Screening for illicit drug use in psychiatric hospitals: whose job is it?

Ilana Crome is Professor of Addiction Psychiatry and Academic Director of Psychiatry at Keele University (Academic Suite, Harplands Hospital, Hilton Road, Harpfields, Stoke on Trent ST4 6TH, UK. Email: i.crome{at}keele.ac.uk) and Chair of the Faculty of Addictions at the Royal College of Psychiatrists 1998–2002. She has extensive clinical, training, research and policy experience in drug, alcohol and nicotine use, particularly by older and younger people. She has special interest in the ‘dual diagnosis’ domain and in enhancing ways to identify and treat substance misuse in psychiatric patients. Roger Bloor is a senior lecturer in addiction at Keele University and Medical Director of North Staffordshire Combined Healthcare National Health Service Trust. He is leader for the assessment and screening module of the Keele University MSc in adolescent addiction and has a research interest in the development of breath gas analysis techniques in the detection of illicit drug use. Betsy Thom is a reader in drug and alcohol studies and Head of the Social Policy Research Centre at Middlesex University. She is an honorary professor at the London School of Hygiene and Tropical Medicine and alcohol advisor to the Joseph Rowntree Foundation. Current research includes a study on the links between alcohol consumption and blood pressure.

This review focuses on screening and assessment in general psychiatric settings, where drug use is unlikely to be known to service providers. It builds on the recurrent finding that psychiatric patients are at high risk of substance misuse. The application of self-report questionnaires and rating scales and more in-depth assessment instruments is outlined, as are biological screening techniques. The use of brief self-completion questionnaires probably offers the most practical approach to routine screening by non-specialist staff in general hospital settings. The importance of implementing such tools lies in reaching an accurate diagnosis, choosing treatments more appropriately and monitoring the management of patients’ psychiatric disorders.