Tests of a symptom checklist to screen for comorbid psychiatric disorders in alcoholism

In the treatment of substance use disorders, it is advantageous to identify patients with comorbid (nonsubstance) psychiatric disorders because treating comorbid disorders improves outcome. Because accurate psychiatric diagnosis is time-consuming, there is a need for strategies to screen for these comorbid conditions. This study used receiver operating characteristic analysis to investigate a symptom checklist (revised Symptom Checklist 90 [SCL-90-R]) as a screening instrument for comorbid conditions diagnosed using the Structured Clinical Interview for DSM-IV in 171 primarily military personnel with alcohol use disorders. Several approaches to applying receiver operating characteristic analysis to this problem are demonstrated. Although these results require replication in other populations, the SCL-90-R performed well in predicting comorbid conditions, with an area under the curve of 0.88 for current and 0.85 for lifetime comorbid diagnoses. Self-report symptom checklists such as the SCL-90-R may be useful in screening substance rehabilitation patients for more detailed psychiatric assessment and may prove clinically useful in the assessment of alcoholic patients.