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Predicting the dual diagnosis client among substance abusers using demographic and substance -related variables

Jerry B. Gulledge, University of Nebraska - Lincoln


The concept of dual diagnosis emerged in the 1980s following the era of deinstitutionalization as health providers began to address the issues of individuals with substance use disorders co-occurring with other mental illnesses. Since 1990, there has been a steady recognition of the links between substance use disorders and negative outcomes for dual diagnosis clients, especially the high rate of substance relapse due to undiagnosed and therefore untreated comorbid psychiatric disorders. The assessment process for dual diagnosis must begin at first entry into services for substance abuse treatment in order to increase the prognosis for recovery. ^ The ultimate goal of the present study was to develop a screening instrument that would identify those clients being admitted into a substance abuse treatment program that were likely to have a co-occurring psychiatric disorder. The Screening Tool for the Identification of Dual Diagnosis (STIDD) utilizes clients' responses to 14 questions related to non-threatening demographic characteristics and substance-related factors. The model selected correctly predicted 37.5% of the dual diagnosis clients, a rate higher than what would have been accomplished with chance reassignment, with a lower number of chance false positives. ^ This research utilized an archived database of all adult admissions into state-funded substance abuse treatment centers in Nebraska over a five-year period. After excluding non-treatment and multiple admissions, 21,633 unique client records were analyzed. Fourteen variables were used as predictors to obtain a logistic regression formula that would indicate the clients' likelihood of belonging to two groups: dual diagnosis or substance abuse only. The best predictive model was the result of varying the regression cutoff value, significantly increasing the STIDD's sensitivity and selectivity. ^ The prevalence of dual diagnosis is much higher than clinicians typically believe. Future research should focus on early assessment; diagnostic accuracy informs effective treatment and results in improved success. ^

Subject Area

Psychology, Clinical

Recommended Citation

Gulledge, Jerry B., "Predicting the dual diagnosis client among substance abusers using demographic and substance -related variables" (2004). ETD collection for University of Nebraska - Lincoln. AAI3147139.