Prevalence and severity of substance misuse among referrals to a local forensic service

Substance misuse is frequently present alongside mental illness and persona lity disorder, complicating all aspects of management. We describe self-rep orted levels of substance misuse in referrals to a forensic psychiatry serv ice, to establish degrees of dependency and co-morbidity with other diagnos tic categories and to report the implications for treatment. There were 146 (70%) of 209 consecutive referrals who completed a semi-structured questio nnaire, including the Alcohol Use Disorders Identification Test (AUDIT), Se verity of Alcohol Dependency Questionnaire (SADQ), Alcohol Problem Question naire (APQ) and, for frequent users of opiates or stimulants, the Severity of Dependence Scales (SDS). Psychiatric diagnoses were made from clinical a ssessment using the International Classification of Diseases (World Health Organization, 1992). ICD-10 diagnoses of substance misuse were found in 83 (57%) subjects. A combination of mental illness and a substance misuse diag nosis was found in 54 (37%). The subgroup accepted into forensic psychiatri c services was found to have higher levels of co-morbidity, although levels of dependency were low. Forensic services need expertise in assessing drug -related morbidity; in motivational interviewing and other techniques for e ncouraging change; and in consolidating recovery.