Chapter 9

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

Ingmar H.A. Franken, M. Sc.

Vincent M. Hendriks, Ph.D.

In the past two decades, the prevalence of comorbid psychopathological disorders in the population of substance abuse patients has received ample attention. 1,2 Studies indicate that the prevalence of co-occurring Axis I and Axis II disorders in substance abuse patients is high. 2,3 Moreover, these studies show that anxiety and mood disorders are the most prevalent comorbid Axis I disorders in this population. Patients with this psychiatric comorbidity have worse response rates in substance abuse treatment compared to patients with a substance abuse disorder only. 1,4,5 In addition, studies show that patients with poorer psychiatric functioning have increased risk for dropout during substance abuse treatment. 6 To adequately treat these co-occurring psychiatric disorders and consequently reduce substance abuse treatment dropout rates and improve outcome, it is of major importance to screen for these disorders early in treatment.

There are several methods for diagnosing psychiatric morbidity. The most common methods are psychiatric interviewing and (semi) structured interviewing. Psychiatric interviewing by a psychiatrist and the administration of structured interviews, such as the Composite International Diagnostic Interview (CIDI) 7 and the Structured Clinical Interview for DSM-III-R (SCID), 8 are time-consuming and therefore are often not applicable as standard assessments for all admissions in substance abuse services. In addition, the availability of trained psychiatric staff is often limited in substance abuse treatment services. 9 The result is that only small proportions of patients in substance abuse treatment services are being

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