Screening and Assessment of Co-Occurring Disorders in the Justice ...
Screening and Assessment of Co-Occurring Disorders in the Justice ...
Screening and Assessment of Co-Occurring Disorders in the Justice ...
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Appendix J: <strong>Assessment</strong> Instruments ThatAddress Both Mental <strong>and</strong> Substance Use<strong>Disorders</strong>Psychiatric Research Interview for Substance <strong>and</strong> Mental <strong>Disorders</strong>(PRISM)The PRISM is a semi-structured <strong>in</strong>terview designed to address <strong>the</strong> problem<strong>of</strong> diagnos<strong>in</strong>g psychopathology people who abuse substances. The <strong>in</strong>strumentrequires approximately 90 m<strong>in</strong>utes to adm<strong>in</strong>ister. As a result <strong>of</strong> <strong>the</strong> <strong>in</strong>creas<strong>in</strong>grecognition <strong>of</strong> <strong>the</strong> relevance <strong>of</strong> co-occurr<strong>in</strong>g mental <strong>and</strong> substance use disorders,DSM-IV emphasizes <strong>the</strong> importance <strong>of</strong> dist<strong>in</strong>guish<strong>in</strong>g between substance-<strong>in</strong>ducedpsychiatric symptoms related to active use <strong>and</strong> withdrawal, <strong>and</strong> “primary”psychiatric disorders (Samet, Nunes, & Has<strong>in</strong>, 2004). S<strong>in</strong>ce specific guidel<strong>in</strong>esfor <strong>the</strong>se diagnostic decisions did not exist prior to DSM-IV, <strong>the</strong>re were problemswith reliability <strong>and</strong> validity <strong>of</strong> mental health diagnoses among people who abusedsubstances. The PRISM exam<strong>in</strong>es current <strong>and</strong> lifetime substance abuse <strong>and</strong>dependence, Axis I mental disorders, <strong>and</strong> borderl<strong>in</strong>e <strong>and</strong> antisocial personalitydisorders. The substance use sections are presented prior to o<strong>the</strong>r diagnosticsections. Therefore, <strong>the</strong> <strong>in</strong>terviewer has <strong>the</strong> substance use history <strong>in</strong>formationavailable when assess<strong>in</strong>g mental disorders.Positive Features•y The PRISM addresses <strong>the</strong> problem <strong>of</strong> diagnos<strong>in</strong>g depression <strong>in</strong> people whoabuse substances•y The PRISM has excellent reliability for current primary major depression(Has<strong>in</strong>, Samet, Nunes, Mateseoane, & Waxman, 2006)•y Severity measures, consist<strong>in</strong>g <strong>of</strong> a cont<strong>in</strong>uous rat<strong>in</strong>g <strong>of</strong> <strong>the</strong> number <strong>of</strong>symptoms present, are provided for some Axis I disorders such as MajorDepressive Disorder <strong>and</strong> Substance Dependence•y For higher prevalence categories <strong>of</strong> DSM-IV substance dependence, suchas alcohol, coca<strong>in</strong>e or cannabis, reliability is good to excellent (alpha =.72–.97; Has<strong>in</strong> et al., 2006)•y The <strong>in</strong>strument dist<strong>in</strong>guishes between primary <strong>and</strong> substance-<strong>in</strong>duceddisorders•y A Spanish version <strong>of</strong> <strong>the</strong> PRISM is available <strong>and</strong> appears to have someadvantages over <strong>the</strong> Spanish version <strong>of</strong> <strong>the</strong> SCID <strong>in</strong> diagnos<strong>in</strong>g majordepression <strong>and</strong> borderl<strong>in</strong>e personality disorders among people who abusesubstances (Torrens, Serrano, Astals, Pérez-Domínguez, & Martín-Santos,2004)•y The PRISM was tested us<strong>in</strong>g a racially/ethnically diverse sample85
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