Development of a brief screen for substance misuse amongst people with severe mental health problems living in the community

Abstract

Background: The only specific screening tool for substance misuse by people with severe mental health problems is the Dartmouth Assessment of Lifestyle Instrument (DALI), which was not developed for use amongst community-based people.

Aim: To use the DALI to develop a brief community screen to detect the possibility of harmful substance use (N = 216 people with psychosis).

Method: Anglicized versions of the DALI (DALI-UK), and the DALI adapted to accommodate changing patterns of drug use (DALI-MOD) were validated against criterion measures of substance misuse. Data from 160 patients were analysed to find which items best predicted problematic alcohol and drug use. A validation group (n = 56) was used to evaluate the scoring system and develop a short version.

Results: Using logistic regression, a single item predicted our criterion measure for alcohol problems and two items predicted our criterion measure for drug problems. We developed the Simple Substance Use Screening Scale (SUSS), which correctly classified 86% of participants for problematic alcohol use (sensitivity 88%, specificity 84%) and 84% for problematic drug use (sensitivity 82%, specificity 84%).

Conclusion: Because of its brevity and simplicity, SUSS would be a useful screen for use in routine community mental health practice.

Keywords:

• Comorbidity
• dual diagnosis
• severe mental illness
• substance abuse detection