Undiagnosed Drug Misuse among Admissions to Psychiatric Day Treatment and Prediction of Early Exit

A challenge for psychiatric treatment programs is to accurately identify individuals with drug misuse problems at admission to treatment. Consecutive new admissions to an urban continuing day treatment (n=229) during 2003-2005 were recruited and their treatment status was determined after one year. At admission, 34% were diagnosed with drug dependence/abuse based on a DSM-IV clinical interview, whereas 69% were found to be misusing drugs based on a research protocol consisting of self-reports of use within the past 30 days and drug toxicologies. Drug misuse as identified by the research protocol predicted a clinically meaningful outcome - early exit from treatment (relative risk = 2.7, p < .01), but DSM-IV diagnosis of drug use disorder was not predictive. These results suggest that psychiatric outpatient programs should consider adding an assessment for drug misuse to a comprehensive clinical assessment at admission to treatment.