Brief screening for co-occurring disorders among women entering substance abuse treatment.
BACKGROUND
Despite the importance of identifying co-occurring psychiatric disorders in substance abuse treatment programs, there are few appropriate and validated instruments available to substance abuse treatment staff to conduct brief screen for these conditions. This paper describes the development, implementation and validation of a brief screening instrument for mental health diagnoses and trauma among a diverse sample of Black, Hispanic and White women in substance abuse treatment. With input from clinicians and consumers, we adapted longer existing validated instruments into a 14 question screen covering demographics, mental health symptoms and physical and sexual violence exposure. All women entering treatment (methadone, residential and out-patient) at five treatment sites were screened at intake (N = 374).


RESULTS
Eighty nine percent reported a history of interpersonal violence, and 70% reported a history of sexual assault. Eighty-eight percent reported mental health symptoms in the last 30 days. The screening questions administered to 88 female clients were validated against in-depth psychiatric diagnostic assessments by trained mental health clinicians. We estimated measures of predictive validity, including sensitivity, specificity and predictive values positive and negative. Screening items were examined multiple ways to assess utility. The screen is a useful and valid proxy for PTSD but not for other mental illness.


CONCLUSIONS
Substance abuse treatment programs should incorporate violence exposure questions into clinical use as a matter of policy. More work is needed to develop brief screening tools measures for front-line treatment staff to accurately assess other mental health needs of women entering substance abuse treatment.
Lincoln
Alisa K
AK
Department of Social and Behavioral Sciences, Boston University School of Public Health, Department of Psychiatry, Boston UniversitySchool of Medicine,715 Albany Street, T246W, Boston, MA 02118, USA. alincoln@bu.edu
Liebschutz
Jane M
JM
Chernoff
Miriam
M
Nguyen
Dana
D
Amaro
Hortensia
H
D000293:Adolescent; D000328:Adult; D000368:Aged; D018585:Battered Women / Q000523:psychology; D001900:Boston / Q000453:epidemiology; D015897:Comorbidity; D055030:Drug Users / Q000523:psychology; D005260:Female; D006801:Humans; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D011594:Psychometrics; D015203:Reproducibility of Results; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000453:epidemiology* / Q000523:psychology; D016320:Substance Abuse Treatment Centers / Q000379:methods*; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000534:rehabilitation; D011795:Surveys and Questionnaires; D014754:Violence / Q000523:psychology; D016387:Women's Health; D055815:Young Adult