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The aim of this study was to examine the accuracy of patients’ accounts of their psychoactive substance use in the week before admission to an acute mental health unit. Fifty consecutively admitted patients undertook a semistructured clinician-administered questionnaire for recent substance use. The results of the interview were compared to the results of gas chromatography mass spectrometry/ mass spectrometry. No patient refused to participate, 46 patients were able to complete the interview, and 48 patients provided a blood sample. Six patients had unreported cocaine or amphetamine in their blood. Cannabis and opiates were not detected in the blood of most of the patients who reported using these drugs. The self-reports of the use of prescription sedatives were inaccurate, but self-reports of recent use of caffeine, nicotine, antidepressants, antipsychotics, and carbamazepine had good overall reliability. Patient reports of recent illicit substance use at the point of admission were found to be unreliab...