ESTABLISHING A RESEARCH AGENDA

The preceding review identifies several directions for future research. First, basic information on the temporal stability of self-reported substance use patterns among persons with co-occurring mental and addictive disorders is needed. Second, empirical investigation of the effects of various task variables on the accuracy of self-reported

substance use patterns should be undertaken. Relevant variables include the format of the measurement tools (e.g., ASI versus TLFB) and the timeframes employed. Third, it is important to investigate ways of minimizing the impact of respondent and cognitive limitations. In addition to drug-related cognitive impairment, attention must be paid to those aspects of psychopathology that can reduce self-report accuracy and the interaction between the two. Fourth, it would be beneficial to understand the kinds of motivational variables that might distort self-report in this population. Ultimately, these factors will allow a better answer to the question: When and under what conditions are self-reports of substance use valid for persons with major mental disorders?

REFERENCES

Babor, T.F.; Brown, J.; and DelBoca, F.K. Validity of self-reports in applied research on addictive behaviors: Fact or fiction? Behav Assess 12:5-31, 1990. Barbee, J.G.; Clark, P.D.; Crapanzano, M.S.; Heintz, G.C.; and Kehoe, C.E. Alcohol and substance abuse among schizophrenic patients presenting to an emergency psychiatric service. J Nerv Ment Dis 177(7):400-407, 1989. Brown, J.; Kranzler, H.R.; and DelBoca, F.K. Self-reports by alcohol and drug abuse inpatients: Factors affecting reliability and validity. Br J Addict 87:1013-1024, 1992. Cahalan, D., and Room, R. Problem Drinking Among American Men. New Brunswick, NJ: Rutgers Center of Alcohol Studies, 1974. Carey, K.B. Substance use reduction in the context of outpatient psychiatric treatment: A collaborative, motivational, harm reduction approach. Commun Ment Health J, in press. Cohen, J.A. Coefficient of agreement for nominal scales. Educ Psychol Meas 20: 37-46, 1960. Drake, R.E.; Alterman, A.I.; and Rosenberg, S.R. Detection of substance use disorders in severely mentally ill patients. Commun Ment Health J 29:175-192, 1993. Drake, R.E.; Osher, F.C.; Noordsy, D.L.; Hurlbut, S.C.; Teague, G.B.; and Beaudett, M.S. Diagnosis of alcohol use disorders in schizophrenia. Schizophr Bull 16(1): 57-67, 1990. Harrell, A.V. Validation of self-report: The research record. In: Rouse, B.A.; Kozel, N.J.; and Richards, L.G., eds. Self-Report Methods of Estimating Drug Use. National Institute on Drug Abuse Research Monograph 57. DHHS Pub. No. (ADM)85-1402. Washington, DC: Supt. of Docs., U.S. Govt. Print. Off., 1985. pp. 12-21. Maisto, S.A.; McKay, J.R.; and Connors, G.J. Self-report issues in substance abuse: State of the art and future directions. Behav Assess 12(1):117-134, 1990. McLellan, A.T.; Luborsky, L.; O'Brien, C.P.; and Woody, G. An improved evaluation instrument for substance abuse patients: The Addiction Severity Index. J Nerv Ment Dis 168(1):26-33, 1980. Nurco, D.N. A discussion of validity. In: Rouse, B.A.; Kozel, N.J.; and Richards, L.G., eds. Self-Report Methods of Estimating Drug Use. National Institute on Drug Abuse Research Monograph 57. DHHS Pub. No. (ADM)85-1402. Washington, DC: Supt. of Docs., U.S. Govt. Print. Off., 1985. pp. 4-11. O'Farrell, T.H.; Cutter, H.S.G.; Bayog, R.D.; Dentch, G.; and Fortgang, J. Correspondence between one-year retrospective reports of pretreatment drinking by alcoholics and their wives. Behav Assess 6:263-274, 1984. O'Farrell, T.H., and Maisto, S.A. The utility of self report and biological measures of drinking in alcoholism treatment outcome studies. Adv Behav Res Ther 9:91-125, 1987. Polich, J.M.; Armor, K.D.; and Braiker, H.B. The Course of Alcoholism: Four Years After Treatment. New York: Wiley, 1981. Ridgely, M.S.; Goldman, H.H.; and Willenbring, M. Barriers to the care of persons with dual diagnoses: Organizational and financing issues. Schizophr Bull 16:123-132, 1990. Safer, D.J. Substance abuse by young adult chronic patients. Hosp Commun Psychiatry 38:511-514, 1987. Schwartz, R.H. Urine testing in the detection of drugs of abuse. Arch Intern Med 148:2407-2412, 1988. Shaner, A.; Khalsa, M.E.; Roberts, L.; Wildins, J.; Anglin, D.; and Hsieh, S. Unrecognized cocaine use among schizophrenic patients. Am J Psychiatry 150:758-762, 1993. Skinner, H.A. Assessing alcohol use by patients in treatment. In: Smart, R.G.; Cappell, H.D.; Glaser, F.B.; Israel, Y.; Kalant, H.; Schmidt, W.; and Sellers, E.M., eds. Research Advances in Alcohol and Drug Problems. Vol. 8. New York: Plenum Press, 1984. Sobell, L.C., and Sobell, M.B. Convergent validity: An approach to increasing confidence in treatment outcome conclusions with alcohol and drug abusers. In: Sobell, L.C.; Sobell, M.B.; and Ward, E., eds. Evaluating Alcohol and Drug Abuse Treatment Effectiveness: Recent Advances. New York: Pergamon Press, 1980. pp. 177-183. Sobell, L.C., and Sobell, M.B. Timeline follow-back: A technique for assessing self-reported alcohol consumption. In: Litten, R., and Allen, J., eds. Measuring Alcohol Consumption. The Humana Press, 1992. pp. 41-72. Sobell, L.C.; Sobell, M.B.; and Nirenberg, T.D. Behavioral assessment and treatment planning with alcohol and drug abusers: A review with emphasis on clinical application. Clin Psychol Rev 8(1):19-54, 1988. Sobell, M.B.; Sobell, L.C.; and VanderSpek, R. Relationships between clinical judgment, self-report and breath analysis measures of intoxication in alcoholics. J Consult Clin Psychol 47:204-206, 1979. Teitelbaum, L., and Carey, K.B. Alcohol assessment in psychiatric settings. Clin Psychol, in press. Test, M.A.; Wallisch, L.S.; Allness, D.J.; and Ripp, K. Substance use in young adults with schizophrenic disorders. Schizophr Bull 15(3):465-476, 1989.