ASSESSMENT OF ALCOHOL AND OTHER DRUG DISORDERS IN THE SERIOUSLY MENTALLY-ILL

Brief assessment methods are needed to determine the presence of alcoh ol and drug problems in persons with severe mental illness. The purpos es of this study were to determine the prevalence of alcohol and other drug problems in a rural population of 253 clients with severe mental illness and to determine the accuracy of case manager responses to sp ecific alcohol and drug assessment questions about their clients. Clie nts were assessed for the presence of past and present alcohol and dru g disorders by means of a face-to-face diagnostic interview. The speci fic questions the case managers were asked to complete were designed t o assess the quantity and frequency of recent alcohol and drug use and the presence of three criteria for alcohol or drug dependence and to differentiate present versus past history of substance problems. On th e basis of the Diagnostic Interview Schedule-Revised, 35 percent of th e clients met current DSM-III-R alcohol or drug criteria for abuse, de pendence, or both. There were differences between client and case mana ger reports on the clients' use of alcohol, marijuana, cocaine, narcot ics, and unprescribed tranquilizers in the last year. The best predict or of a client's present alcohol or drug problem was whether the case manager thought that the client had substance use problems at some tim e in his or her life (sensitivity = 0.86, specificity = 0.75). This re port provides additional evidence that case manager reports are a vali d method of determining the prevalence of substance use problems in pe rsons with severe mental illness.