The use of screening instruments for detecting alcohol and other drug use disorders in first-episode psychosis Ragnar Nesvåg a,b, ⁎, Elisabeth H. Lange b,c , Ann Færden d , Elizabeth Ann Barrett e , Björn Emilsson b,f , Petter Andreas Ringen e , Ole A. Andreassen b,d , Ingrid Melle d , Ingrid Agartz b,c a Department of Psychiatry, Diakonhjemmet Hospital, Oslo, Norway b Department of Psychiatry, University of Oslo, Norway c Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway d Department of Psychiatry, Oslo University Hospital, Ullevål, Oslo, Norway e Department of Mental Health, Oslo University Hospital, Aker, Oslo, Norway f Faculty of Health Sciences, University of Linköping, Linköping, Sweden abstract article info Article history: Received 6 November 2009 Received in revised form 12 January 2010 Accepted 22 January 2010 Keywords: Psychoses Alcohol Psychometrics Psychostimulants The high rate of drug abuse among patients with psychosis represents a challenge to clinicians in their treatment of the patients. Powerful screening tools to detect problematic drug use in an early phase of psychotic illness are needed. The aim of the present study was to investigate prevalence of drug use disorders and psychometric properties of the Alcohol Use Disorder Identification Test (AUDIT) and the Drug Use Disorder Identification Test (DUDIT) in 205 first-episode psychosis patients in Oslo, Norway. Internal consistency of the instruments and criterion-based validity as compared to a current DSM-IV diagnosis of abuse or dependence of alcohol or other drugs were analyzed. Fifteen percent of the men and 11% of the women had a DSM-IV diagnosis of alcohol use disorders while 33% of the men and 16% of the women had non-alcohol drug use disorders. The instruments were reliable (Cronbach's alpha above 0.90) and valid (Area under the curve above 0.83). Suitable cut-off scores (sensitivity N 0.80 and specificity N 0.70) were ten for men and eight for women on AUDIT and three for men and one for women on DUDIT. The results of this study suggest that AUDIT and DUDIT are powerful screening instruments for detecting alcohol and other drug use disorders in patients with first-episode psychosis. © 2010 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Among patients with schizophrenia and other psychotic disorders there is a high prevalence of alcohol and other drug use disorders, in some studies found to be as high as 50% (Regier et al., 1990; Cantor- Graae et al., 2001; Margolese et al., 2004; Swartz et al., 2006). A high prevalence of substance use disorders has also been found in patients with first-episode psychosis (Larsen et al., 2006; Addington and Addington, 2007; Petersen et al., 2007). In terms of course and outcome, substance use disorders have been associated with a range of negative factors, including more positive symptoms (Buhler et al., 2002; Mauri et al., 2006), higher number of hospitalisations (Cantor- Graae et al., 2001; Salyers and Mueser, 2001), poorer treatment response and poorer outcome (DeQuardo et al., 1994; Buhler et al., 2002; Kavanagh et al., 2004), although this has not been found by all (Mueser et al., 1990; Zisook et al., 1992). On the other hand, some studies have demonstrated that first-episode patients with a co-morbid drug use disorder experience less severe negative symptoms (Salyers and Mueser, 2001) and better neurocognitive functioning (McCleery et al., 2006) as compared to patients without drug use disorders. Systematic screening may enhance detection of drug use disorders among patients with psychiatric disorders (Appleby et al., 1997). The most commonly used screening tests for alcohol use disorders are the Michigan Alcohol Screening test (MAST) (Selzer, 1971) and the CAGE questionnaire (Ewing, 1984), while the Drug Abuse Screening Test (DAST) (Skinner, 1982) has been widely used for detecting non- alcohol drug use disorders. In a study of patients with severe mental illness, MAST, CAGE and DAST were all found to discriminate well between patients with and without a co-morbid drug use disorder (Wolford et al., 1999). In addition, the CAGE questionnaire has been evaluated in patients with mood disorders (Agabio et al., 2007), and DAST has been evaluated among patients with ADHD (McCann et al., 2000). The MAST and the CAGE questionnaires were primarily focused on detecting alcoholism, i.e. alcohol dependence. During the last two decades, there has been an increasing emphasis on proactive detection of problematic alcohol consumption before it has developed to alcohol dependence. Accordingly, the World Health Organization Collaborative Project on Early Detection of Persons with Harmful Psychiatry Research 177 (2010) 228–234 ⁎ Corresponding author. Department of Psychiatry, Diakonhjemmet Hospital, P.O. Box 85, Vinderen, N-0319 Oslo, Norway. Tel.: +47 22 02 98 63; fax: +47 22 02 98 01. E-mail address: ragnar.nesvag@medisin.uio.no (R. Nesvåg). 0165-1781/$ – see front matter © 2010 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.psychres.2010.01.007 Contents lists available at ScienceDirect Psychiatry Research journal homepage: www.elsevier.com/locate/psychres