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

A wide range of population-based and clinical studies in the literature consistently demonstrate that substance use/dependence is one of the most common mental health-related disorders (Cohen et al, 1999; Coulthard et al, 2002; Crawford et al, 2003). A national study of psychiatric comorbidity in the UK found that the prevalence of dependence on any drug was 4% and dependence on cannabis was reported most often at 3% (Coulthard et al, 2002). Drug-dependent individuals were more likely to be receiving current treatment and to have spoken to a general practitioner (GP) about mental health problems or to have used community services. A variety of studies have consistently confirmed the clear association between mental ill health and substance misuse (Table 1). Affective disorders, personality difficulties, eating problems and attention-deficit hyperactivity disorder are all related to substance misuse. Substance misuse is also a powerful predictor of suicide. Childhood psychiatric disorders are very likely to continue into adulthood and they are often exacerbated by substance misuse, which is increasingly prevalent in young people. These studies argue powerfully for the need to include screening for substance misuse as part of any comprehensive psychiatric treatment plan. Skilled assessment and effective treatment of substance misuse may be important in the prevention and alleviation of disabling and life-threatening comorbid psychiatric conditions. Despite these reported prevalence rates, substance use disorders are not being identified by hospital doctors: of 2347 in-patients referred consecutively to the consultation liaison psychiatry services of four general teaching hospitals in Australia, over half were diagnosed by psychiatrists as having a substance use disorder that had been missed by the referring doctor (Smith et al, 1995; Wolford et Screening for illicit drug use in psychiatric hospitals: whose job is it?