Screening and Diagnosis of Anxiety and Mood Disorders in Substance Abuse Patients

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Abstract
The aims of this study are (1) to study the prevalence of anxiety and mood disorders in a clinical substance abuse population, (2) to asses the pre‐ and post‐detoxification change in SCL‐90 score in this population for subjects with psychopathology compared to subjects without psychopathology, and (3) to asses the value of the SCL‐90 and the Addiction Severity Index‐psychiatric problems scale as clinical diagnostic screening instrument for psychopathology. The design was a longitudinal prospective cohort study with pre‐detoxification ASI and SCL‐90 data and post‐detoxification CIDI and SCL‐90 data on a clinical sample of 116 substance abuse patients. The present results indicate that the ASI‐Psychiatric problems score is a limited indicator of psychiatric comorbidity. When a pre‐detoxification screening for psychopathology is warranted, the present results show that the use of the SCL‐90 is preferable above the ASI‐PSY scale. Of the screening scores under study, the post‐detoxification SCL‐90 score is found to be the most valid screening instrument for diagnosis of anxiety and mood disorders in a clinical substance abuse population. Although the post‐detoxification SCL‐90 score holds moderate specificity combined with high sensitivity, applying this instrument in clinical substance abuse practice will result in a substantial reduction of patients unnecessarily referred for further psychiatric diagnostic evaluation. Further studies aimed at improvement of screening instruments in this population are needed.