TAPS-tool reveals severe under detection of substance use problems in patients with severe mental illness

Substance use problems and disorders (SUD) are highly prevalent but often undetected in patients with Severe Mental Illness (SMI). This study investigates the prevalence, under detection, and variables that are associated with a high risk of SUD in a Dutch sample of adult outpatient SMI patients (N = 83).
Methods: Substance use (TAPS-tool), quality of life (Manchester Short Assessment of Quality of Life - MANSA), general functioning (Health of the Nation Outcome Scale – HoNOS), DSM-5 classifications and patient characteristics (age, education, marital status) were assessed. Detection of SUD was determined by calculating % agreement of DSM-5 classification to TAPS outcome. A logistic regression analysis was performed to determine the association of patient characteristics, quality of life and general functioning to an increased risk of SUD as determined by the TAPS.
Results:
Prevalence: 89% of the patients used tobacco, above guideline-recommended daily limits of alcohol, illicit drugs or prescription medications for nonmedical purposes. Almost all smokers, half of the alcohol users and three-quarter of the patients that use marihuana or stimulant drugs had a high risk of SUD. All patients at high risk of SUD associated with due to alcohol, drugs or medications also had SUD associated to due to tobacco use.
Under detection: Less than half of the patients with a high risk of SUD according the TAPS had a SUD in their DSM-5 classification.
Associations: Gender, partner, age and satisfaction about the relationship with family had a significant association with a high risk of SUD.
Conclusions: Screening for addiction in an SMI sample with the TAPS-tool revealed a high prevalence of substance use and a high risk of SUD. TAPS outcomes compared to the clinically obtained DSM-5 classification revealed a high degree great amount of under- detection of substance use problems.