A Comparison of the SADS/RDC and the DSM-III Diagnosing Drug Abusers

Abstract

Two methods were compared in determining the psychiatric diagnosis of 62 drug abusers applying for treatment: research associates using the Schedule for Affective Disorders and Schizophrenia (SADS) interview and the specified Research Diagnostic Criteria (RDC); and psychiatrists using open-ended interviews and making diagnoses based on the American Psychiatric Association''s Diagnostic and Statistical Manual, Third Edition (DSM-III). On the basis of the SADS/RDC, 84%, and on the DSM-III, 53% of the drug abusers met the criteria for some current or past psychiatric disorder outside of the category of substance abuse disorders. Using an unstructured interview and the DSM-III, psychiatrists were less likely than research associates using the SADS/RDC to detect nonopiate substance abuse, depressive disorders or anxiety disorders. To investigate the sources of diagnostic disagreement in the 2 most prevalent categories, drug use disorders and depressive disorders, reliability data based on the SADS/RDC were used. Apparently use of a structured interview will enhance a clinician''s reliability and thoroughness in detecting a substance use disorder. In diagnosing depressive disorders, use of a structured interview did not improve the fair but unacceptable level of diagnostic agreement noted between the SADS/RDC and DSM-III methods. This finding, possibly indicative of lability of moods in sample drug abusers, points to the need for multiple assessments over time if affective disorders are to be reliably diagnosed in this population.