Addic i e Beha io s 129 (2022) 107288
A ailable online 22 Feb ua y 2022
0306-4603/© 2022 The Au ho (s). Published by Else ie L d. This is an open access a icle unde he CC BY license (h p://c ea i ecommons.o g/licenses/by/4.0/).
Psychome ic p ope ies o CAST o ea ly de ec ion o p oblema ic
cannabis use in Spanish adolescen s
An onio Rial
a
, Nu ia Ga cía-Coucei o
b
,
*
, Pa icia G´
omez
a
, Na meen Mallah
b
,
c
,
d
,
e
,
Jesús Va ela
a
, Ge a do Fl´
o ez-Men´
endez
, Manuel Iso na
g
a
Depa men o Social Psychology, Basic Psychology, and Me hodology, Uni e si y o San iago de Compos ela, San iago de Compos ela, Spain
b
Depa men o Psychia y, Radiology, Public Heal h, Nu sing and Medicine, Uni e si y o San iago de Compos ela, Spain
c
Gene ics, Vaccines and Pedia ic In ec ious Diseases Resea ch G oup (GENVIP), Ins i u o de In es igaci´
on Sani a ia de San iago, San iago de Compos ela, Spain.
d
WHO Collabo a ing Cen e o Vaccine Sa e y, San iago de Compos ela, Spain
e
Cen e o Biomedical Resea ch in he Respi a o y Diseases Ne wo k (CIBER-ESP), Mad id, Spain
Addic i e Beha io s Uni , Ou ense Uni e si y Hospi al Complex, Spain
g
Depa men o Psychosocial-Educa ional Analysis and In e en ion, Uni e si y o Vigo, Spain
ARTICLE INFO
Keywo ds:
CAST
Cannabis
Sc eening
Adolescen s
D ugs
P e en ion
ABSTRACT
The high p e alence a es o cannabis use in adolescen s and i s ea ly onse cons i u es a majo public heal h
p oblem, aising he need o i s ea ly de ec ion. The a ailabili y o alida ed ools o analyze ea ly cannabis use
is essen ial o de ec p oblema ic use a an ea ly age. The Cannabis Abuse Sc eening Tes (CAST) (Legleye e al.,
2007) is widely applied in Eu ope; howe e , he CAST cu -o sco es a y acco ding o he se ing, he sc eening
objec i e, and he co ec ion e sion (CAST- o CAST-b), c ea ing he e o e con usion in i s applica ion.
Mo eo e , he psychome ic p ope ies o he CAST as a ool o de ec ing p oblema ic cannabis use a e
unde s udied. To ill his gap, such psychome ic p ope ies ha e been analyzed in a sample o Spanish ado-
lescen s while using di e en cu -o sco es o CAST- and CAST-b. Based on ou indings, he op imal cu -o
sco es a e 2 poin s o CAST-b and 4 poin s o CAST- . The in e nal eliabili y o CAST- (
α
=0.83) and
CAST-b (KR-20 =0.80) a e sa is ac o y. Fac o ial analysis sugges ed he assump ion o a one-dimension model.
The CAST seems o be a alid and eliable ool o ea ly sc eening o p oblema ic cannabis use in Spanish
adolescen s.
1. In oduc ion
Cannabis con inues o be he mos used illegal subs ance by he
gene al popula ion in Eu ope (Eu opean Moni o ing Cen e o D ugs
and D ug Addic ion [EMCDDA], 2020a). Acco ding o he Eu opean
School Su ey P ojec on Alcohol and O he D ugs (ESPAD) Repo
2019, 16% o Eu opean s uden s be ween he ages o 15 and 16 epo ed
ha ing e e used cannabis (EMCDDA, 2020a). The highes p e alence o
cannabis use in Eu ope was obse ed in Czech Republic (28%), I aly
(27%), La ia (26%) and Spain (23%) (EMCDDA, 2020a).
Beyond he ala ming high p e alence a es o cannabis consump ion,
i is c ucial o ackle o he pe sis ing ela ed pa ame e s: he impac o
syn he ic cannabinoids (Ka ila, Benyamina, Blecha, Co encin, & Bil-
lieux, 2016), new consump ion o ma s such as he use o hookahs,
“dabbing”, “canna aping” o apo ize s (Papasei e al., 2018), and he
a ia ion o e ahyd ocannabinol (THC) le els (Chand a e al., 2019),
which has led o he p oduc ion and consump ion o powe ul p oduc s,
wi h high THC concen a ion (Meie , Doche y, Leischow, G imm, &
Pa dini, 2019), as well as o he comme cializa ion o p oduc s wi h low
THC con en by he balis s (EMCDDA, 2020b).
Expe s ha e also ale ed abou he upwa d end o you h cannabis
consump ion. Fo ins ance, in Spain, 222,000 s uden s ini ia ed
cannabis use in 2018, wi h highe equency among gi ls han boys
(Spanish Obse a o y on D ugs and Addic ions, & Go e nmen Dele-
ga ion o he Spanish Na ional D ugs Plan, 2020). In 2020, he p e a-
lence o Spanish s uden s in he age ange be ween 14 and 18 who
decla ed e e using cannabis eached 33% (Spanish Obse a o y on
D ugs and Addic ions, & Go e nmen Delega ion o he Spanish
* Co esponding au ho a : Facul y o Nu sing, Uni e si y o San iago de Compos ela, Campus No e, A enida de Xo´
an XXIII, s/n, 15782 San iago de Compos ela, A
Co u˜
na, Spain.
E-mail add ess: [email p o ec ed] (N. Ga cía-Coucei o).
Con en s lis s a ailable a ScienceDi ec
Addic i e Beha io s
jou nal homepage: www.else ie .com/loca e/addic beh
h ps://doi.o g/10.1016/j.addbeh.2022.107288
Recei ed 15 Sep embe 2021; Recei ed in e ised o m 26 No embe 2021; Accep ed 18 Feb ua y 2022
Addic i e Beha io s 129 (2022) 107288
2
Na ional D ugs Plan, 2020).
The ea ly onse o cannabis use con inues o be a majo conce n.
Since 2000, he age o ini ia ion o cannabis use in Spain has been unde
15 yea s (Rial e al., 2019; Spanish Obse a o y on D ugs and Addic-
ions, & Go e nmen Delega ion o he Spanish Na ional D ugs Plan,
2020). In compa ison wi h la e-onse cannabis use, ea ly use is associ-
a ed wi h g ea e heal h consequences (Bech old, Simpson, Whi e, &
Pa dini, 2015; Di Fo i e al., 2019; Feingold, Weise , Rehm, & Le -Ran,
2016; Fonseca-Ped e o, Lucas-Molina, P´
e ez-Alb´
eniz, Inchaus i, &
O u˜
no-Sie a, 2020), highe isk o dependency on he d ug, poo e
academic o wo k pe o mance, and highe p obabili y o de eloping a
isky pa e n o alcohol consump ion o binge d inking, and/o poly-
subs ance use (Míguez-Va ela & Beco˜
na, 2015; Volkow e al., 2016).
Acco ding o ESPAD Repo 2019, 4% o he Eu opean s uden s can
be classi ied as high- isk cannabis use s (EMCDDA, 2020b), al hough
his p e alence a ies g ea ly wi hin he di e en Eu opean coun ies,
wi h he lowes and highes p e alence egis e ed in Macedonia (1.4%)
and F ance (7.3%), espec i ely. The EU Agenda and Ac ion Plan on D ugs
2021–2025 (Eu opean Commission, 2020) insis s on p io i izing de ec-
ion and p e en ion o d ug use by adolescen s. The e o e, he a ail-
abili y o alida ed sc eening ins umen s adap ed o he adolescen
popula ion in each coun y is o he u mos impo ance.
The Cannabis Abuse Sc eening Tes (CAST) (Legleye e al., 2007) is
he mos applied sc eening ool in Eu ope. I encompasses 6 i ems ha
a e answe ed using a i e-poin Like scale. Two co ec ion e sions o
he CAST a e a ailable in he li e a u e: he ull e sion (CAST- ) in
which 0 o 4 poin s a e a ibu ed o each i em o o m a inal maximum
sco e o 24 poin s; and a bina y e sion (CAST-b) in which a sco e o 0 o
1 poin is assigned o each i em, and he inal sco e o he es anges
be ween ze o and six poin s. In CAST-b he h eshold o posi i e e-
sponses a ies be ween ques ions, such as “some imes” o some ques-
ions, and “ a ely” o o he s (Legleye e al., 2007).
Se e al s udies ha e e alua ed he psychome ic p ope ies o he
CAST o i s applica ion in he adolescen popula ion (as shown in
Table 1 hose s udies we e gene ally ca ied ou in Eu opean coun ies
such as F ance, Spain, I aly, and Hunga y. Excep o he s udy unde -
aken in F ance, whe e he CAST was alida ed o he sc eening o
p oblema ic cannabis consump ion using he P oblem O ien ed Sc eening
Ins umen o Teenage s (POSIT) as a gold s anda d (Legleye e al.,
2007), mos s udies ha e pe o med he alida ion o he CAST o de ec
Cannabis Dependence (CD) o Cannabis Use Diso de (CUD) using he
Diagnos ic and S a is ical Manual o Men al Diso de s (DSM-IV-TR) as a
gold s anda d (Bas iani e al., 2013; Cuenca-Royo e al., 2012;
Fe nandez-A amendi, Fe n´
andez-He mida, Mu˜
niz-Fe n´
andez, Secades-
Villa, & Ga cía-Fe n´
andez, 2012; Gyepesi e al., 2014; Legleye, K aus,
Pion ek, Phan, & Jouanne, 2012; Legleye, Pion ek, & K aus, 2011;
Legleye, Pion ek, K aus, Mo and & Falissa d, 2013).
A p oblem pending o be sol ed among he esea che s in his ield is
he lack o ag eemen on he e minology used o desc ibe he p oblem
o cannabis use. Some au ho s choose o use isky use (Seidel, Mo gen-
s e n, & Hanewinkel, 2020), p oblema ic use (Spanish Obse a o y on
D ugs and Addic ions, & Go e nmen Delega ion o he Spanish Na-
ional D ugs Plan, 2020), o haza dous use (Wong e al., 2019), while
o he s op o cannabis abuse (Legleye e al., 2013), cannabis use diso de
(Gyepesi e al., 2014), o cannabis dependence (Bas iani e al., 2013). In
his ega d, he o iginal au ho s o he CAST de eloped his ool “ o
sc een o ha m ul cannabis use” (Legleye e al., 2007, p. 235), aking
he e m used by he Wo ld Heal h O ganiza ion in he In e na ional
S a is ical Classi ica ion o Diseases and Rela ed Heal h P oblems 10 h
Re ision (ICD-10), de ined as “a pa e n o cannabis use ha is causing
damage o heal h. The damage may be physical o men al” (Wo ld
Heal h O ganiza ion. (2008), 2008, p. 290). Ne e heless, in he same
pape , he au ho s also desc ibed he CAST as “an e icien ool in o de
o sc een o cannabis use diso de s among adolescen s and young
adul s” (Legleye e al., 2007, p. 233), and hen hey emphasized he need
o a “sc eening and assessmen o ha m ul d ug consump ion in his
popula ion g oup, by de ining h ee isk le els o he CAST, which
speci ically deals wi h p oblema ic cannabis use” (Legleye e al., 2007,
p. 241). Expe s ha e wa ned abou e minological di e ences in his
a ea on se e al occasions, as desc ibed in he sys ema ic e iew by
Casajuana e al. (2016). The au ho s s a e ha “while cannabis depen-
dence has been widely s udied, p e ious cannabis use s a es emain
imp ecisely desc ibed” (Casajuana e al., 2016, p. 8) and insis ha
“wo king on o icial de ini ions is highly necessa y, as he c i e ia used
emain incomple e, leading o inc eased con usion in he ield” (Casa-
juana e al., 2016, p. 1). Taking in o conside a ion his con using con-
cep ual amewo k and being awa e o he p oblem a ising om
cannabis use a ea ly ages, his s udy adop s he e m p oblema ic
cannabis use, ollowing he wo king de ini ion p oposed by he
EMCDDA: “P oblema ic use can be de ined as use leading o nega i e
consequences on a social o heal h le el, bo h o he indi idual use and
o he la ge communi y” (Beck & Legleye, 2008, p. 31). No ice ha his
coincides wi h he p e alence concep es ima ed in na ional and in e -
na ional adolescen popula ion su eys when using he CAST, such as
he Spanish S a e Su ey on he Use o D ugs in Seconda y Schools
(ESTUDES) o he F ench Su ey on Heal h and Use on Na ional De ence
and Ci izenship Day (ESCAPAD).
Ano he issue is he ac ha he p oposed CAST cu -o sco e a ies
depending on he e sion (CAST-b o CAST- ), he age ange o he
sample, and he coun y, hus leading o some con usion in he in e -
p e a ion o he CAST esul s. Fo ins ance, in Spain, he ESTUDES
applied a cu -o sco e o 4 poin s o CAST-b (Spanish Obse a o y on
D ugs and Addic ions, & Go e nmen Delega ion o he Spanish Na-
ional D ugs Plan, 2020), as i was sugges ed by Cuenca-Royo e al.
(2012). Acco ding o he la es epo o ESTUDES in 2019, a qua e o
he Spanish adolescen s who had used cannabis in he p io yea could
be conside ed p oblema ic cannabis use s. Howe e , he ESPAD su ey,
which also applied CAST-b bu used a cu -o sco e o 2 poin s
(EMCDDA, 2020b), epo ed a highe p e alence (35%) o p oblema ic
cannabis use s in Eu ope in ha same yea . This a ia ion in he es i-
ma ed p e alence could be due o a di e ence in he expansion o
cannabis use ac oss coun ies o due o he applica ion o di e en
co ec ion sys ems o he CAST as wa ned by ESPAD in hei s a emen
“i is clea ha di e en compu a ion me hods would p oduce di e en e-
sul s. I is widely ecognized ha u he esea ch is needed o each a com-
mon ag eemen on he bes compu a ion me hod o he CAST o di e en
a ge popula ions” (EMCDDA, 2020b, p. 112). Fu he mo e, any applied
cu -o sco e should be alida ed in each se ing and acco ding o he
pu pose o he sc eening (e. g. de ec ion o p oblema ic cannabis use,
cannabis abuse diso de o dependence on cannabis). On he o he hand,
inconsis encies also exis ega ding he dimensionali y o he CAST;
while mos s udies indica ed a one-dimensional s uc u e o he ool
(Bas iani e al., 2013; Fe nandez-A amendi e al., 2012; Gyepesi e al.,
2014), o he esea che s (Legleye, 2018; Legleye e al., 2015) ha e
sugges ed a bidimensional s uc u e.
Conside ing he ea ly-onse cannabis use, i is impo an o imple-
men ea ly de ec ion p og ams, and hence he a ailabili y o alida ed
sc eening ools o p oblema ic use is c ucial (Ga cía-Coucei o e al.,
2021).
The CAST is unde s udied in he con ex o p oblema ic cannabis use.
The e o e, his s udy aims o analyze he psychome ic p ope ies o he
CAST as a ool o he ea ly de ec ion o p oblema ic cannabis use in
Spanish adolescen s. The wo co ec ion e sions o he CAST (CAST-
and CAST-b) ha e also been compa ed in o de o p o ide e idence o
he mos sui able o ma and cu -o sco e o he sc eening o p ob-
lema ic cannabis use.
2. Me hods
2.1. S udy popula ion
To add ess hese issues, a c oss-sec ional s udy was conduc ed. Fo
A. Rial e al.
Addic i e Beha io s 129 (2022) 107288
3
Table 1
Psychome ic p ope ies o CAST o adolescen s epo ed in scien i ic li e a u e.
Au ho s Yea Coun y n Sc eening objec i e Gold S anda d CAST Ve sion Cu -o sco es C onbachs
α
Sensi i i y Speci ici y AUC
Legleye e al. 2007 F ance 1728 (14–22 yea s old) P oblema ic Use POSIT Bina y 4 0.81 0.93 0.81 0.92
Legleye e al. 2011 F ance 2566 (17 yea s old) Cannabis dependence
(CD) and Cannabis
use diso de (CUD)
DSM IV c i e ia Bina y 2 (same o CD
and CUD)
0.74 CD: 0.77
CUD: 0.70
CD: 0.79
CUD: 0.87
CD: 0.84
(CI95%:
0.83–0.86)
CUD: 0.85
(CI95%:
0.84–0.87)
Full 3–4 (same o
CD and CUD)
0.77 CD: 0.84 (3);
0.76 (4)
CUD: 0.79
(3); 0.71 (4)
CD: 0.71 (3);
0.78 (4)
CUD: 0.80
(3); 0.87 (4)
Legleye e al. 2012 F ance 140 (15–26 yea s old)
[clinical simple use s
seeking ea men ]
Cannabis Use
Diso de s (CUD)
Adolescen Diagnos ic
In e iew-Ligh (ADI-
Ligh ) DSM-IV
Bina y 3 0.66 0.92 0.66 0.87
Full 6 0.73 0.93 0.66 0.86
Fe nandez-
A amendi
e al.
2012 Spain 144 (16–20 yea s old) Cannabis dependence
(CD)
DSM IV-TR c i e ia Full [scale wi h
i e esponse
op ions 1: ne e o
5: e y o en]
5 0.84 0.83 87 0.92
(CI95%: 0.88-
0.96)
Cuenca-Royo
e al.
2012 Spain 241 (18–25 yea s old) Subs ance Use
Diso de s (SUD) and
Dependence
The Psychia ic
In e iew o Subs ance
and Men al Diso de s
(PRISM)-
DSM-IV
Bina y SUD: 4 0.74 0.81 0.57 0.75
Dependence: 4 0.75 0.89 0.49 0.74
Full SUD: 9 0.79 0.74 0.69 0.79
Dependence: 12 0.79 0.57 0.84 0.79
Legleye e al. 2013 F ance 3266 (17–19 yea s old) La en classes o
cannabis use (DSM-
IV)
La en class s uc u e o
he DSM-IV
Full Se e e Class: 7 No
in o ma ion
0.88 0.84 0.92
Mode a e Class:
3
0.77 0.80 0.85
Bas iani e al. 2013 I aly 5787 (15–19 yea s old) Cannabis dependence
(CD)
Munich composi e
In e na ional Diagnos ic
In e iew (DSM-IV)
Bina y 3 0.78 0.78 0.82 0.88
Full 6 0.80 0.80 0.87
MCA [new e sion
o he scale made
by he au ho s]
7 0.80 0.81 0.87
Gyepesi e al. 2014 Hunga y 467 high school s uden s
(mean age =16.41) and
439 college s uden s (mean
age =23.9)
Cannabis dependence
(CD) and Cannabis
use diso de (CUD)
Munich composi e
In e na ional Diagnos ic
In e iew (DSM-IV)
Bina y High school: 2 High
school =0.76
CD =0.86
CUD =0.62
CD =0.95
CUD =0.97
CD =0.95
CUD =0.95
College school:
2
College
school =0.71
CD =0.78
CUD =0.68
CD =0.94
CUD =0.97
CD =0.93
CUD =0.89
A. Rial e al.
Addic i e Beha io s 129 (2022) 107288
4
his pu pose, a su ey on subs ance use was ca ied ou in a sample o
s uden s ec ui ed om 12 schools in Galicia (Spain), o which en we e
public and wo we e cha e schools.
The sample was selec ed by using con enience sampling. Gi en he
impo ance o ea ly de ec ion, his s udy popula ion, unlike o he
s udies, included pa icipan s o 12–13 yea s o age. A o al o 3,363
s uden s (50.1% women) aged be ween 12 and 18 yea s (M =14.60;
SD =1.79) accep ed o pa icipa e in he s udy and comple ed he
ques ionnai e. Thi y- h ee pe cen we e aged 12–13 yea s, 48.5% we e
aged 14–16 yea s, and 18.5% we e aged 17–18 yea s. Acco ding o hei
educa ion le el, 72.1% we e in compulso y seconda y educa ion (38.9%
in lowe seconda y educa ion and 33.2% in uppe seconda y educa ion),
and 27.9% we e baccalau ea e s uden s. The psychome ic p ope ies o
he CAST we e hen e alua ed using he subpopula ion o s uden s who
decla ed ha ing e e consumed cannabis in hei li e.
Twen y- ou ques ionnai es we e excluded due o he high numbe o
unanswe ed i ems. The e o e, 3,339 ques ionnai es we e included in he
s udy. Ou o 3,339 adolescen s, 283 (8.5%) epo ed ha ing used
cannabis in he las 30 days, 522 (15.2%) in he las 12 mon hs and 555
(16.5%) in hei li e ime. Da a om hose 555 adolescen s we e used o
he assessmen o he CAST psychome ic p ope ies. This decision was
based on h ee main easons: (1) 91.7% o hose who ha e e e used
cannabis in hei li e ime also used cannabis in he las yea , so hey
ep esen almos he same subsample; (2) he au ho s o he CAST, in he
i s alida ion o he es (Legleye e al., 2007), also ook he in-
di idual’s en i e li e as a e e ence pe iod; and (3) conside ing ha hey
a e adolescen s, he ac ha hey ha e e e used cannabis in hei
li e ime cons i u es a isk i sel , as poin ed ou by he o iginal au ho s
(Legleye e al., 2007).
2.2. Ques ionnai e
An ad hoc ques ionnai e was used o collec da a on subs ance use.
The ques ionnai e consis ed o h ee blocks o ques ions:
a) The i s block inqui ed abou he cannabis habi s o consump ion. I
included h ee ad hoc ques ions o assess li e ime cannabis use
(“Ha e you e e used ma ijuana o hashish in you li e ime?”), in he
las yea (“Ha e you used ma ijuana o hashish in he las
12 mon hs?”), and in he las mon h (“Ha e you used ma ijuana o
hashish in he las 30 days?”).
b) The second block included he Cannabis Abuse Sc eening Tes (CAST)
and he subscale o P oblem O ien ed Sc eening Ins umen o Teen-
age s (POSIT-
UAS
) on he use and abuse o subs ances. The Cannabis
Abuse Sc eening Tes (CAST) is a ool de eloped in F ance in 2002 as
pa o he ESCAPAD su ey (Beck and Legleye, 2003), consis ing o
six Like - ype i ems wi h i e esponse op ions (“Ne e ” [0],
“Ra ely” [1], “Some imes” [2], “Qui e o en” [3] and “Ve y o en”
[4]). Two co ec ion op ions a e a ailable in he li e a u e: he ull
CAST (CAST- ), in which each i em is sco ed om 0 o 4, and he inal
sco e om 0 o 24; and a bina y CAST (CAST-b), in which each i em
is sco ed 0 o 1, and he inal sco e om 0 o 6. Fo he la e , he
h eshold o posi i e esponses a ies depending on he ques ion: o
he i s wo ques ions he h eshold is “some imes” and o he
o he s “ a ely”. I was alida ed o he i s ime in 2007 by Legleye
e al. (2007). The in e nal consis ency achie ed was 0.81. The
P oblem O ien ed Sc eening Ins umen o Teeneage s (POSIT) was
de eloped by he Na ional Ins i u e on D ug Abuse as pa o he
Adolescen Assessmen /Re e al Sys em (AARS) (Rahde , 1991),
wi h he aim o de ec ing speci ic p oblems o adolescen d ug use s/
abuse s in gene al. I consis s o 139 dicho omous esponse i ems
ha a e g ouped in o 10 subscales. Each o he subscales assesses a
di e en a ea o he adolescen ’s li e unc ioning, one o hem being
he Subs ance Use and Abuse subscale (POSIT-
UAS
). This subscale
consis s o 17 i ems ha allow a apid assessmen o young people
who may be a isk o de eloping a possible subs ance use diso de .
The POSIT-
UAS
subscale was alida ed in an adolescen popula ion in
Spain (A aujo, Golpe, B a˜
na, Va ela, & Rial, 2018), ob aining an
in e nal consis ency o 0.82. In his s udy, he in e nal consis ency
calcula ed was 0.84.
c) The hi d block en ailed he sociodemog aphic cha ac e is ics o he
popula ion such as sex, age, school yea and kind o school (public o
cha e ).
2.3. P ocedu e
Da a we e collec ed using a sel -adminis e ed ques ionnai e. Da a
collec ion ook place in he class ooms o he pa icipa ing schools wi h
he help o ained psychologis s who ha e expe ience in hese ypes o
s udies. A aining session was held be o ehand wi h such psychologis s,
in o de o s anda dize he p ocedu e o be ollowed as much as possible
and o cla i y any possible ques ions a a echnical le el. The academic
s a was no p esen in he class ooms du ing he da a collec ion.
Likewise, a pilo s udy was unde aken on 30 s uden s o es ima e he
ime needed o comple e he ques ionnai e and ensu e he unde s and-
abili y o he ques ions by he s uden s. The ques ionnai e ook 10 min o
comple e and he e we e no comp ehension p oblems.
Pa icipan s we e p e iously in o med o he pu pose o he s udy
and hei pa icipa ion was comple ely olun a y and unpaid. The an-
onymi y and con iden iali y o he da a was ensu ed. The school di-
ec o s in o med he s uden s’ pa en s o he s udy and i s olun a y
na u e. The pa en s could accep o ejec he pa icipa ion o hei
child en in he s udy. A w i en in o med consen was ob ained om he
schools as well as om he pa en s o he pa icipa ing s uden s be o e
hei en ollmen in he s udy. The s udy was app o ed by he Bioe hics
Commi ee o he Uni e si y o San iago de Compos ela.
2.4. Analysis
P elimina y da a analysis was pe o med, emo ing cases wi h mo e
han 5% o missing alues o inconsis en esponse pa e ns. The in e nal
consis ency o CAST- was es ima ed by calcula ing he C onbach
α
and
o dinal omega Ω coe icien , while ha o CAST-b was de e mined
h ough KR-20. The co ec ed Homogenei y Index (CHI) was also
calcula ed o each i em, and hen C onbach
α
was ecalcula ed a e he
emo al o any i em. To check he dimensionali y o he scales, a
Con i ma o y Fac o ial Analysis was pe o med on each e sion o he
CAST (CAST- and CAST-b) using he unweigh ed leas squa es (ULS)
me hod. ULS does no equi e assump ions abou he dis ibu ion o he
da a and he me hod is obus wi h small samples (Fo e o, Maydeu-
Oli a es, & Galla do-Pujol, 2009; Xim´
enez, 2007).
C i e ion alidi y was assessed h ough he Pea son and Spea man
co ela ion coe icien s wi h he Subs ance Use and Abuse Subscale o
he P oblem O ien ed Sc eening Ins umen o Teenage s (POSIT-
UAS
).
Finally, ollowing he o iginal au ho s (Legleye e al., 2007), each e -
sion’s accu a e de ec ion abili y was examined by using he POSIT-
UAS
wi h a cu -o sco e o 2 as a Gold S anda d. Sensi i i y and speci ici y
indices, posi i e p edic i e alue (PPV) and nega i e p edic i e alue
(NPV) we e calcula ed. The analyses we e comple ed by es ima ing he
a ea unde he ecei e ope a ing cha ac e is ic (ROC) cu e.
The analyses we e ca ied ou using IBM SPSS S a is ics 25 and
AMOS 23 (IBM SPSS S a is ics o Windows, 2017).
3. Resul s
Table 2 ep esen s he p e alence o p oblema ic cannabis use ha
was es ima ed by applying he commonly used cu -o sco es o bo h he
CAST- and CAST-b. Subs an ial di e ences in he p e alence o p ob-
lema ic cannabis consump ion we e obse ed be ween CAST- and
CAST-b as well as wi hin he same CAST co ec ion e sion when
applying a di e en cu -o sco e. The o e all p e alence o p oblema ic
cannabis consump ion, de e mined by using he di e en e sions o he
A. Rial e al.
Addic i e Beha io s 129 (2022) 107288
5
CAST and cu -o sco es, anged be ween 2.5% and 7.2%. Wide anges
o p e alence we e obse ed in socio-demog aphic g oups such as males
(2.8% o 8.8%) and he 17–18 yea s age g oup (6.8% o 18.3%). The
a e age onse age o cannabis use was 14.6 yea s.
The p e alence o p oblema ic cannabis use was also calcula ed
based on he CAST alida ion subsample ( hose who ha e e e used
cannabis in hei li e ime). The esul s show ha 41.8% (n =232) we e
iden i ied as p oblema ic cannabis use s when applying he CAST-
e sion and a cu -o sco e o 3; 32.1% (n =178) wi h a cu -o sco e
o 4, and 18.6% (n =103) when using a cu -o sco e o 7. When
employing he CAST-b co ec ion e sion, 33,9% (n =188) sc eened
posi i e wi h a cu -o sco e o 2; and 14.6% (n =81), wi h a cu -o
sco e o 4.
Likewise, he p e alence da a o p oblema ic cannabis use among
hose who ha e used cannabis in he las 12 mon hs we e e y simila .
The esul s show ha 44.3% (n =231) we e iden i ied as p oblema ic
cannabis use s when applying he CAST- e sion and a cu -o sco e o
3; 34.1% (n =178) wi h a cu -o sco e o 4, and 19,5% (n =102) when
using a cu -o sco e o 7. When employing he CAST-b co ec ion
e sion, 36% (n =188) sc eened posi i e wi h a cu -o sco e o 2; and
15,1% (n =79), wi h a cu -o sco e o 4.
Rega ding POSIT-
UAS
, 31% (n =1,036) o he o al sample sc eened
posi i e (cu -o sco e o 2). Among hose who used cannabis in he las
12 mon hs, he pe cen age ose o 87.4% (n =485), and 87.7%
(n =458) among he subsample o cannabis use s in he las mon h.
3.1. Desc ip i e s a is ics and in e nal consis ency
The in e nal consis ency indica o s o CAST- and CAST-b we e
accep able. Fo CAST- , he alues o C onbach
α
and o dinal omega Ω
coe icien we e 0.83 and 0.82, espec i ely (Table 3), and o CAST-b,
Table 2
P e alence o P oblema ic Cannabis Use acco ding o di e en co ec ion e sions and cu -o sco es.
Global (n =3339) Male (n =1666) Female (n =1673)
χ
2
12–13 yea s old (n =1101) 14–16 yea s old (n =1620) 17–18 yea s old (n =618)
χ
2
CAST- 3 (a) 7.2% 8.8% 5.5% 13.28*** 0.7% 7.3% 18.3% 183.04***
4 (b) 5.5% 6.6% 4.4% 7.14** 0.6% 5.4% 14.7% 150.30***
7 (c) 3.2% 3.7% 2.8% 1.93 0.5% 2.9% 9.1% 94.81***
CAST-b 2 (d) 5.8% 6.8% 4.9% 5.34* 0.6% 5.9% 14.9% 146.22***
4 (e) 2.5% 2.8% 2.1% 1.54 0.4% 2.3% 6.8% 68.10***
(*) p <.05; (**) p <.01; (***) p <.001.
(a) Cu -o sco e used by Khalily, Schwannaue & Hallahan (2015).
(b) Cu -o sco e used by Rial e al. (2019).
(c) Cu -o sco e used by Blanke s e al. (2014).
(d) Cu -o sco e used by he 2019 ESPAD su ey.
(e) Cu -o sco e used by he 2020 ESTUDES su ey.
Table 3
I em analysis and desc ip i e s a is ics o CAST- and CAST-b.
Full CAST Bina y CAST
Mean
(SD)
IHC C onbach
α
*
Pe cen
posi i e
IHC KR-
20**
Ha e you smoked
cannabis be o e
midday?
0.93
(1.1)
0.70 0.78 28.5 0.59 0.75
Ha e you smoked
cannabis when
you we e alone?
0.78
(1.17)
0.69 0.78 23.6 0.58 0.76
Ha e you had
memo y p oblems
when you smoked
cannabis?
0.53
(0.95)
0.59 0.80 31.9 0.53 0.77
Ha e iends o
membe s o you
amily old you
ha you ough o
educe you
cannabis use?
0.32
(0.82)
0.61 0.80 16.8 0.58 0.76
Ha e you ied o
educe o s op
cannabis use
wi hou
succeeding?
0.32
(0.85)
0.43 0.83 16.2 0.48 0.78
Ha e you had
p oblems because
o you use o
cannabis
(a gumen , igh ,
acciden , bad
esul a school,
e c.)?
0.30
(0.77)
0.60 0.80 17.1 0.55 0.77
To al sco e 3.18
(4.26)
* C onbach
α
a e i em dele ion.
** KR-20 a e i em dele ion.
A. Rial e al.
Addic i e Beha io s 129 (2022) 107288
6
he es ima ed KR-20 was 0.80. Co ec ed HI o he i ems anged be ween
0.43 and 0.70 o CAST- and be ween 0.48 and 0.59 o CAST-b.
Al hough i em 5 showed he leas homogenei y index in bo h e sions
o he CAST, he elimina ion o his i em does no seem o imply a g ea
imp o emen in he in e nal consis ency o he scale.
3.2. Cons uc alidi y
The cons uc alidi y o he wo CAST e sions (CAST- and CAST-b)
was de e mined by using a con i ma o y ac o ial analysis whe e wo
models we e es ed: one- ac o and wo- ac o models (Table 4). In he
wo- ac o model, i ems 1 and 2 we e a ibu ed o he same ac o and
i ems 3 o 6 we e assigned o he o he ac o . In he one and wo- ac o
models o each o he wo co ec ion e sions, i ems 1 and 2 showed he
highes loads on hei espec i e ac o s, while i em 5 had he lowes
load. The elimina ion o i em 5 did no in oduce an imp o emen in he
goodness o i indica o s o he model (Table 5).
Bo h one- ac o and wo- ac o models showed simila alues o he
goodness o i indica o s o he model, which we e accep able (By ne,
2012; Kline, 2016). Al hough he goodness o i indica o s we e sligh ly
be e o he wo- ac o model in CAST- and CAST-b, he high co e-
la ion be ween he wo ac o s (0.80 in CAST- and 0.85 in CAST-b) does
no jus i y he assump ion o a wo-dimensional model.
3.3. C i e ion alidi y and de ec ion capabili y
The co ela ion coe icien s o Pea son and Spea man be ween he
de ec ion esul s o he ins umen unde alida ion (CAST-b and CAST-
) and ha o he ins umen used as a Gold S anda d, subs ance use and
abuse subscale o P oblem O ien ed Sc eening Ins umen o Teenage s
(POSIT-
UAS
), a e ep esen ed in Table 6. The wo e sions o he CAST
showed s a is ically signi ican and ela i ely high co ela ions wi h
POSIT-
UAS
.
The analysis o he de ec ion capabili y o he CAST using he POSIT
-
UAS
(2-poin cu -o sco e) as he Gold S anda d, showed ha CAST- and
CAST-b ha e low sensi i i y and NPV alues, howe e , he speci ici y
and PPV a e high (g ea e han 0.90) (Table 7).
In he case o CAST-b, he 2-poin cu -o limi showed he bes
speci ici y-sensi i i y a io. In he case o CAST- , bo h cu -o limi s o 3
and 4 poin s showed a simila speci ici y-sensi i i y a io. The ROC
cu e (Figs. 1 and 2) o ue posi i e alues agains he alse posi i e
alues showed a disc e e disc imina ion capabili y wi h an a ea unde
he cu e o 0.67 o CAST- and 0.68 o CAST-b.
4. Discussion
Ea ly de ec ion o p oblema ic subs ance use is a cu en conce n o
p o essionals who deal wi h you hs in pedia ics and p ima y heal h ca e
se ices as well as in schools. Gi en he upwa d end in he p e alence
o ea ly cannabis use (EMCDDA, 2020b), he a ailabili y o sho
sc eening ools wi h alida ed psychome ic p ope ies has become a
p io i y.
The CAST has been widely applied o assess cannabis abuse (Amado
e al., 2020; A ias-de la To e e al., 2020; Blanke s e al., 2014; B unaul
e al., 2019; Golpe, G´
omez, B a˜
na, Va ela, & Rial, 2017). I also se ed as
a massi e sc eening ool in na ional-scale su eys, bu no always using
he same co ec ion e sion and he same cu -o poin s (Beck and
Legleye, 2003; EMCDDA, 2020b; P esidenza del Consiglio dei Minis i &
Dipa imen o pe le Poli iche An id oga, 2018; Spanish Obse a o y on
D ugs and Addic ions, & Go e nmen Delega ion o he Spanish Na-
ional D ugs Plan, 2020). Howe e , despi e he ac ha se e al s udies
assessed he psychome ic p ope ies o he CAST as a sc eening ool o
dependence on cannabis o cannabis use diso de (Bas iani e al., 2013;
Cuenca-Royo e al., 2012; Gyepesi e al., 2014; Legleye e al., 2012;
Legleye, Pion ek, & K aus, 2011, 2013, 2014), he CAST capabili y o
de ec ing p oblema ic cannabis use in adolescen s has been much less
s udied.
The analyses ca ied ou in his s udy se ed o highligh he
impo ance o using an op imal cu -o sco e o each co ec ion e sion
o he CAST. I has been ound ha he applica ion o di e en CAST
e sions and cu -o sco es in in e p e ing he da a collec ed om he
same sample could lead o subs an ially di e en esul s and o inac-
cu a e conclusions. Fo ins ance, a s a is ically signi ican di e ence in
p e alence be ween men and women was obse ed when he CAST-b
Table 4
S anda dized ac o loadings o he one and wo- ac o models ob ained by ULS.
One- ac o model Two- ac o model
Full
CAST
Bina y
CAST
Full
CAST
Bina y
CAST
Ha e you smoked cannabis
be o e midday?
0.83 0.69 F1 0.87 0.75
Ha e you smoked cannabis
when you we e alone?
0.81 0.68 0.84 0.72
Ha e you had memo y
p oblems when you smoked
cannabis?
0.63 0.61 F2 0.69 0.63
Ha e iends o membe s o
you amily old you ha you
ough o educe you
cannabis use?
0.65 0.67 0.71 0.69
Ha e you ied o educe o s op
cannabis use wi hou
succeeding?
0.45 0.55 0.49 0.56
Ha e you had p oblems because
o you use o cannabis
(a gumen , igh , acciden ,
bad esul a school, e c.)?
0.64 0.64 0.70 0.65
Table 5
Goodness-o - i indexes o he one and wo- ac o models ob ained by ULS.
Ve sion Model
χ
2
/gl GFI NFI RFI AGFI
CAST- ull 1-Fac o 23.54 0.99 0.98 0.97 0.98
2-Fac o 5.40 0.99 0.99 0.99 0.99
CAST-bina y 1-Fac o 0.48 0.99 0.98 0.97 0.98
2-Fac o 0.25 0.99 0.99 0.98 0.99
Table 6
Co ela ion o CAST- and CAST-b wi h he subs ance use and abuse subscale o
he P oblem O ien ed Sc eening Ins umen o Teenage s (POSIT-
UAS
).
POSIT
Pea son R coe icien Spea man Rho coe icien
CAST- 0.54*** 0.45***
CAST-b 0.54*** 0.47***
(*) p <.05; (**) p <.01; (***) p <.001.
Table 7
Sensi i i y, speci ici y, posi i e and nega i e p edic i e alues o he cu -o
sco es o CAST- and CAST-b.
Sensi i i y Speci ici y PPV NPV
CAST- (Cu -o sco e o 4 poin s – A ea unde he ROC Cu e: 0.67; 95% CI: 0.61 - 0.73)
3 0.45 0.82 0.94 0.18
4 0.35 0.90 0.96 0.17
5 0.28 0.96 0.98 0.16
6 0.23 1 1 0.16
7 0.21 1 1 0.15
CAST-b (Cu -o sco e o 2 poin s – A ea unde he ROC Cu e: 0.68; 95% CI: 0.63 - 0.74)
1 0.55 0.76 0.94 0.20
2 0.37 0.91 0.97 0.17
3 0.25 0.97 0.98 0.16
4 0.17 1 1 0.15
A. Rial e al.
Addic i e Beha io s 129 (2022) 107288
7
and a 2-poin cu -o sco e we e used, bu his di e ence was no
obse ed when a cu -o sco e o 4 poin s was applied.
Coinciding wi h Legleye e al. (2007) and Legleye e al. (2011), ou
indings sugges ha he op imum cu -o sco es o de e mining p ob-
lema ic use in adolescen s a e: 2 poin s o CAST-b and 4 poin s o
CAST- , bu no 4 poin s o CAST-b, as used by he ESTUDES su ey
(Spanish Obse a o y on D ugs and Addic ions, & Go e nmen Dele-
ga ion o he Spanish Na ional D ugs Plan, 2020), because his would
lead o an unde es ima ion o he p e alence. In he case o including
pa icipan s in he 12–13 age ange, he use o a 3-poin cu -o sco e o
CAST- will be he mos app op ia e due o he highe sensi i i y o
CAST- a his cu -o sco e. CAST- , in addi ion o en ailing a simple
co ec ion han CAST-b, implies a sligh imp o emen in he ea ly
de ec ion capabili y as showed by he ROC cu e.
The indica o s o he CAST in e nal consis ency ob ained we e high
and exceeded hose ob ained in some p io s udies (Bas iani e al., 2013;
Legleye e al., 2012; Legleye e al., 2011). Mos s udies had sugges ed a
unidimensional s uc u e o he CAST (Bas iani e al., 2013; Fe nandez-
A amendi e al., 2012; Gyepesi e al., 2014), ye o he s udies sugges ed
a bidimensional CAST model (Cuenca-Royo e al., 2012; Legleye, Eslami,
& Bougea d, 2017). In ou s udy, he con i ma o y ac o ial analysis
wi h one and wo ac o s in bo h e sions o he ool (CAST- and CAST-
b) e ealed ha he goodness-o - i indica o s o he wo- ac o model
a e sligh ly be e han hose o he one- ac o model. None heless, om
a p ac ical poin o iew, he applica ion o wo sco es (one o each
ac o ) is no jus i ied gi en he high co ela ion be ween he wo ac o s
and he high in e nal consis ency o he scale.
The high co ela ion be ween he CAST and POSIT-
UAS
has made i
possible o e i y he c i e ion alidi y o he CAST. When adolescen s
p esen a p oblema ic use o cannabis, hey a e also e y likely o engage
in he p oblema ic consump ion o o he subs ances, which is consis en
wi h he indings om ea lie s udies (Rial e al., 2019).
The s udy had some limi a ions. Despi e in ol ing a sample o mo e
han 3,000 pa icipan s, he con enience sampling in he No hwes
egion o Spain does no allow o gene alize ou indings o he whole
Spanish popula ion. Addi ional na ional-scale s udies a e needed o es-
ima e he p e alence o p oblema ic cannabis use in Spain. In addi ion,
he es ima ed p e alence was no con olled o po en ially con ounding
a iables such as socioeconomic le el, men al heal h, and clinical ea-
u es like in elligence quo ien . As i is he case o all sel -adminis e ed
ques ionnai es, he answe s o he pa icipan s migh be a ec ed by
social desi abili y bias whe e he esponden migh epo hei ue
beha io s owa ds cannabis. Howe e , i should be no ed ha di e en
expe s in he ield o addic i e beha io s ha e poin ed ou ha sel -
epo measu es a e eliable and e en p e e able o o he me hods
when e alua ing subs ance use in he you h popula ion (Babo , K an-
zle , & Laue man, 1989; Win e s, S inch ield, Henly, & Schwa z, 1990).
Finally, he esul s ob ained indica e ha he CAST is no a sensi i e ool
o de ec ing p oblema ic cannabis use. The low sensi i i y ob ained
may be due o he used Gold S anda d. POSIT
-UAS
is a gene al subs ance
Cu e coo dina es CAST-
Sensi i i y
1 - Speci ici y
-1.00
1.000
1.000
.50
.643
.443
1.50
.534
.229
2.50
.452
.186
3.50
.353
.100
4.50
.278
.043
5.50
.233
.000
6.50
.212
.000
7.50
.179
.000
8.50
.142
.000
9.50
.115
.000
10.50
.093
.000
11.50
.072
.000
12.50
.054
.000
13.50
.043
.000
14.50
.031
.000
15.50
.023
.000
16.50
.016
.000
17.50
.008
.000
19.00
.006
.000
20.50
.004
.000
22.50
.002
.000
25.00
.000
.000
Fig. 1. ROC and AUC o CAST- .
A. Rial e al.
Addic i e Beha io s 129 (2022) 107288
8
p oblema ic sc eening ool ha can yield posi i e esul s o he use o
subs ances o he han cannabis such as alcohol o obacco. Fu u e
s udies a e ad ised o use a Gold S anda d ha allows a mo e p ecise
examina ion o he sc eening capabili y o p oblema ic cannabis use,
especially in he onse o ea ly cannabis use, whe e le els o CUD o CD
a e expec ed o be low. Da a collec ion based on indi idual in e iews
and using a ool such as he Adolescen Diagnos ic In e iew (ADI) could
se e as he abo e-men ioned Gold S anda d.
In conclusion, he p esen wo k p o ides e idence abou he psy-
chome ic p ope ies o he CAST o he sc eening o p oblema ic
cannabis use in he adolescen popula ion. To ca y ou a massi e
sc eening in Spain, i is p oposed o upda e and adap he op imal cu -o
poin s o each co ec ion e sion (“4′′ o CAST- and “2” o CAST-b).
Despi e he obse ed limi a ions, he CAST cons i u es a alid and eli-
able ool ha can be used in he con ex o ea ly cannabis use in ado-
lescen s, wi hin he amewo k o p e en ion policies, bo h o pe iodic
massi e sc eening as well o case inding.
CRediT au ho ship con ibu ion s a emen
An onio Rial: Concep ualiza ion, Funding acquisi ion, Me hodol-
ogy, Supe ision, W i ing – e iew & edi ing. Nu ia Ga cía-Coucei o:
W i ing – o iginal d a , W i ing – e iew & edi ing, Visualiza ion.
Pa icia G´
omez: W i ing – e iew & edi ing. Na meen Mallah: W i ing
– e iew & edi ing. Jesús Va ela: Funding acquisi ion, Me hodology,
Fo mal analysis, Valida ion. Ge a do Fl´
o ez-Men´
endez: Resou ces,
In es iga ion. Manuel Iso na: Concep ualiza ion, Resou ces, Da a
cu a ion.
Decla a ion o Compe ing In e es
The au ho s decla e ha hey ha e no known compe ing inancial
in e es s o pe sonal ela ionships ha could ha e appea ed o in luence
he wo k epo ed in his pape .
Acknowledgmen s
This wo k was suppo ed by he by Spanish Na ional Plan on D ugs
[File 2018/008].
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