Assessment of alcohol and other drug disorders in the seriously mentally ill

Brief assessment methods are needed to determine the presence of alcohol and drug problems in persons with severe mental illness. The purposes of this study were to determine the prevalence of alcohol and other drug problems in a rural population of 253 clients with severe mental illness and to determine the accuracy of case manager responses to specific alcohol and drug assessment questions about their clients. Clients were assessed for the presence of past and present alcohol and drug disorders by means of a face-to-face diagnostic interview. The specific questions the case managers were asked to complete were designed to assess the quantity and frequency of recent alcohol and drug use and the presence of three criteria for alcohol or drug dependence and to differentiate present versus past history of substance problems. On the basis of the Diagnostic Interview Schedule- Revised, 35 percent of the clients met current DSM-III-R alcohol or drug criteria for abuse, dependence, or both. There were differences between client and case manager reports on the clients' use of alcohol, marijuana, cocaine, narcotics, and unprescribed tranquilizers in the last year. The best predictor of a client's present alcohol or drug problem was whether the case manager thought that the client had substance use problems at some time in his or her life (sensitivity = 0.86, specificity = 0.75). This report provides additional evidence that case manager reports are a valid method of determining the prevalence of substance use problems in persons with severe mental illness.