Evaluation of methods for detecting substance use disorder in persons withsevere mental illness

Substance use disorders are frequently undiagnosed in psychiatric settings. One possible reason for this underdiagnosis is the lack of screening proce dures designed or validated specifically for psychiatric patients. To evalu ate the utility of current detection methods, (a) criterion diagnoses were established of alcohol use disorder and drug (cannabis or cocaine) use diso rder on 320 patients with severe mental illness recently admitted to a psyc hiatric hospital, using a combination of structured diagnostic interviews a nd clinician ratings, and (b) the classification accuracy of several substa nce abuse measures developed for the general population was examined. For t his particular sample, demographic variables, clinical variables, medical e xams, laboratory tests, and collateral reports did not yield accurate detec tion. Screens based on self-report were superior to these other approaches but still yielded modest sensitivity. The results suggest that many individ uals are classified incorrectly with current techniques.