Screening and Assessment of Co-Occurring Disorders in the Justice ...

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instruments for co-occurring disorders should be administered concurrently withdrug testing and examination of collateral information.Key Issues in Selecting Screening InstrumentsThere are several key issues in selecting screening instruments:• y Reliability. Reliability of screening instruments can be difficult to achievebecause individuals with co-occurring disorders often present a changingdiagnostic picture due to the influence of intoxication and withdrawal.• y Validity. Many standardized mental health and substance abuseinstruments are not sensitive to or specific in identifying co-occurringdisorders. Sensitivity refers to an ability to identify individuals withmental health or substance abuse problems, or both, while specificity refersto an ability to identify individuals without such problems.• y Use in Criminal Justice Settings. Not all mental health or substanceabuse instruments have been validated for use within criminal justicesettings, although a growing number of studies have been conducted inthese settings.Comparing Mental Health Screening InstrumentsAs part of the National Institute on Drug Abuse (NIDA) Criminal Justice–DrugAbuse Treatment Studies (CJ-DATS) network, a multisite study was conductedto identify a reliable and valid brief instrument to screen justice-involvedindividuals for co-occurring disorders. Criteria established for the screeninginstruments were that they be brief, have good psychometric properties, notrequire specialized training, and be available in the public domain. Key steps inthis process have included: (1) identification of potential co-occurring disordersscreening instruments, (2) review of instruments and screening approach bystakeholders and national experts, (3) instrument selection and modification, (4)pilot testing to determine the psychometric properties (i.e., reliability, validity) ofthe instruments and optimal cutoff scores, and (5) a validation study to determinethe effectiveness of a particular instrument or set of instruments (Sacks et al., inpress).Following an initial review of instruments, the CJ-DATS study identified theTexas Christian University Drug Screen (TCUDS) as the most effective availablesubstance abuse screen. A study was then conducted to identify the most effectivemental health screening instrument for use with individuals, to be coupled withthe TCUDS to form a co-occurring disorders screening instrument. The GlobalAppraisal of Needs–Short Screener (GAIN-SS), the Mental Health ScreeningForm-III, and the MINI International Neuropsychiatric Interview–Modified(MINI) were selected for inclusion in the study, and results of these screens werecompared to the SCID diagnostic interview, which served as the criterion measure.The effectiveness of these mental health screening instruments was examined byadministering the instruments and the criterion measure to individuals enrolled inprison-based substance abuse treatment services.31
The MHSF-III and the GAIN-SS were found to have somewhat higher overallaccuracy than the MINI, and significantly higher sensitivity than the MINIin detecting any mental disorder, including all Axis I and II disorders, amongindividuals (Sacks et al., in press). Each mental health screening instrumentperformed adequately in detecting severe mental disorder (i.e., major depression,schizophrenia, bipolar disorder). The screening instruments were found to havesomewhat higher overall accuracy among male offenders.Two very brief mental health screening instruments were also derived from thestudy and were identified as potentially promising for use with justice-involvedindividuals (Sacks et al., in press). These included a six-item screen for “anymental disorder,” comprising items from the GAIN, the MINI, and the MHSF-III; and a three-item screen for “severe mental disorder,” composed of questionsfrom the MHSF-III and the MINI. These brief screens performed about as well asthe MHSF-III, the GAIN-SS, and the MINI in detecting mental disorders in theCJ-DATS study. Additional research will be needed to validate the utility of thesebrief screening instruments.Appendix E, F, and G provide additional information regarding recommendedmental health screening instruments for use in detecting co-occurring disorders,and Appendix G provides a detailed critical review of available screeninginstruments for mental disorders.Comparing Substance Use Screening InstrumentsIn a study examining the comparative validity of substance abuse screeninginstruments in prisons, three instruments were found to be the most effective inidentifying individuals with substance dependence problems:•y Alcohol Dependence Scale and Addiction Severity Index–Drug Use section(this was a combined instrument, consisting of the ADS and the ASI-DrugUse section)•y Simple Screening Instrument (SSI)•y Texas Christian University Drug Dependence Screen (TCUDS)(Peters et al., 2000)These instruments outperformed several other screens, including the MichiganAlcoholism Screening Test (MAST)–Short version, the ASI–Alcohol Use section,the Drug Abuse Screening Test (DAST-20), and the Substance Abuse SubtleScreening Inventory (SASSI-2) on key measures of positive predictive value,sensitivity, and overall accuracy.Appendix E, F, and H provide additional information regarding recommendedsubstance abuse screening instruments for use in detecting co-occurring disorders,and Appendix H provides a detailed critical review of available screeninginstruments for substance use disorders.32
Page 1: Screening and Assessmentof Co-Occur
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Page 32 and 33: should be determined by the severit
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Concerns•y The validity of the SS
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Appendix I: Recommended Instruments
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Concerns•y•y•y•yReliabiliti
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•y•y•y•yScales and profile
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•y•yand non-interpretable resul
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Appendix L: Assessment Instruments
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Philadelphia, PA 19106, (215) 399-0
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treatment setting. Treatment progra
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Concerns•y•y•yThe CIDI is qui
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•y•y•yThe PDSQ has been used
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Both a Research Version and a Clini
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Bastiaens, L., Riccardi, K., & Sakh
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Carey, K. B., Carey, M. P., & Chand
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Demmel, R., Beck, B., Richter, D.,
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Gray, B. T. (2001). A factor analyt
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Kessler, R. C., Wittchen, H. U., Ab
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McLellan, A. T., Cacciola, J. S., &
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Nochajski, T. H., & Stasiewicz, P.
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Rollnick, H., Heather, N., Gold, R.
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Teitelbaum L. M., & Mullen, B. (200
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Zimmerman, M., & Sheeran, T. (2003)
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