Validation of the Alcohol Use Disorders Identification Test and the Drug Abuse Screening Test in First Episode Psychosis

Objective: To determine the validity and reliability of the Alcohol Use Disorders Identification Test (AUDIT) and Drug Abuse Screening Test (DAST) for detecting alcohol and drug use disorders, respectively, in a population with first-episode psychosis (FEP). Method: Subjects with FEP completed the AUDIT and DAST and were divided into groups according to me presence or absence of a Structured Clinical Interview for DSM-IV (SCID) diagnosis of either current alcohol or drug misuse. The data were analyzed to see whether AUDIT and DAST scores were predictive of SCID diagnosis. Results: Patients with alcohol-related SCID diagnoses and those with drug-related SCID diagnoses scored significantly higher on the AUDIT and DAST, respectively, than the group without the respective SCID diagnosis (P Conclusion: The DAST and AUDIT may reliably identify FEP patients with substance abuse. Can J Psychiatry 2007;53(1):26-33 Information on funding and support and author affiliations appears at the end of the article. Clinical Implications * Given the efficacy of the AUDIT and DAST in patients with FEP, clinicians should be able to screen for substance use disorders quickly and regularly, with minimal burden on resources. * This might promote better monitoring of substance use disorders in this population, which is prone to adverse consequences from such use. * These instruments function better in a population with FEP when cut-off scores are altered to better suit this population. Limitations * AUDIT cut-off points are less precise because there were few subjects with problem drinking. A slightly larger sample might have helped in this regard. * One-third of the total catchment area sample either refused treatment and (or) refused consent to participate in this study, limiting somewhat the generalizability of these findings. Data analyzed derived solely from scores on the AUDIT and DAST administered to patients at baseline. Other time points in treatment were not examined. Key Words: early psychosis, substance abuse, screening instruments The rates of substance use in FEP populations vary widely but are generally very high, ranging from 35% to 73%. 1-5 The most commonly misused substances in FEP are cannabis and alcohol, with rates of cannabis misuse ranging from 25% to 63% and rates of alcohol misuse ranging from 24% to 28%.1,2,5 It is critical that substance use be addressed in FEP because it has been associated with medication nonadherence, symptom exacerbation, and higher rates of relapse in this population.6-9 There is also evidence that interventions to reduce substance use are more effective in a population with early psychosis, compared with populations having a longer history of psychotic illness, perhaps because substance use is less consolidated at this early stage.10,11 In most clinical settings, it is not feasible to conduct detailed structured diagnostic assessments to determine die presence of comorbidity with alcohol and other substance abuse in a young patient population seeking treatment for the first time. Brief screening tools may be of particular value in this regard. The AUDIT and DAST are brief self-report instruments designed, respectively, to screen for alcohol and other substance use disorders in the general population.12,13 They have previously been effectively applied in various psychiatric populations.14-19 Although some of these studies involved heterogeneous populations of psychiatric patients, including mose diagnosed with schizophrenia, only the AUDIT has been previously applied specifically to a population with schizophrenia. …