 2023; 15(6):e40728. doi: 10.7759/cureus.40728

[13] UNODC. World Drug Report; 2023. Available from: https://www.unodc.org/res/wdr-2023/wdr23_exsum_fin_dp.pdf [Last accessed on 2024 Aug 01].

[14] De Haan L, Kuipers E, Kuerten Y, Van Laar M, Olivier B, Verster JC. The RT-18: A new screening tool to assess young adult risk-taking behavior. Int J Gen Med. 2011; 4:575-584. doi: 10.2147/IJGM.S23603

[15] Lange R, Maraldi EDO, Zangari W, Corredato V, Machado FR, Alvarado CS. A cross-cultural validation of the revised transliminality scale in Brazil. Psychol Conscious Theory Res Pract. 2018; 5(4):414-424. doi: 10.1037/cns0000161

[16] Trógolo MA, Ledesma RD, Medrano LA. Adaptation of the aversion to risk taking scale in Argentinian drivers. Psykhe. 2019; 28(1):1-6. doi: 10.7764/psykhe.28.1.1181

[17] Aslan EA, Batmaz S, Çelikbaş Z, Kılınçel O, Hızlı Sayar G, Ünübol H. The effect of Turkish green crescent society APTP program on students’ knowledge and emotional awareness about tobacco, alcohol, drug, and technology addiction. Turk J Addict. 2021; 8(1):35-44.

[18] LaSpada N, Delker E, East P, et al. Risk taking, sensation seeking and personality as related to changes in substance use from adolescence to young adulthood. J Adolesc. 2020; 82:23-31. doi: 10.1016/j.adolescence.2020.04.011

[19] Son J. Back translation as a documentation tool. Transl Interpret. 2018; 10(2):89-100. doi: 10.12807/ti.110202.2018.a07

[20] Zuckerman M. Behavioral Expressions and Biosocial Bases of Sensation Seeking. United Kingdom: Cambridge University Press; 1994.

[21] Weber EU, Blais AR, Betz NE. A domain‐specific risk‐attitude scale: Measuring risk perceptions and risk behaviors. J Behav Decis Mak. 2002; 15(4):263-290. doi: 10.1002/bdm.414

[22] Kahneman D. Thinking, Fast and Slow. New York: Farrar, Straus and Giroux; 2011.

[23] Lemeshow S, Hosmer DW, Klar J, Lwanga SK, World Health Organization. Adequacy of Sample Size in Health Studies. Chichester: John Wiley & Sons; 1990. p. 1-4.

[24] Malakafzali H, Majdzadeh R, Fotouhi A, Tavakoli S. Research methodologies in applied medical sciences. In: Sampling and Sample Size. 1st ed.ed. Tehran: Tehran University of Medical Sciences; 2005. p. 295-316.

[25] Somoza E, Dyrenforth S, Goldsmith J, Mezinskis J, Cohen M. In Search of a Universal Drug Craving Scale. Paper Presented at the Annual Meeting of the American Psychiatric Association. Miami Florida; 1995.

[26] Basharpoor S, Khosravinia D, Atadokht A, Daneshvar S, Narimani M, Massah O. The role of self-compassion, cognitive self-control, and illness perception in predicting craving in people with substance dependency. Pract Clin Psychol. 2014; 2(3):155-164.

[27] Shrout PE, Bolger N. Mediation in experimental and nonexperimental studies: New procedures and recommendations. Psychol Methods. 2002; 7(4):422-445. doi: 10.1037/1082-989X.7.4.422

[28] Brown TA. Confirmatory Factor Analysis for Applied Research. New York: Guilford Publications; 2015.

[29] Fornell C, Larcker DF. Evaluating structural equation models with unobservable variables and measurement error. J Market Res. 1981; 18(1):39-50. doi: 10.2307/3151312

[30] Hair JF, Black WC, Babin BJ, Anderson RE. Multivariate data analysis. In: A Global Perspective. New Jersey, USA: Pearson Prentice Hall; 2010.

[31] Kline P. Handbook of Psychological Testing. 2nd ed. London: Routledge; 2013. doi: 10.4324/9781315812274

[32] Stamates AL, Lau-Barraco C. Impulsivity and risk-taking as predictors of alcohol use patterns and alcohol related-problems. Addict Res Theory. 2017; 25(5):390-396. doi: 10.1080/16066359.2017.1296953

[33] Sinha R. New findings on biological factors predicting addiction Relapse vulnerability. Curr Psychiatry Rep. 2011; 13(5):398-405. doi: 10.1007/s11920-011-0224-0

[34] Koob GF, Volkow ND. Neurobiology of addiction: A neurocircuitry analysis. Lancet Psychiatry. 2016; 3(8):760-773. doi: 10.1016/S2215-0366(16)00104-8

[35] Goldstein RZ, Volkow ND. Dysfunction of the prefrontal cortex in addiction: Neuroimaging findings and clinical implications. Nat Rev Neurosci. 2011; 12(11):652-669. doi: 10.1038/nrn3119

[36] Volkow ND, Wang GJ, Tomasi D, Baler RD. The addictive dimensionality of obesity. Biol Psychiatry. 2017; 81(9):734-744.

[37] Bechara A. Decision making, impulse control and loss of willpower to resist drugs: A neurocognitive perspective. Nat Neurosci. 2005;8:1458-1463. doi: 10.1038/nn1584

[38] Reyna VF, Farley F. Risk and rationality in adolescent decision making: Implications for theory, practice, and public policy. Psychol Sci Public Interest. 2006; 7(1):1-44. doi: 10.1111/j.1529-1006.2006.00026.x