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

Abstract

The Drug Use Disorder Identification Test – Extension (DUDIT-E) is an advanced, multidimensional clinical and psychometric assessment instrument developed by Anne H. Berman and colleagues to provide a comprehensive evaluation of illicit drug consumption patterns, cognitive expectancies, subjective consequences, and readiness to change. While its parent screening instrument, the 11-item Drug Use Disorders Identification Test (DUDIT), was engineered primarily for rapid epidemiological and clinical screening of harmful drug use and dependence, the DUDIT-E expands this assessment framework to a comprehensive 54-item inventory. Rather than conceptualizing substance involvement purely through a pathology-oriented or symptom-count lens, the DUDIT-E is theoretically rooted in social cognitive theory, motivational psychology, and decision-making models. It operationalizes drug use as an intentional behavioral choice driven by positive outcome expectancies and perceived functional utility, such as existential coping, affect regulation, or social facilitation.

The instrument is organized into four distinct, psychometrically validated sections: Section D assesses the frequency of use across six major classes of psychoactive substances (Items D1–D6); Section P assesses positive aspects and outcome expectancies of drug use across 18 items (Items P1–P18; Pleasure/Enhancement, Social/Belonging, Self-Medication/Coping); Section N evaluates negative aspects and adverse biopsychosocial consequences across 19 items (Items N1–N19; Psychological, Physical, Social/Relational); and Section T captures motivational readiness for change across 11 items (Items T1–T11; Ambivalence, Recognition, Taking Steps) mapped to the Transtheoretical Model (TTM). Standardized validation studies conducted across inpatient, outpatient, correctional, and web-based cohorts in Sweden, Norway, and Hungary demonstrate exceptional internal consistency (Cronbach’s alpha ranging from .73 to .93 across subscales), robust test-retest reliability, and strong construct and criterion-related validity. Consequently, the DUDIT-E bridges the divide between formal psychometric screening and individualized motivational interviewing, equipping clinicians and researchers with granular diagnostic profiles to tailor stage-matched behavioral interventions.

Keywords

Drug Use Disorder Identification Test – Extension, DUDIT-E, substance use assessment, outcome expectancies, readiness to change, motivational interviewing, psychometrics, transtheoretical model, addiction psychology, dual diagnosis, clinical assessment

Authors

The DUDIT-E was conceptualized, developed, and empirically validated by an interdisciplinary team of clinical psychologists, psychiatrists, and addiction researchers affiliated with the Department of Clinical Neuroscience at the Karolinska Institutet in Stockholm, Sweden:

• Anne H. Berman, Ph.D. — Professor of Clinical Psychology and Licensed Psychologist/Psychotherapist, Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Region Stockholm, Sweden. Primary investigator in the development of both the original DUDIT and the DUDIT-E.
• Torkel Palmstierna, M.D., Ph.D. — Professor and Senior Consultant in Forensic Psychiatry, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden, and Centre for Forensic Psychiatry, Oslo University Hospital, Norway.
• Håkan Källmén, Ph.D. — Associate Professor of Psychometrics and Addiction Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
• Hans Bergman, Ph.D. — Professor Emeritus of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.

Subsequent psychometric adaptations, language translations, and cross-cultural validations have been conducted by research consortiums including Rune Wynn, Per M. Aslaksen, and colleagues (Norwegian adaptation; University of Tromsø) and József Gerevich, Barbara Matuszka, and colleagues (Hungarian adaptation; Eötvös Loránd University).

Purpose

The overarching clinical and empirical purpose of the Drug Use Disorder Identification Test – Extension (DUDIT-E) is to move beyond conventional, binary diagnostic screening by delineating the complex motivational and cognitive architectures that sustain non-medical substance use. Standard diagnostic taxonomies, such as the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or the International Classification of Diseases (ICD-11), classify substance use disorders primarily on the basis of accumulated symptoms, physiological tolerance, neurobiological withdrawal, and functional impairment. While this symptom-count approach is indispensable for psychiatric nosology, it frequently fails to inform clinical stage-matching, motivational readiness, or treatment planning because it ignores the perceived positive utility that drives the individual to consume substances.

The DUDIT-E was designed to address this clinical gap. It operates under the foundational behavioral premise that illicit drug consumption represents a conscious, goal-directed behavioral strategy chosen by the individual because it produces desired psychological outcomes. For individuals experiencing intense psychological distress, systemic trauma, or social marginalization, substance consumption is often perceived not as an irrational deficit in self-control, but rather as a highly effective, self-efficacious response to unmet existential, emotional, or physical needs. Consequently, effective therapeutic engagement requires an empirical balancing of the ledger: measuring not only the objective harms incurred by drug consumption, but also the subjective functional gains, social reinforcements, and self-regulatory benefits that make cessation difficult.

In routine clinical practice, the DUDIT-E serves as an assessment tool specifically tailored to inform motivational interviewing (MI) and cognitive-behavioral therapy (CBT). By administering the DUDIT-E at intake, clinicians can construct a visual or narrative “decisional balance sheet” that contrasts the patient’s explicit positive expectancies (Section P) directly against their endorsed adverse consequences (Section N). This explicit comparison allows therapists to explore ambivalence non-confrontationally. Furthermore, Section T evaluates where the patient resides along the continuum of change—ranging from precontemplative non-recognition to active change—enabling clinicians to deliver stage-appropriate interventions. In research environments, the DUDIT-E provides an empirically standardized outcome measure to track cognitive shifts in expectancies, changes in polydrug consumption severity, and trajectories of motivational commitment across longitudinal clinical trials, correctional rehabilitation programs, and outpatient addiction clinics.

Psychological Construct

The DUDIT-E operationalizes substance involvement as a multifaceted psychological construct composed of four distinct yet functionally interconnected behavioral and cognitive dimensions:

1. Polysubstance Consumption Topology (Section D)

This dimension quantifies the specific frequency and pattern of substance use across six mutually exclusive, internationally standardized psychoactive substance categories: cannabis, central stimulants (e.g., amphetamine, methamphetamine, cocaine, crack), prescription sedatives/hypnotics taken without medical authorization, illicit and prescribed opiates/opioids, hallucinogens/dissociatives, and other volatile or atypical substances (e.g., GHB, inhalants, anabolic-androgenic steroids). Rather than aggregating drug use into a single heterogeneous severity metric, this dimension provides granular profiling of polysubstance repertoires, facilitating targeted clinical monitoring of concurrent physical risk and toxicological interactions.

2. Positive Outcome Expectancies and Perceived Functional Utility (Section P)

Section P measures the individual’s subjective positive cognitive expectancies and functional motivations for using drugs across 18 items. This construct reflects the cognitive representations of anticipated positive reinforcement, mood modification, and perceived functional adaptation. Factor analyses identify three distinct second-order subdimensions:

• Pleasure and Enhancement: The expectation that drug consumption will generate acute euphoria, augment hedonic tone, heighten energy, intensify sensory experiences (e.g., music, sexual intimacy, food), and unlock creative or introspective cognition (e.g., Items P1, P5, P8, P11, P13).
• Social and Belonging Facilitation: The belief that psychoactive substances alleviate social anxiety, improve interpersonal communication, facilitate social conformity within peer networks, foster feelings of solidarity, and reinforce externalized rebellion or autonomy (e.g., Items P3, P7, P9, P14, P16).
• Self-Medication and Existential Coping: The perception of psychoactive substances as self-prescribed pharmacotherapies utilized to induce sedation, blunt somatic pain, relieve psychological dysphoria (such as depression, panic, trauma, or unmanaged anger), and escape visceral feelings of existential void, loneliness, or boredom (e.g., Items P2, P4, P6, P10, P12, P15, P17, P18).

3. Negative Biopsychosocial Consequences (Section N)

Section N captures the perceived frequency and severity of adverse consequences attributable to drug use across 19 items. Rather than recording external administrative metrics, this construct evaluates the respondent’s subjective awareness of life disruption across three core life domains:

• Psychological Consequences: Endorsement of post-consumption dysphoria, severe rebound anxiety, paranoia, cognitive impairments such as memory blackouts, feelings of debilitating shame, pervasive cravings, and the terrifying perception of having surrendered personal agency and internal locus of control to the drug (e.g., Items N2, N5, N13, N15, N19).
• Physical and Somatic Deterioration: Reports of acute physiological toxicity, severe comedown/hangover states, physical injuries, sleep disturbances, objective somatic deterioration, hygiene neglect, and physiological withdrawal states upon cessation (e.g., Items N1, N8, N10, N14, N16, N18).
• Social, Relational, and Legal Impairment: Endorsement of severe friction within primary support networks, partner conflict, parental distress, occupational or educational absenteeism, severe financial depletion, involvement in secondary criminality to finance drug purchasing, and involuntary surveillance or sanctions from law enforcement and social welfare agencies (e.g., Items N3, N4, N6, N7, N9, N11, N12, N17).

4. Motivational Readiness to Change (Section T)

Section T evaluates the internal motivational dynamics governing behavioral transformation across 11 items. Operating on a continuum of recognition, contemplation, and action, this construct evaluates the respondent’s subjective dissatisfaction with their current substance involvement, the degree of cognitive dissonance experienced regarding their drug habits, and their mobilization of self-regulatory effort to implement and sustain behavioral modification. It stratifies respondents into clinically actionable profiles of readiness, discerning between individuals who actively resist change, those trapped in ambivalent reflection, and those actively taking behavioral steps toward recovery.

Theoretical Framework

The conceptual architecture of the DUDIT-E is anchored in the integration of two prominent psychological frameworks: Bandura’s Social Cognitive Theory—specifically through the lens of Expectancy Theory and Self-Efficacy Theory—and the Transtheoretical Model of Behavior Change (TTM) formulated by James Prochaska and Carlo DiClemente.

Social Cognitive Expectancy Theory and Functional Self-Regulation

Classical conditioning and biological reductionism frequently depict substance addiction as an automated, reflexive compulsion governed exclusively by neurochemical adaptations within mesolimbic dopamine circuits. While neurobiological adaptations are undeniable, Social Cognitive Theory posits that human behavior is governed by triadic reciprocal determinism: the dynamic interplay between neurobiological states, environmental influences, and cognitive mediation. Central to this formulation are outcome expectancies—anticipatory cognitive structures regarding the reinforcing or punishing effects of a behavior.

Drawing on the expectancy paradigms articulated by Goldman, Brown, and Marlatt, the DUDIT-E posits that active drug consumption is maintained because the individual harbors highly consolidated positive outcome expectancies that override distal, probabilistic negative consequences. When an individual anticipates that administering a stimulant will rapidly mitigate fatigue and confer social charisma, or that an opiate will alleviate overwhelming existential dread, the immediate subjective utility of that substance is exceptionally high. In this context, drug consumption is conceptualized as an act of functional self-regulation. Individuals often employ substances not because they perceive themselves as inherently powerless, but because, in the absence of alternative psychosocial coping resources, psychoactive chemical administration represents the most reliable, rapid, and self-efficacious mechanism available to achieve emotional equilibrium. The DUDIT-E’s detailed assessment of Section P directly operationalizes these cognitive expectancies, allowing clinicians to decode the exact self-regulatory functions the drug fulfills.

The Decisional Balance and Transtheoretical Stages of Change

The DUDIT-E directly operationalizes the Decisional Balance construct central to the Transtheoretical Model (TTM). According to Prochaska and DiClemente, intentional behavioral modification is mediated through an ongoing cognitive assessment of the “pros” and “cons” of the target behavior. In early stages—such as Precontemplation—the perceived pros of substance use substantially outweigh the perceived cons, maintaining behavioral continuation. As adverse consequences accumulate, or as the subjective efficacy of the substance wanes due to pharmacological tolerance, the individual transitions into Contemplation, characterized by profound cognitive ambivalence where the pros and cons hang in precarious equilibrium. Progression into Preparation, Action, and Maintenance occurs only when the perceived negative consequences and the anticipated benefits of sobriety outweigh the positive utilities of continued consumption.

By juxtaposing Section P (the Pros) against Section N (the Cons), the DUDIT-E maps the exact empirical topology of the client’s decisional balance. Furthermore, Section T operationalizes the specific stages of readiness. Drawing structural inspiration from instruments like the University of Rhode Island Change Assessment (URICA) and the Stages of Change and Treatment Eagerness Scale (SOCRATES), Section T evaluates three distinct subconstructs: Precontemplation/Non-Recognition (e.g., Item T1: “I don’t think I have any real problems with drugs”), Ambivalence/Contemplation (e.g., Item T2: “Sometimes I wonder if my drug use is getting out of hand”), and Recognition/Taking Steps (e.g., Item T4: “I have already started to change my drug habits”). This synthesis provides a clear theoretical roadmap for implementing stage-matched clinical interventions, ensuring therapists do not prematurely prescribe action-oriented techniques to patients who remain in precontemplative ambivalence.

Validity

The psychometric validity of the DUDIT-E has been rigorously evaluated across diverse clinical and forensic populations, demonstrating robust construct, convergent, discriminant, and criterion-related validity.

Construct and Factorial Validity

Construct validity was initially established in the seminal psychometric investigation conducted by Berman, Palmstierna, Källmén, and Bergman (2007) across a diverse Swedish sample of clinical substance-dependent inpatients, prison inmates, and an open web-based community cohort. Exploratory and confirmatory factor analyses verified that the conceptual subdivisions of the scale correspond to distinct, empirically observable cognitive-behavioral constructs. Section P cleanly differentiated into three correlated factors reflecting Pleasure/Enhancement, Social Facilitation, and Coping/Self-Medication. Section N resolved into factors mapping onto psychological distress, physical dysfunction, and severe socio-relational disruption. Section T demonstrated clear alignment with established stages-of-change dimensions, successfully isolating ambivalence from concrete action-taking.

Convergent and Concurrent Validity

Convergent validity has been repeatedly corroborated through strong statistical correlations with established gold-standard diagnostic and screening instruments. In the original validation studies (Berman et al., 2007), scores on Section N correlated heavily with total scores on the original 11-item DUDIT ($r = .68$ to $.82, p < .001$), confirming that the negative consequences dimension accurately reflects the clinical severity of drug-related pathology. Furthermore, Section N exhibited significant positive correlations with the Addiction Severity Index (ASI) composite scores across the medical, legal, family/social, and psychiatric domains.

In cross-cultural validation research in Norway, Sletteng et al. (2011) evaluated the DUDIT-E within a clinical sample of hospitalized substance abusers and community controls. They observed strong convergent validity between Section T (Treatment Readiness) and external measures of treatment motivation, demonstrating that patients with elevated scores on the Taking Steps subscale attended a significantly higher proportion of scheduled therapeutic sessions and demonstrated greater adherence to treatment protocols. Similarly, Matuszka, Bácskai, Berman, Czobor, Sinadinovic, and Gerevich (2014) validated the Hungarian version of the DUDIT and DUDIT-E among young substance users, demonstrating robust convergent validity with standardized psychiatric symptom checklists (SCL-90-R), with Section N correlating strongly with general psychiatric distress, depression, and hostility subscales.

Discriminant and Predictive Validity

Discriminant validity has been demonstrated by the tool’s capacity to reliably distinguish between clinical populations, incarcerated forensic cohorts, and non-dependent recreational users. Individuals meeting DSM criteria for substance dependence scored significantly higher across all Section N items and showed marked elevations on specific coping items within Section P compared to recreational users, whose Section P profiles were predominantly confined to hedonic enhancement and social facilitation. Predictive validity has been substantiated in longitudinal settings, where elevated scores on the baseline Readiness to Change dimension (Section T) predicted significant reductions in consumption frequency (Section D) at 6-month and 12-month post-treatment follow-up intervals.

Reliability

The DUDIT-E possesses high internal consistency, strong scale precision, and excellent temporal stability across multiple testing environments and cultural contexts.

Internal Consistency

In the primary psychometric validation study by Berman et al. (2007), the internal consistency of the DUDIT-E subscales was established using Cronbach’s coefficient alpha across both clinical cohorts and an extensive web-based sample ($N = 1,126$):

• Section P (Positive Aspects): Demonstrated excellent internal consistency, with overall scale alpha coefficients ranging from $\alpha = .89$ to $\alpha = .93$. Subscale alphas remained consistently high: Pleasure/Enhancement ($\alpha = .84$), Social Aspects ($\alpha = .81$), and Coping/Self-Medication ($\alpha = .86$).
• Section N (Negative Aspects): Yielded outstanding reliability metrics, with total scale Cronbach’s alpha reaching $\alpha = .92$ to $\alpha = .94$, confirming that the 19 items assess a unified underlying continuum of drug-related biopsychosocial adversity. Subdimension alphas were robust: Psychological Consequences ($\alpha = .88$), Physical Consequences ($\alpha = .83$), and Social/Relational Consequences ($\alpha = .85$).
• Section T (Treatment Readiness / Motivation): Displayed solid internal consistency across its multi-item components, ranging from $\alpha = .73$ to $\alpha = .85$. Specifically, the Taking Steps and Recognition dimensions demonstrated alpha values exceeding $.80$, while the Ambivalence dimension hovered between $.73$ and $.78$.

Subsequent psychometric examinations have reaffirmed these values. In the Norwegian adaptation conducted by Sletteng et al. (2011), Cronbach’s alphas for Section P and Section N were $.91$ and $.93$, respectively, with Section T exhibiting an overall alpha of $.79$. In the Hungarian youth cohort assessed by Matuszka et al. (2014), all primary subscales exceeded the accepted psychometric threshold of $\alpha = .75$, demonstrating the structural stability of the scale across adolescent and young adult populations.

Test-Retest Reliability and Temporal Stability

Temporal stability was evaluated by Berman et al. (2007) across a subset of clinically stable respondents retested over an interval of 14 to 21 days. Intraclass correlation coefficients (ICC) were remarkably high across all four structural sections:

• Section D (Substance Frequency): $ICC = .88$ ($p < .001$)
• Section P (Positive Aspects): $ICC = .84$ ($p < .001$)
• Section N (Negative Aspects): $ICC = .89$ ($p < .001$)
• Section T (Treatment Motivation): $ICC = .78$ ($p < .001$)

The marginally lower ICC observed for Section T is theoretically congruent with the Transtheoretical Model, which posits that motivational readiness is an intrinsically dynamic, state-dependent psychological construct prone to natural fluctuations over time, unlike relatively stable behavioral frequencies or established cognitive expectancy networks.

Factor Analysis

The latent dimensional architecture of the DUDIT-E has been rigorously interrogated using both Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) across several independent international investigations.

Factor Structure of Section P (Positive Aspects)

Initial principal components and maximum likelihood factor analyses conducted with oblimin and varimax rotations on Section P revealed a clear three-factor solution accounting for approximately 58.4% of the total variance:

• Factor 1: Coping and Self-Medication (Items P2, P4, P6, P10, P12, P15, P17, P18). High item loadings (.58 to .81) were observed for statements reflecting tension reduction, pain alleviation, insomnia management, emotional numbing, and alleviation of loneliness.
• Factor 2: Pleasure and Hedonic Enhancement (Items P1, P5, P8, P11, P13). Factor loadings (.62 to .79) clustered around euphoria, vitality, sensory enhancement, and creative thought facilitation.
• Factor 3: Social Inclusion and Belonging (Items P3, P7, P9, P14, P16). Factor loadings (.54 to .75) gathered around peer conformity, party facilitation, perceived social confidence, and externalized rebellion.

Factor Structure of Section N (Negative Aspects)

Factor analysis of the 19 negative items in Section N revealed a robust, dominant primary factor capturing overall drug-related life impairment (accounting for over 46% of initial variance), which can be further resolved into three correlated second-order factors:

• Factor 1: Psychological Impairment and Loss of Agency (Items N2, N5, N13, N15, N19). Marked by high loadings (.64 to .84) on items measuring post-use paranoia, depression, memory gaps, intense guilt, and the subjective perception that drugs have seized control of the respondent’s existence.
• Factor 2: Physical Harm and Somatic Collapse (Items N1, N8, N10, N14, N16, N18). Characterized by high loadings (.55 to .78) on hangover severity, somatic injuries, sleep destruction, physical health deterioration, and physiological withdrawal symptoms.
• Factor 3: Social, Relational, and Systemic Conflict (Items N3, N4, N6, N7, N9, N11, N12, N17). Dominated by loadings (.52 to .76) reflecting financial ruin, absenteeism, familial and peer disputes, illicit acts, and criminal justice contact.

Factor Structure of Section T (Treatment Readiness)

CFA procedures conducted by Berman et al. (2007) and replicated by Sletteng et al. (2011) confirmed that Section T mirrors the triadic structural topology of the SOCRATES instrument, showing acceptable model fit ($\chi^2 / df < 2.5, CFI = .94, TLI = .92, RMSEA = .058$):

• Recognition (Items T3, T6, T9, T10): Highly loaded on explicit acknowledgment of severe drug problems and desire for therapeutic intervention (.68 to .85).
• Taking Steps (Items T4, T7, T11): Marked by high loadings on behavioral implementation of change and active cessation efforts (.72 to .88).
• Ambivalence / Precontemplation (Items T1, T2, T5, T8): Characterized by loadings capturing uncertainty regarding whether substance use is problematic, alongside explicit denial of the need for change (.52 to .74).

Instrument / Measurement Tool

• Test Type: Multidimensional Clinical Assessment Instrument and Motivational Profiling Inventory (Self-Report Questionnaire or Clinician-Administered Structured Interview).
• Format: Available in paper-and-pencil format, standalone computerized software, and secure online survey architectures.
• Total Item Count: 54 standardized items organized into four discrete sections: Section D (6 items), Section P (18 items), Section N (19 items), and Section T (11 items).
• Administration Time: Approximately 15 to 25 minutes for self-administration; 20 to 30 minutes for structured clinician-guided administration.
• Target Population: Adolescents and adults (ages 15 and older) presenting in outpatient addiction clinics, inpatient psychiatric facilities, residential detoxification units, correctional institutions, primary care settings, and epidemiological research cohorts.
• Standard Response Scale:
  • Section D (Substance Frequency; Items D1–D6): Rated on a 5-point Likert scale: 0 = Never / Not at all, 1 = Rarely / A little, 2 = Sometimes / Somewhat, 3 = Often / Quite a bit, 4 = Very often / Very much.
  • Section P (Positive Aspects; Items P1–P18): Rated on a 5-point Likert scale: 0 = Not at all, 1 = Rarely / A little, 2 = Sometimes / Somewhat, 3 = Often / Quite a bit, 4 = Very often / Very much.
  • Section N (Negative Aspects; Items N1–N19): Rated on a 5-point Likert scale: 0 = Not at all, 1 = Rarely / A little, 2 = Sometimes / Somewhat, 3 = Often / Quite a bit, 4 = Very often / Very much.
  • Section T (Treatment Readiness; Items T1–T11): Rated on a 5-point Likert agreement scale: 0 = Do not agree at all, 1 = Agree somewhat, 2 = Agree moderately, 3 = Agree strongly, 4 = Agree completely.
• Scoring Rules and Motivational Index Calculation:
  • Section D Score: Summed individually per drug category (0–4 each) or aggregated to evaluate the breadth of polysubstance exposure (Range: 0–24).
  • Section P Score: Total sum of Items P1–P18 (Range: 0–72). Can be subdivided into Pleasure/Enhancement (P1, P5, P8, P11, P13; Range: 0–20), Social/Belonging (P3, P7, P9, P14, P16; Range: 0–20), and Self-Medication/Coping (P2, P4, P6, P10, P12, P15, P17, P18; Range: 0–32).
  • Section N Score: Total sum of Items N1–N19 (Range: 0–76). Reflects overall severity of experienced negative consequences. Can be broken down into Psychological (N2, N5, N13, N15, N19; Range: 0–20), Physical (N1, N8, N10, N14, N16, N18; Range: 0–24), and Social/Relational (N3, N4, N6, N7, N9, N11, N12, N17; Range: 0–32).
  • Section T Score: Scored along its three primary stages-of-change dimensions: Ambivalence/Precontemplation (T1, T2, T5, T8; Items T1 and T5 indicate precontemplative non-recognition), Recognition (T3, T6, T9, T10), and Taking Steps (T4, T7, T11).
  • Decisional Balance / Motivational Index (DUDIT-E MI): Calculated clinically by contrasting Section N against Section P: $$\text{Motivational Balance} = \text{Score}_N – \text{Score}_P$$ A positive differential indicates that negative consequences outweigh positive expectancies, representing an opportune clinical window for action-oriented change. A negative or zero balance indicates strong perceived positive utility, signaling the necessity for motivational interviewing to build discrepancy before initiating cessation protocols.

Permissions & Fee and Test Year

The Drug Use Disorder Identification Test – Extension (DUDIT-E) was originally published in 2007 by Anne H. Berman, Torkel Palmstierna, Håkan Källmén, and Hans Bergman. In alignment with international public health objectives and academic open-access principles, the DUDIT-E is distributed in the public domain for clinical, educational, and non-commercial scientific research purposes. No licensing fees, royalties, or mandatory purchase costs are required to administer, score, or electronically implement the scale.

Clinicians, health boards, and academic investigators are permitted to utilize the instrument provided that appropriate academic attribution is accorded to the original authors (Karolinska Institutet). Researchers wishing to adapt, validate, or translate the DUDIT-E into additional languages are encouraged to communicate with the corresponding author, Dr. Anne H. Berman, at the Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden, to maintain standardized international translation protocols and avoid duplicate initiatives.

References

Berman, A. H., Bergman, H., Palmstierna, T., & Schlyter, F. (2005). DUDIT: The Drug Use Disorders Identification Test: Manual. Karolinska Institutet, Department of Clinical Neuroscience. https://ki.se

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. https://doi.org/10.1016/j.jsat.2006.10.001

DiClemente, C. C., Schlundt, D., & Gemmell, L. (2004). Readiness and stages of change in addiction treatment. The American Journal on Addictions, 13(2), 103–119. https://doi.org/10.1080/10550490490435968

Goldman, M. S., Del Boca, F. K., & Darkes, J. (1999). Alcohol expectancy theory: The application of cognitive neuroscience. In K. E. Leonard & H. T. Blane (Eds.), Psychological theories of drinking and alcoholism (2nd ed., pp. 203–246). Guilford Press.

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. https://doi.org/10.1007/s12529-013-9316-2

Miller, W. R., & Rollnick, S. (2012). Motivational Interviewing: Helping People Change (3rd ed.). Guilford Press.

Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51(3), 390–395. https://doi.org/10.1037/0022-006X.51.3.390

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. https://doi.org/10.2466/03.18.PR0.109.5.663-674

Items of the Scale