COMPARISON OF DSM-III-R DIAGNOSES AND A BRIEF INTERVIEW FOR SUBSTANCEUSE AMONG STATE-HOSPITAL PATIENTS

Objective. Identifying substance use disorders in persons with mental illness is often difficult. In this study prevalence rates of substanc e use disorders among state psychiatric hospital patients were obtaine d by six different methods: DSM-III-R substance use diagnoses and five additional strategies based on frequency of use and past substance ab use treatment. Overlaps and differences between patients identified by the six methods were examined. Methods: Chart review and a structured substance use screening interview were used with a random sample of 2 0 percent (N = 474) of the population of the Maryland state hospital s ystem. Comparisons focused on cohorts identified by two of the methods : DSM-III-R substance use diagnoses and recent regular use (any past p eriod of daily or weekly use plus any use during the 30 days before ho spitalization). Results: The prevalence rates Of substance use identif ied by the six strategies ranged from 23 percent to 55 percent. The re cent-regular-use criteria identified 176 patients, and DSM-III-R diagn oses identified 111. The recent-regular-use criteria also identified a greater number of patients as likely to benefit from substance use tr eatment. Patients identified by both methods were significantly younge r and more likely to be male and nonschizophrenic than patients withou t substance use disorders. Conclusions: The need for substance use tre atment may be underestimated if discharge planners consider only DSM-I II-R diagnoses. A brief screen for recent regular use may be a better way to assess treatment needs in d state hospital population.