Screening and diagnosis of anxiety and mood disorders in substance abuse patients.

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.