Diagnosing comorbidity in substance abusers. Computer assessment and clinical validation

Abstract

This study compares DSM-III-R lifetime diagnoses assigned to a sample of substance abusers in treatment made by the Computerized Diagnostic Interview Schedule (C-DIS) with those made by clinicians on the basis of the Structured Clinical Interview for DSM-III-R (SCID) and patient chart information. A sample of 173 subjects were interviewed with the C-DIS and then by a clinician using the SCID. A second SCID was administered by a different clinician to 80 of the subjects 1 to 2 weeks later and consensus diagnoses were then made using all available information. With the exception of antisocial personality disorder and most psychoactive substance use disorders, the initial C-DIS showed poor diagnostic agreement with the initial SCID. As a potential screening instrument, the C-DIS did identify 30 of the 32 subjects with a consensus axis I (nondrug) disorder, but diagnosed twice as many positives as were confirmed by the consensus diagnoses. A negative C-DIS for comorbid disorders was confirmed in 9 out of 10 cases by clinicians.