# Protocol for a new family history of addiction density score to aid in the treatment of alcohol and substance use disorders

## TL;DR

This study introduces a simple, free tool called the Family Density Score to assess addiction risk based on family history, aiming to improve treatment for substance use disorders.

## Contribution

A novel, freely available protocol and algorithm to convert family history data into a clinical tool for addiction risk assessment.

## Key findings

- The protocol collects family history via four key questions about first and second-degree relatives.
- The Family Density Score accounts for affectedness and relatedness of family members, with an average of 5.24 affected relatives per patient.
- Significant differences in scores were found by sex, race, and primary substance used.

## Abstract

While molecular and non-molecular genetic testing are the gold standard for assessing a person’s familial liability for substance use disorders, such testing is often inaccessible. Family history information collected at intake is an alternative, but tools to effectively utilize this information are excessively complex. The aims of the study are threefold: 1) Describe a protocol for the collection of family history in a thorough and straightforward manner. 2) Provide an algorithm to convert family history information to numerical scores. 3) Present the aggregated results from the pilot testing of the protocol.

All patients (N = 871) underwent a comprehensive assessment that included the family history protocol. Descriptive statistics, t-tests and Pearson Correlation were used to analyze the scores and determine key differences by demographic categories (sex/race/ethnicity/substance/age).

The protocol asked patients four key questions about 1st and 2nd degree relatives while completing a family pedigree. Answers were transferred into an algorithm to output a score for each patient. This score took affectedness and relatedness of each family member into account. The average number of affected relatives was 5.24 (SD=3.17), and there were significant sex, race, and primary substance score differences.

This study provides the addiction field with a novel, freely available, and easily implementable family history protocol that has several potential clinical applications. While more research is needed, pilot results provide a valuable research tool, insight into a typical family history for those at an inpatient addiction treatment center, and steps toward closing the research-to-practice gap in this field.

•Most assessments of genetic liability for substance use are inaccessible and/or cumbersome.•Properly leveraging family history can have potential clinical applications.•The Family Density Score offers a simple and easily implemented tool.•This study freely provides the protocol, algorithm, and pilot data for the Family Density Score.

Most assessments of genetic liability for substance use are inaccessible and/or cumbersome.

Properly leveraging family history can have potential clinical applications.

The Family Density Score offers a simple and easily implemented tool.

This study freely provides the protocol, algorithm, and pilot data for the Family Density Score.