DARTMOUTH ASSESSMENT OF LIFE-STYLE INSTRUMENT (DALI) - A SUBSTANCE USE DISORDER SCREEN FOR PEOPLE WITH SEVERE MENTAL-ILLNESS

Objective: Despite high rates of co-occurring substance use disorder I n people with severe mental illness, substance use disorder is often u ndetected in acute-care psychiatric settings. Because underdetection i s related to the failure of traditional screening instruments with thi s population, the authors developed a new screen for detection of subs tance use disorder in people with severe mental Illness. Method: On th e basis of criterion (''gold standard'') diagnoses of substance use di sorder for 247 patients admitted to a state hospital, the authors used logistic regression to select the best items from 10 current screenin g instruments and constructed a new instrument. They then tested the v alidity of the new instrument, compared with other screens, on an inde pendent group of 73 admitted patients. Results: The new screening inst rument, the Dartmouth Assessment of lifestyle Instrument (DALI), is br ief, is easy to use, and exhibits high classification accuracy for bot h alcohol and drug (cannabis and cocaine) we disorders. Receiver opera ting characteristic curves showed that the DALI functioned significant ly better than traditional instruments for both alcohol and drug use d isorders. Conclusions: Initial findings suggest the DALI may be useful for detecting substance use disorder in acutely ill psychiatric patie nts. Further research is needed to validate the DALI in other settings and with other groups of psychiatric patients.