Prevalence and severity of substance misuse among referrals to a local forensic service

Abstract

Substance misuse is frequently present alongside mental illness and personality disorder, complicating all aspects of management. We describe self-reported levels of substance misuse in referrals to a forensic psychiatry service, to establish degrees of dependency and co-morbidity with other diagnostic categories and to report the implications for treatment. There were 146 (70%) of 209 consecutive referrals who completed a semi-structured questionnaire, including the Alcohol Use Disorders Identification Test (AUDIT), Severity of Alcohol Dependency Questionnaire (SADQ), Alcohol Problem Questionnaire (APQ) and, for frequent users of opiates or stimulants, the Severity of Dependence Scales (SDS). Psychiatric diagnoses were made from clinical assessment using the International Classification of Diseases (World Health Organization, 1992). ICD-10 diagnoses of substance misuse were found in 83 (57%) subjects. A combination of mental illness and a substance misuse diagnosis was found in 54 (37%). The subgroup accepted into forensic psychiatric services was found to have higher levels of co-morbidity, although levels of dependency were low. Forensic services need expertise in assessing drugrelated morbidity; in motivational interviewing and other techniques for encouraging change; and in consolidating recovery.

Keywords:

• Substance Misuse
• Co-MORBIDITY
• Severity Of Dependency
• Inpatient Management