Temporal and gender trends in concordance of urine drug screens and self-reported use in cocaine treatment studies

Megan S. Schuler, William V. Lechner, Rickey E. Carter, Robert Malcolm

Research output: Contribution to journalArticlepeer-review

30 Scopus citations


Objectives: To describe temporal trends in concordance, sensitivity, and specificity and to explore demographic trends in concordance in 2 outpatient treatment studies for cocaine dependence. Methods: We obtained 2229 urine drug screens (UDS) from 129 individuals, along with accompanying self-use reports (SUR). Paired SUR and UDS were considered concordant if the 2 measures of cocaine use were in agreement. The sensitivity and specificity of the SUR in predicting the UDS was also estimated. To model concordance, sensitivity, and specificity as a function of time, generalized estimating equations were used. Demographic effects on concordance among subjects who achieved 100% concordance and subjects who achieved a recently proposed 70% concordance threshold were tested. Results: During the course of our studies, both sensitivity and concordance statistically decreased; however, specificity remained relatively constant. Median concordance for all subjects was 88%. Among all subjects, concordance varied significantly by gender, with women achieving significantly higher concordance than men (96% vs 86%). Similarly, women were almost twice as likely to achieve 100% concordance as men (42% vs 22%). Finally, 80% of participants achieved the 70% concordance threshold, and no differences among demographic groups with regards to the 70% concordance threshold were observed. Conclusions: Temporal effects of concordance and sensitivity may have profound repercussions when using SUR to gauge efficacy of an experimental intervention. Furthermore, gender may differentially affect concordance. Finally, a substance abuse outcome measure that reliably combines objective and self-report data is promising, but further research is needed.

Original languageEnglish (US)
Pages (from-to)211-217
Number of pages7
JournalJournal of Addiction Medicine
Issue number4
StatePublished - Dec 2009


  • Cocaine
  • Concordance
  • Gender
  • Sensitivity
  • Temporal effects

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Pharmacology (medical)


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