Screening for mental disorder comorbidity in Australian alcohol and other drug residential treatment settings

Addiction treatment guidelines recommend routinely screening for cooccurring mental disorders. Improvement in the identification of clients with psychiatric comorbidity has been prioritized because of the negative consequences of failing to detect it. There is a lack of research on the prevalence of co-occurring mental disorders in residential alcohol and other drug treatment services. There is need for research that validates and compares the short screening measures used to identify cooccurring mental disorders in alcohol and other drug treatment participants. In Study 1, the mental disorder status of 278 participants resident in alcohol and other drug treatment settings in Australia was estimated using the Addiction Severity Index—Self Report (Cacciola, Pecoraro, & Alterman, 2008) and the Mental Health Screening Form III (Carroll & McGinley, 2001). The estimated rate of diagnosable Axis I mental disorder comorbidity varied from 64% to 71% depending upon the cutoff score used. Due to the high estimated rates of comorbid mental disorder the prevalence and taxonomy of mental disorder comorbidity in residential alcohol and other drug treatment services was then assessed in Study 2 using a semi-structured interview. Study 2 involved administration of five commonly used mental disorder screening instruments validated against the Structured Clinical Interview for DSM-IV-TR Axis I Disorders (First, Spitzer, Gobbon, & Williams, 2002). Participants were 124 randomly selected clients with alcohol and other drug problems attending residential recovery services of The Salvation Army. Presence of comorbid Axis I mental disorder(s), total scores on the Psychiatric Status domain of the Addiction Severity Index, the Mental Health Screening Form III, the Self-Reporting Questionnaire 20, the Self-Reporting Questionnaire 25 and the Modified Mini Screen were recorded. Lifetime prevalence of any comorbid Axis I disorder was 87.5% and 30-day prevalence was 73.3%. More than 19% of participants met full criteria for a psychotic disorder over the previous 30 days. Among the short screening measures validated the Modified Mini Screen and the Mental Health Screening Form III displayed high sensitivity, high negative predictive values and high area under the curve scores. Psychiatric comorbidity exists in almost eight-out-of-ten clients in residential alcohol and other drug treatment services. Psychotic disorders are particularly prevalent when compared to the general population (19% vs. 0.45%) (Morgan et al., 2011). The findings suggest a need for integrated treatment of comorbid disorders, strong linkages between alcohol and other drug treatment services and psychological services and training for alcohol and other drug treatment workers to better address comorbidity