Substance use disorders and cooperative research on addictions: Spanish approach as a model.

Substance use disorders (SUD), also named addiction when it is severe, is a chronic brain disorder with serious impact on individual who suffer, the public health and with high burden of disease. They are multitude of mechanisms/factors involved in addiction: from individual characteristics of the person (from genetic to impacts of stress, sex, and age) to social and environmental situation (availability and accessibility of substances, cultural and legal aspects, socio-economical situation) and type of substance of use (pharmacological characteristics) Then, research on Addiction must include different, complementary, and translational perspectives. In this review, we explore the neurobiological, psychosocial, and epidemiological knowledge of substance addiction, and the main role played by pharmacology in the research in this field. In Spain, since 2002, collaborative networks have emerged for comprehensive research on addictions, with the creation of the Addictive Disorders Network (RTA), currently redefined as the Research Network for Primary Care in Addictions (RIAPAd) with the support of the Carlos III Health Institute (Instituto de Salud Carlos III). Basic (including neuropharmacology and behavioral pharmacology), clinical and epidemiological research groups stand out, combining efforts to address prevention, early detection and treatment through interdisciplinary cooperation and the subsequent dissemination of results.

BDNF and Cortisol in the Diagnosis of Cocaine-Induced Depression.

Background: Major depressive disorder (MDD) and cocaine use disorder (CUD) are related with disability and high mortality rates. The assessment and treatment of psychiatric comorbidity is challenging due to its high prevalence and its clinical severity, mostly due to suicide rates and the presence of medical comorbidities. The aim of this study is to investigate differences in brain derived neurotrophic factor (BDNF) and cortisol plasmatic levels in patients diagnosed with CUD-primary-MDD and CUD-induced-MDD and also to compare them to a sample of MDD patients (without cocaine use), a sample of CUD (without MDD), and a group of healthy controls (HC) after a stress challenge. Methods: A total of 46 subjects were included: MDD (n = 6), CUD (n = 15), CUD-primary-MDD (n = 16), CUD-induced-MDD (n = 9), and 21 HC. Psychiatric comorbidity was assessed with the Spanish version of the Psychiatric Research Interview for Substance and Mental Disorders IV (PRISM-IV), and depression severity was measured with the Hamilton Depression Rating Scale (HDRS). Patients were administered the Trier Social Stress Test (TSST) before and after the biological measures, including BDNF, and cortisol levels were obtained. Results: After the TSST, Cohen's d values between CUD-primary-MDD and CUD-induced-MDD increased in each assessment from 0.19 post-TSST to 2.04 post-90-TSST. Pairwise differences among CUD-induced-MDD and both MDD and HC groups had also a large effect size value in post-30-TSST and post-90-TSST. In the case of the BDNF concentrations, CUD-primary-MDD and CUD-induced-MDD in post-90-TSST (12,627.27 ± 5488.09 vs.17,144.84 ± 6581.06, respectively) had a large effect size (0.77). Conclusion: Results suggest a different pathogenesis for CUD-induced-MDD with higher levels of cortisol and BDNF compared with CUD-primary-MDD. Such variations should imply different approaches in treatment.

Dual Disorders in the Consultation Liaison Addiction Service: Gender Perspective and Quality of Life.

Dual disorders (DD) and gender differences comprise an area of considerable concern in patients with substance use disorder (SUD). This study aims to describe the presence of DD among patients with SUD admitted to a general hospital and attended by a consultation liaison addiction service (CLAS), in addition to assessing its association with addiction severity and quality of life from a gender perspective, between 1 January and 30 September 2020. The dual diagnosis screening interview (DDSI), the severity of dependence scale (SDS), and the WHO well-being index were used to evaluate the patients. In the overall sample, DD prevalence was 36.8%, (women: 53.8% vs. men: 32.7%, NS). In both genders the most prevalent DD was depression (33.8%, women: 46.2% vs. men: 30.9%, p = 0.296). Women presented more panic disorders (46.2% vs. 12.7%, p = 0.019) and generalized anxiety (38.5% vs. 10.9%, p = 0.049) than men. When DD was present, women had worse quality of life than men (21.7 vs. 50 points, p = 0.02). During lockdown period 77 patients were attended to and 13 had COVID-19 infection, with no differences in relation to sociodemographic and consumption history variables. The study confirms a high prevalence of DD among patients with SUD admitted to a general hospital for any pathology, and its being associated with worse quality of life, particularly in women.

Developing an App to Screen for Dual Disorders: A Tool for Improving Treatment Services in Mexico.

Background: Previous studies in Mexico undertaken at residential facilities for treating substance use disorders (SUDs) reported that the prevalence of Dual Disorders (DDs) is over 65%. DDs pose a major challenge for the Mexican health system, particularly for community-based residential care facilities for SUDs, due to the shortage of certified professionals to diagnose and treat these patients. Moreover, the lack of standardized algorithms for screening for and evaluating DDs to refer patients to specialized services (whether private or public) hinders timely care, delaying the start of integrated treatment. The use of new technologies provides a strategic opportunity for the timely detection of DDs through the development of standardized digital applications for the timely detection of DDs. Objective: To develop an app to screen for DDs, which will contribute to referral to specialized services in keeping with the level of severity of psychiatric and addictive symptomatology, and be suitable for use by community-based residential care facilities for SUDs. Method: The research project was implemented in two stages. Stage 1 involved obtaining the psychometric properties of the Dual Diagnosis Screening Interview (DDSI). Stage 2 consisted of two steps to test the Beta version of the app and the quality of version 1.0. Results: The DDS obtained sensitivity and specificity scores above 85%. The app and its algorithm to screen for and refer DDs proved to be efficient and easy to apply with satisfactory community acceptance. Conclusion: The app promises to be a useful screening tool at residential addiction treatment centers.

A Gender Perspective of Addictive Disorders.

PURPOSE OF REVIEW: Substance use disorders (SUD) affect differentially women and men. Although the prevalence has been reported higher in men, those women with addictive disorders present a more vulnerable profile and are less likely to enter treatment than men. The aim of this paper is to present an overview of how sex and gender may influence epidemiology, clinical manifestations, social impact, and the neurobiological basis of these differences of women with SUD, based on human research. RECENT FINDINGS: The differences in prevalence rates between genders are getting narrower; also, women tend to increase the amount of consumption more rapidly than men, showing an accelerated onset of the SUD (telescoping effect). In respect to clinical features, the most important differences are related to the risk of experience psychiatric comorbidity, the exposure to intimate partner violence, and the associated high risks in sexual and reproductive health; and those who are mothers and addicted to substances are at risk of losing the custody of children accumulating more adverse life events. Some of these differences can be based on neurobiological differences: pharmacokinetic response to substances, sensitivity to gonadal hormones, differences in neurobiological systems as glutamate, endocannabinoids, and genetic differences. SUMMARY: Specific research in women who use drugs is very scarce and treatments are not gender-sensitive oriented. For these reasons, it is important to guarantee access to the appropriate treatment of women who use drugs and a need for a gender perspective in the treatment and research of substance use disorders.

Personality Disorders in the ICD-11: Spanish Validation of the PiCD and the SASPD in a Mixed Community and Clinical Sample.

The International Classification of Diseases-11th revision (ICD-11) classification of personality disorders is the official diagnostic system that is used all over the world, and it has recently been renewed. However, as yet very few data are available on its performance. This study examines the Personality Inventory for ICD-11 (PiCD), which assesses the personality domains of the system, and the Standardized Assessment of Severity of Personality Disorder (SASPD), which determines severity. The Spanish versions of the questionnaires were administered to a community (n = 2,522) and a clinical sample (n = 797). Internal consistency was adequate in the PiCD (α = .75 to .84) but less so in the SASPD (α = .64 and .73). Factor analyses suggested a unidimensional or bidimensional structure for severity, while revealing that the personality trait qualifiers are organized into four factors: negative affectivity, detachment, dissociality, and a bipolar domain of disinhibition-anankastia. The mutual relationships between traits and severity were analyzed, as well as the ability of the whole system to identify clinical subjects. Although further improvements are required, the results generally support the use of the PiCD and the SASPD and help substantiate the new ICD-11 taxonomy that underlies them.

Cocaine and depressive disorders: When standard clinical diagnosis is insufficient. / Trastorno por uso de cocaína y depresión: Cuando el diagnóstico clínico no es suficiente.

BACKGROUND: Cocaine use is a growing global health problem and patients with cocaine use disorders (CUD) present several complications, including high rates of major depression. These subjects present two types of major depressive disorder (MDD): primary major depressive disorder (P-MDD) and cocaine-induced major depressive disorder (CI-MDD). To improve treatment, it is necessary to distinguish between both types. The aim of this study was to assess the differences in depressive symptomatology criteria (P-MDD vs CI-MDD) in CUD patients. METHODS: Secondary data analysis was carried out with a cross-sectional sample of 160 patients presenting CUD and MDD. Clinical assessment was performed using the Psychiatric Research Interview for Substance and Mental Disorders (PRISM). A differential diagnosis was obtained between P-MDD and CI-MDD. RESULTS: Men represented 80% of the sample, the mean age was 38.61 years, and 64.5% had elementary studies. CI-MDD diagnosis (61.3%) was more frequent than P-MDD (38.7%). There was a younger age of CUD onset in CI-MDD patients. In addition, 79.4% of the patients had another substance use disorder diagnosis. The criterion "Changes in weight or appetite" was more prevalent (57.1%) in P-MDD group. CONCLUSIONS: We found differences in the criterion "Changes in weight or appetite". Further research is needed in this field to establish a differential diagnosis and thus provide better treatment for CUD patients.

Antecedentes: El consumo de cocaína es un creciente problema de salud en todo el mundo. Además, los pacientes con trastorno por consumo de cocaína (TCC) presentan una alta comorbilidad con el trastorno depresivo mayor (TDM). Estos pacientes pueden presentar dos tipos de TDM: trastorno depresivo mayor primario (TDM-P) y trastorno depresivo mayor inducido por cocaína (TDM-IC). El objetivo de este estudio es evaluar las diferencias en la sintomatología depresiva (TDM-P vs. TDM- IC) en los pacientes con TCC para mejorar su tratamiento. Métodos: Se llevó a cabo un análisis secundario en una muestra transversal de 160 pacientes que presentaban TCC y algún TDM. La evaluación clínica, así como el diagnóstico diferencial entre TDM-P y TDM-IC, se realizó utilizando la entrevista PRISM. Resultados: Los hombres representaron el 80% de la muestra con una edad media de 38,61 años y el 64,5% sólo tenía estudios primarios. El diagnóstico de TDM-IC (61,3%) fue más frecuente que el de TDM-P (38,7%). Los pacientes con TDM-IC mostraron una edad de aparición más temprana para el TCC. El 79,4% de los pacientes cumplían criterios para otro trastorno por consumo de sustancias. Únicamente el criterio "Cambios en el peso o en el apetito" fue estadísticamente más prevalente (57,1%) en los pacientes con TDM-P. Conclusiones: Existen diferencias en el criterio "Cambios en el peso o en el apetito" entre TDM-P y TDM-IC. Se necesita más investigación a fin de obtener un diagnóstico diferencial entre los dos tipos de depresión y proporcionar un mejor tratamiento para los pacientes con TCC.

Trastorno por uso de cocaína y depresión: Cuando el diagnóstico clínico no es suficiente / Cocaine and depressive disorders: When standard clinical diagnosis is insufficient

Antecedentes: El consumo de cocaína es un creciente problema de saluden todo el mundo. Además, los pacientes con trastorno por consumode cocaína (TCC) presentan una alta comorbilidad con el trastornodepresivo mayor (TDM). Estos pacientes pueden presentar dos tipos deTDM: trastorno depresivo mayor primario (TDM-P) y trastorno depresivo mayor inducido por cocaína (TDM-IC). El objetivo de este estudio esevaluar las diferencias en la sintomatología depresiva (TDM-P vs. TDMIC) en los pacientes con TCC para mejorar su tratamiento. Métodos: Sellevó a cabo un análisis secundario en una muestra transversal de 160pacientes que presentaban TCC y algún TDM. La evaluación clínica,así como el diagnóstico diferencial entre TDM-P y TDM-IC, se realizóutilizando la entrevista PRISM. Resultados: Los hombres representaronel 80% de la muestra con una edad media de 38,61 años y el 64,5%sólo tenía estudios primarios. El diagnóstico de TDM-IC (61,3%) fuemás frecuente que el de TDM-P (38,7%). Los pacientes con TDM-ICmostraron una edad de aparición más temprana para el TCC. El 79,4%de los pacientes cumplían criterios para otro trastorno por consumo desustancias. Únicamente el criterio “Cambios en el peso o en el apetito” fueestadísticamente más prevalente (57,1%) en los pacientes con TDM-P.Conclusiones: Existen diferencias en el criterio “Cambios en el peso o en elapetito” entre TDM-P y TDM-IC. Se necesita más investigación a fin deobtener un diagnóstico diferencial entre los dos tipos de depresión yproporcionar un mejor tratamiento para los pacientes con TCC. (AU)

Background: Cocaine use is a growing global health problem and patients with cocaine use disorders (CUD) present several complications, including high rates of major depression. These subjects present two types of major depressive disorder (MDD): primary majordepressive disorder (P-MDD) and cocaine-induced major depressivedisorder (CI-MDD). To improve treatment, it is necessary to distinguish between both types. The aim of this study was to assess the differences in depressive symptomatology criteria (P-MDD vs CI-MDD)in CUD patients. Methods: Secondary data analysis was carried out witha cross-sectional sample of 160 patients presenting CUD and MDD.Clinical assessment was performed using the Psychiatric ResearchInterview for Substance and Mental Disorders (PRISM). A differential diagnosis was obtained between P-MDD and CI-MDD. Results: Menrepresented 80% of the sample, the mean age was 38.61 years, and64.5% had elementary studies. CI-MDD diagnosis (61.3%) was morefrequent than P-MDD (38.7%). There was a younger age of CUD onset in CI-MDD patients. In addition, 79.4% of the patients had anothersubstance use disorder diagnosis. The criterion “Changes in weight orappetite” was more prevalent (57.1%) in P-MDD group. Conclusions:We found differences in the criterion “Changes in weight or appetite”.Further research is needed in this field to establish a differential diagnosis and thus provide better treatment for CUD patients. (AU)

The Tryptophan System in Cocaine-Induced Depression.

Major depression disorder (MDD) is the most prevalent psychiatric comorbid condition in cocaine use disorder (CUD). The comorbid MDD might be primary-MDD (CUD-primary-MDD) or cocaine-induced MDD (CUD-induced-MDD), and their accurate diagnoses and treatment is a challenge for improving prognoses. This study aimed to assess the tryptophan/serotonin (Trp/5-HT) system with the acute tryptophan depletion test (ATD), and the kynurenine pathway in subjects with CUD-primary-MDD, CUD-induced-MDD, MDD and healthy controls. The ATD was performed with a randomized, double-blind, crossover, and placebo-controlled design. Markers of enzymatic activity of indoleamine 2,3-dioxygenase/tryptophan 2,3-dioxygenase, kynurenine aminotransferase (KAT) and kynureninase were also established. Following ATD, we observed a decrease in Trp levels in all groups. Comparison between CUD-induced-MDD and MDD revealed significant differences in 5-HT plasma concentrations (512 + 332 ng/mL vs. 107 + 127 ng/mL, p = 0.039) and the Kyn/5-HT ratio (11 + 15 vs. 112 + 136; p = 0.012), whereas there were no differences between CUD-primary-MDD and MDD. Effect size coefficients show a gradient for all targeted markers (d range 0.72-1.67). Results suggest different pathogenesis for CUD-induced-MDD, with lower participation of the tryptophan system, probably more related to other neurotransmitter pathways and accordingly suggesting the need for a different pharmacological treatment approach.

Inflammatory mediators and dual depression: Potential biomarkers in plasma of primary and substance-induced major depression in cocaine and alcohol use disorders.

Major depressive disorder (MDD) is the most prevalent comorbid mental disorder among people with substance use disorders. The MDD can be both primary and substance-induced and its accurate diagnosis represents a challenge for clinical practice and treatment response. Recent studies reported alterations in the circulating expression of inflammatory mediators in patients with psychiatric disorders, including those related to substance use. The aim of the study was to explore TNF-α, IL-1ß, CXCL12, CCL2, CCL11 (eotaxin-1) and CX3CL1 (fractalkine) as potential biomarkers to identify comorbid MDD and to distinguish primary MDD from substance-induced MDD in patients with substance disorders. Patients diagnosed with cocaine (CUD, n = 64) or alcohol (AUD, n = 65) use disorders with/without MDD were recruited from outpatient treatment programs [CUD/non-MDD (n = 31); CUD/primary MDD (n = 18); CUD/cocaine-induced MDD (N = 15); AUD/non-MDD (n = 27); AUD/primary MDD (n = 16) and AUD/alcohol-induced MDD (n = 22)]. Sixty-two healthy subjects were also recruited as control group. Substance and mental disorders were assessed according to "Diagnostic and Statistical Manual of Mental Disorders, 4th edition, text revision" (DSM-IV-TR) and a blood sample was collected for determinations in the plasma. The cocaine group showed lower TNF-α (p<0.05) and CCL11 (p<0.05), and higher IL-1ß (p<0.01) concentrations than the control group. In contrast, the alcohol group showed higher IL-1ß (p<0.01) and lower CXCL12 (p<0.01) concentrations than the control group. Regarding MDD, we only observed alterations in the cocaine group. Thus, CUD/MDD patients showed lower IL-1ß (p<0.05), CXCL12 (p<0.05) and CCL11 (p<0.05), and higher CXC3CL1 (p<0.05) concentrations than CUD/non-MDD patients. Moreover, while CUD/primary MDD patients showed higher CCL11 (p<0.01) concentrations than both CUD/non-MDD and CUD/cocaine-induced MDD patients, CUD/cocaine-induced MDD patients showed lower CXCL12 (p<0.05) concentrations than CUD/non-MDD patients. Finally, a logistic regression model in the cocaine group identified CXCL12, CCL11 and sex to distinguish primary MDD from cocaine-induced MDD providing a high discriminatory power. The present data suggest an association between changes in inflammatory mediators and the diagnosis of primary and substance-induced MDD, namely in CUD patients.

Dual diagnosis in Depression: treatment recommendations. / Patología dual en Depresión: recomendaciones en el tratamiento.

Comorbidity between substance use disorders (SUD) and major depression (MD) is the most common dual pathology in the field of addiction to substances and has prevalence rates ranging between 12% and 80%, which complicates the response to treatment and worsens the prognosis of patients. Differentiating between diagnoses of induced depressive episodes and primary depressive episodes concurrent to substance use is especially relevant for therapeutic management. This article presents the state of the art of the currently available pharmacologic treatments of comorbid depression in patients with SUD, taking into account the safety and risk of abuse of antidepressant drugs. Due to the fact that comorbidity of MD and SUD is frequent and presents greater psychopathological and medical severity, as well as worse social functioning, it is crucial to treat MD and SUD simultaneously using the integrated treatment model and not to treat both conditions separately.

La comorbilidad entre los trastornos por uso de sustancias (SUD) y la depresión mayor (DM) es la patología dual más común en el campo de las adicciones a sustancias, con prevalencias que oscilan entre el 12 y el 80% complicando la respuesta al tratamiento y empeorando el pronóstico de los pacientes. Diferenciar entre el diagnóstico de episodios depresivos inducidos y episodios depresivos primarios concurrentes al uso de sustancias es especialmente relevante para el manejo terapéutico. En este artículo se presenta el estado actual de los tratamientos farmacológicos disponibles hasta el momento para la depresión comórbida en pacientes con SUD, teniendo en cuenta la seguridad y el potencial de abuso de los fármacos antidepresivos. Debido a que la comorbilidad de DM y SUD es frecuente y a que estos pacientes presentan mayor gravedad psicopatológica y peor funcionamiento social, es crucial un modelo de tratamiento integrado y no abordar el tratamiento por separado.

Patología dual en Depresión: recomendaciones en el tratamiento / Dual diagnosis in Depression: treatment recommendations

La comorbilidad entre los trastornos por uso de sustancias (SUD) y la depresión mayor (DM) es la patología dual más común en el campo de las adicciones a sustancias, con prevalencias que oscilan entre el 12 y el 80% complicando la respuesta al tratamiento y empeorando el pronóstico de los pacientes. Diferenciar entre el diagnóstico de episodios depresivos inducidos y episodios depresivos primarios concurrentes al uso de sustancias es especialmente relevante para el manejo terapéutico. En este artículo se presenta el estado actual de los tratamientos farmacológicos disponibles hasta el momento para la depresión comórbida en pacientes con SUD, teniendo en cuenta la seguridad y el potencial de abuso de los fármacos antidepresivos. Debido a que la comorbilidad de DM y SUD es frecuente y a que estos pacientes presentan mayor gravedad psicopatológica y peor funcionamiento social, es crucial un modelo de tratamiento integrado y no abordar el tratamiento por separado

Comorbidity between substance use disorders (SUD) and major depression (MD) is the most common dual pathology in the field of addiction to substances and has prevalence rates ranging between 12% and 80%, which complicates the response to treatment and worsens the prognosis of patients. Differentiating between diagnoses of induced depressive episodes and primary depressive episodes concurrent to substance use is especially relevant for therapeutic management. This article presents the state of the art of the currently available pharmacologic treatments of comorbid depression in patients with SUD, taking into account the safety and risk of abuse of antidepressant drugs. Due to the fact that comorbidity of MD and SUD is frequent and presents greater psychopathological and medical severity, as well as worse social functioning, it is crucial to treat MD and SUD simultaneously using the integrated treatment model and not to treat both conditions separately

Dual diagnosis: an European perspective. / Patología dual: una perspectiva europea.

Editorial of vol 29-1.

Editorial del vol 29-1.

A Biomarker to Differentiate between Primary and Cocaine-Induced Major Depression in Cocaine Use Disorder: The Role of Platelet IRAS/Nischarin (I1-Imidazoline Receptor).

The association of cocaine use disorder (CUD) and comorbid major depressive disorder (MDD; CUD/MDD) is characterized by high prevalence and poor treatment outcomes. CUD/MDD may be primary (primary MDD) or cocaine-induced (CUD-induced MDD). Specific biomarkers are needed to improve diagnoses and therapeutic approaches in this dual pathology. Platelet biomarkers [5-HT2A receptor and imidazoline receptor antisera selected (IRAS)/nischarin] were assessed by Western blot in subjects with CUD and primary MDD (n = 16) or CUD-induced MDD (n = 9; antidepressant free, AD-; antidepressant treated, AD+) and controls (n = 10) at basal level and/or after acute tryptophan depletion (ATD). Basal platelet 5-HT2A receptor (monomer) was reduced in comorbid CUD/MDD subjects (all patients: 43%) compared to healthy controls, and this down-regulation was independent of AD medication (decreases in AD-: 47%, and in AD+: 40%). No basal differences were found for IRAS/nischarin contents in AD+ and AD- comorbid CUD/MDD subjects. The comparison of IRAS/nischarin in the different subject groups during/after ATD showed opposite modulations (i.e., increases and decreases) in response to low plasma tryptophan levels with significant differences discriminating between the subgroups of CUD with primary MDD and CUD-induced MDD. These specific alterations suggested that platelet IRAS/nischarin might be useful as a biomarker to discriminate between primary and CUD-induced MDD in this dual pathology.

Patología dual: una perspectiva europea / Dual diagnosis: an European perspective

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Can symptoms help in differential diagnosis between substance-induced vs independent psychosis in adults with a lifetime diagnosis of cocaine use disorder?

The main goal of this study it is explore the psychopathological differences between IPD and SIPD in a sample of 125 adults with a lifetime diagnosis of cocaine disorder recruited from treatment setting and through street contacts. A secondary analysis of six cross-sectional studies was conducted between 2000 and 2010. SIPD and IPD were diagnosed using the Psychiatric Research Interview for Substance and Mental Disorders (PRISM). 38 subjects (30.4%) were diagnosed with lifetime IPD and 87 (69.6%) with lifetime SIPD. A binomial logistic regression analysis using SIPD as the reference group showed that only previous prison admissions (OR 2.59; 95% CI 1.05, 6.36) and visual hallucinations (OR 5.21; 95% CI 1.54, 17.65) remained significant variables in the group with lifetime SIPD. In the group with lifetime IPD, grandiose delusions (OR 0.19; 95% CI 0.06, 0.60) and disorganized speech (OR 0.16; 95% CI 0.04, 0.61) remained significant. Model predicts the diagnosis of lifetime SIPD with a sensitivity of 80.3% and a specificity of 78.2%. This clinical profile of lifetime SIPD could help distinguish between IPD and SIPD among adults with lifetime diagnosis of cocaine disorder.

Dual diagnosis screening interview to identify psychiatric comorbidity in substance users: development and validation of a brief instrument.

AIM: The objective of this study was to develop and validate a brief tool, the Dual Diagnosis Screening Instrument (DDSI), to screen psychiatric disorders in substance users in treatment and nontreatment-seeking samples. METHODS: A total of 827 substance users (66.5% male, mean age 28.6±9.9 years) recruited in treatment (in- and outpatient) and nontreatment (substance user volunteers in university research studies) settings were assessed by trained interviewers using the DDSI and the Psychiatric Research Interview for Substance and Mental Disorders (PRISM) as the criterion standard. Both instruments were administered blind to the results of the other. Disorders obtained with the DDSI were compared to lifetime diagnoses obtained with the PRISM. Sensitivity, specificity, negative, and positive predictive values were estimated. Also test-retest reliability of the DDSI was assessed. RESULTS: The DDSI showed a high sensitivity (≥80%) for identifying lifetime depression, mania, psychosis, panic, social phobia, and specific phobia disorders. Specificity was ≥82% for those diagnoses. Test-retest κ showed excellent agreement (range 81-95%). The mean duration of the DDSI administration was 16.8±2.5 min. CONCLUSION: The DDSI is a valid and easy-to-administer screening tool to detect possible psychiatric comorbidity among substance users.