Nearly 9 million adults are processed into U.S. jails annually and the majority present indications of substance use disorder, yet little research has been conducted to examine how certain DSM-5 criteria specify levels of severity in this institutionalized population. Clinical interviews were conducted with 718 adults (M age = 34.3 years, SD = 10.3) detained in four county detention centers using the Comprehensive Addiction and Psychological Evaluation-5 (CAAPE-5). Prevalence rates were examined by severity levels to identify prominent criteria within methamphetamine, opioid, alcohol, and cannabis use disorders. Item response theory models were estimated to determine which criteria effectively identified the most severe conditions. A subset of key criteria, consisting of withdrawal, sacrificed activities, craving, role failure, and failure to cut down on substance use, was clearly observed. These five items identified significant proportions of severe substance use disorders, but the greatest accuracy was among cases of methamphetamine and opioid use. A reduced set of five DSM criteria can detect certain severe substance use disorders efficiently. This information can be applied to diagnostic and clinical service delivery procedures in correctional settings, paying particular attention to the special circumstances found among adults who are incarcerated in local detention centers.

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