A clinical validation of the National Survey on Drug Use and Health assessment of substance use disorders.

Alcohol and illicit drug abuse and dependence continue to be of great national concern in the United States, as is true in other nations. The National Survey on Drug Use and Health (NSDUH) provides national annual estimates of substance use and abuse/dependence among the U.S. civilian, noninstitutionalized population aged 12 years or older. We conducted a clinical validation study of the substance use disorder questions of the NSDUH instrument using a sample of 288 adults and adolescents recruited from the community and outpatient substance abuse treatment programs in North Carolina. Using the Structured Clinical Interview for DSM-IV (SCID-IV) for adults and the Pittsburgh Adolescent Alcohol Research Center's Structured Clinical Interview (PAARC-SCID) for adolescents, we computed the psychometric properties of the NSDUH questions. We found the level of agreement between the NSDUH and the SCID/PAARC-SCID interviews to be fair to moderate overall. There was somewhat better agreement for dependence than for abuse and for adults than for adolescents.

Screening for serious mental illness in the general population.

BACKGROUND: Public Law 102-321 established a block grant for adults with "serious mental illness" (SMI) and required the Substance Abuse and Mental Health Services Administration (SAMHSA) to develop a method to estimate the prevalence of SMI. METHODS: Three SMI screening scales were developed for possible use in the SAMHSA National Household Survey on Drug Abuse: the Composite International Diagnostic Interview Short-Form (CIDI-SF) scale, the K10/K6 nonspecific distress scales, and the World Health Organization Disability Assessment Schedule (WHO-DAS). An enriched convenience sample of 155 respondents was administered all screening scales followed by the 12-month Structured Clinical Interview for DSM-IV and the Global Assessment of Functioning (GAF). We defined SMI as any 12-month DSM-IV disorder, other than a substance use disorder, with a GAF score of less than 60. RESULTS: All screening scales were significantly related to SMI. However, neither the CIDI-SF nor the WHO-DAS improved prediction significantly over the K10 or K6 scales. The area under the receiver operating characteristic curve of SMI was 0.854 for K10 and 0.865 for K6. The most efficient screening scale, K6, had a sensitivity (SE) of 0.36 (0.08) and a specificity of 0.96 (0.02) in predicting SMI. CONCLUSIONS: The brevity and accuracy of the K6 and K10 scales make them attractive screens for SMI. Routine inclusion of either scale in clinical studies would create an important, and heretofore missing, crosswalk between community and clinical epidemiology.

Predictors of treatment receipt among adults with a drug use disorder.

This study used data from the 2000 and 2001 National Household Surveys on Drug Abuse to examine factors that contribute to the receipt of specialty substance abuse treatment, which is defined as treatment in rehabilitation facilities, hospitals, or mental health centers designed to help stop or reduce drug use. The population examined was a nationally representative sample of 3291 adults aged 18 or older with a drug use disorder in the past 12 months. Data were collected by computer-assisted interviews using a combination of computer-assisted personal interviews conducted by the interviewer and audio computer-assisted self-interviewing guided by the computer and respondent. Using descriptive analyses and multivariate logistic regression models, this study compared sociodemographic, substance abuse, and psychosocial characteristics of those receiving treatment with those not receiving treatment; it also examined the factors that influenced treatment receipt while controlling for potential confounders. Characteristics significantly contributing to treatment receipt among adults with a drug use disorder included the following: a woman without social support; a high school graduate with no college education; those receiving insurance through Medicaid or a state Children's Health Insurance Program; those on probation, parole, or supervised release in the past year; a daily smoker of cigarettes; those meeting at least three criteria for drug dependence; those having past year dependence on or abuse of alcohol; and those receiving any mental health treatment or counseling in the past year. Adults associated with the criminal justice system had a different pattern of treatment predictors from those who were not involved with the criminal justice system.