OBJECTIVE: This study sought to determine the impact of a formal
screening program for substance use disorders among psychiatric inpatients.
Both identification of these disorders and referrals to aftercare were
measured. METHODS: A total of 193 patients admitted to a state psychiatric
facility during a two-month period before screening was initiated were
compared with 183 patients admitted during the same two months a year later
when screening was in place. Patients were screened using the Chemical Use,
Abuse, and Dependence Scale. Data were collected from hospital and
statewide computerized files. RESULTS: Consistent with findings of previous
studies, the formal screening procedure increased the identification of
substance use disorders, even among those who were not screened during the
screening period. However, despite heightened awareness of staff, referrals
to outpatient treatment in the community after discharge did not increase.
In fact, patients who did not have a comorbid substance use disorder were
more frequently referred to aftercare than were dually diagnosed patients.
CONCLUSIONS: Access to services for dually diagnosed patients may be
limited by both staff and patient barriers. Underdiagnosis may be partly
overcome by formal screening procedures, but staff bias may influence use
of screening tools as well as aftercare referrals. In turn, individuals
with a comorbid disorder who are not referred to aftercare may be more
resistant to treatment and follow-up care. These issues must be clinically
addressed by educating and sensitizing staff, as well as by administrative