Development and validation of Tagalog versions of the Drug Abuse Screening Test-20 (DAST-20) and Stimulant Relapse Risk Scale (SRRS) for drug users in the Philippines

PLOS ONE RESEARCH ARTICLE Development and validation of Tagalog versions of the Drug Abuse Screening Test-20 (DAST-20) and Stimulant Relapse Risk Scale (SRRS) for drug users in the Philippines Takayuki Harada ID1*, Kazutaka Nomura2, Toshiaki Baba ID3, Tomohiro Shirasaka4, Ayumi Takano5, Shogo Kanamori6 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 Faculty of Human Sciences, University of Tsukuba, Tokyo, Japan, 2 School of Allied Health Sciences, Kitasato University, Kanagawa, Japan, 3 Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo, Japan, 4 Department of Psychiatry, Teine Keijinkai Medical Center, Hokkaido, Japan, 5 Department of Mental Health and Psychiatric Nursing, Tokyo Medical and Dental University, Tokyo, Japan, 6 Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan * OPEN ACCESS Citation: Harada T, Nomura K, Baba T, Shirasaka T, Takano A, Kanamori S (2023) Development and validation of Tagalog versions of the Drug Abuse Screening Test-20 (DAST-20) and Stimulant Relapse Risk Scale (SRRS) for drug users in the Philippines. PLoS ONE 18(1): e0280047. https:// doi.org/10.1371/journal.pone.0280047 Editor: Garumma Tolu Feyissa, Drexel University, UNITED STATES Received: November 18, 2021 Accepted: December 20, 2022 Published: January 6, 2023 Copyright: © 2023 Harada et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: Technical appendix, statistical code, and dataset available from the Dryad repository, DOI: https://doi.org/10.5061/ dryad.dz08kprv3. Funding: TH received the research fund from the Japan International Cooperation Agency (https:// www.jica.go.jp/english/index.html). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Abstract Methamphetamine use is becoming a major social issue in the Philippines, and this has been attracting international interest. Understanding the characteristics of drug users and the severity of their drug use is an urgent requirement for promoting effective treatment and support; however, in the Philippines, a lack of screening and assessment tools with confirmed reliability and validity is a major obstacle in this regard. Therefore, the aim of this study is to develop Tagalog versions of the Drug Abuse Screening Test-20 (DAST-20), a drug-abuse screening tool used worldwide, and the Stimulant Relapse Risk Scale (SRRS), a tool for quantitatively evaluating relapse among stimulant users, and to confirm their validity and reliability. Participants were 305 patients admitted to the Treatment and Rehabilitation Center (TRC) operated by the Philippines Department of Health for treatment for methamphetamine use. Sufficient internal consistency for the DAST-20 was confirmed, with a Cronbach’s alpha value of 0.81. Concerning validity, receiver-operating-characteristic analysis, featuring diagnoses from independent doctors, returned an acceptable areaunder-curve value of 0.62. Sufficient internal consistency was also confirmed for the SRRS, with a Cronbach’s alpha value of 0.89. Correlation analysis of subjective drug craving (measured using a visual analog scale) and the SRRS revealed a significant positive correlation (r = 0.19, p < 0.001), confirming a certain level of validity. The Tagalog versions of the DAST-20 and SRRS developed in this study were confirmed to be reliable and valid. These scales could be effective for use in clinical settings and for research purposes. Introduction The Philippines is one of the most seriously affected countries in the world by methamphetamine problems [1]. Domestic statistics estimate that there are approximately 1.8 million PLOS ONE | https://doi.org/10.1371/journal.pone.0280047 January 6, 2023 1 / 14 PLOS ONE Competing interests: The authors have declared that no competing interests exist. DAST-20 and SRRS in the Philippines methamphetamine users in the country [2]. Along with the associated threats to the mental and physical health of drug users, such widespread drug use can result in serious socio-economic consequences, including fragmentation of families and local communities, increased crime, and obstruction of societal development [3]. Many countermeasures for drug use have been developed in the world, but the effects and costs vary. When the harms of drug use are converted into a monetary value and included in the overall social cost, it becomes apparent that the most expensive option is to do nothing; this is because a lack of action leaves the aforementioned harms unaddressed. According to an estimate by the Institute of Medicine [4], in the US, the drug-related cost to society is over $40,000 per person per year. Criminal sentencing and incarceration were once considered to be effective strategies for addressing drug use, but the effects of such policies have since been disproven [5,6]. In fact, “tough” methods of addressing drug problems, such as criminal punishment and detention, sever the social connections drug users have with their families and communities, and are likely to strengthen drug users’ criminal ties; further, this approach has a similar direct cost of almost $40,000 per year [4]. Currently, the most effective and low-cost strategy to address drug dependence, at just $2,700 per person, is to provide human services, including treatment, welfare, and education, within communities [4,7,8]. Soon after taking office as President of the Philippines in 2016, Rodrigo Duterte proclaimed a “war on drugs,” and launched a nationwide anti-drug campaign, setting this as the highest priority for his administration. In particular, President Duterte’s willingness to allow extrajudicial killing of drug users attracted criticism from around the world [9]; however, in addition to this extreme policy, he discussed providing community support, including treatment, for those who “turn themselves in.” As a result, over one million drug users surrendered to the authorities during the first six months of Duterte’s presidency, revealing the seriousness of the country’s drug problem [10]. When seeking to provide human services for drug users, it is first necessary to screen them to determine their demographic characteristics and the severity of their drug use. In the Philippines, not only is it impossible to provide the same treatment service to one million individuals, but it is also unrealistic to assume that they all require treatment; the level of dependence and seriousness of the problem can vary widely among persons. Therefore, there is an urgent need to screen these drug users using relatively simple and efficient methods, and to develop reliable tools for matching them wit (...truncated)