Detection of substance use disorders among psychiatric inpatients

This study examines the utility of the Addiction Severity Index (ASI) for detecting psychoactive substance use disorders (PSUDs) among psychiatric inpatients. Four hundred thirty-five inpatients at two inner-city psychiatric hospitals completed the ASI and the Structured Clinical Interview for DSM-III-R (SCID). Receiver operating characteristic (ROC) analysis assessed the optimal threshold ASI alcohol and drug composite scores to detect DSM-III-R PSUDs. The correlations of both the ASI alcohol and drug composite scores with their corresponding DSM-III-R PSUD categories were significant (p<.0001). However, the ROC analysis revealed that the ASI misses approximately 20% of SCID-positive PSUD cases. Specificity of the ASI, on the other hand, is quite good (95% to 98%), and optimal ASI threshold scores to rule out a PSUD among these patients are identified. The results also support the sensitivity of these patients to the toxic effects of illicit substance use.