Substance use disorders in patients admitted to a medium secure unit: A comparison of three assessment measures

Abstract

The presence of co-morbid substance use disorders among individuals suffering from a severe mental illness has an adverse effect on risk-related behaviour and prognostic indicators. Using a multi-assessment approach, the study examined the prevalence and risk consequences of substance use disorders in the population of a medium secure unit, by comparing the assessments of professionals and the participants' self-reports. A sample of 58 inpatients was assessed using the severity of dependence scale (SDS), clinician rating scales (CRS), and a case-note questionnaire. For each assessment tool, a majority of the sample recorded a history of substance use disorder and risk-relevant substance use. The morbidity related to individual substances varied and there was support for the self-medication hypothesis of secondary substance misuse. Subjects identified by professionals as having problematic substance use appeared to have disproportionately avoided participation in the study, whereas the professionals did not differ significantly in their diagnosis of rates of substance use disorder. A multi-assessment approach enables a more comprehensive assessment of substance use disorders within a forensic population and this study further highlights the importance of developing therapeutic strategies for dual diagnosis patients.