Addiction Medicine: Closing the Gap between Science and Practice

In clinical samples of adolescents, the T-ASI has
been shown to be valid and reliable.^114

Structured Clinical Interview for the DSM

(SCID)

The Structured Clinical Interview for the DSM-
IV Axis I Disorders (SCID-I) is a semi-structured
assessment instrument for diagnosing addiction
involving alcohol and other drugs (excluding
nicotine) based on the DSM-IV Axis 1
categories.* 115 The SCID can be used for
current and lifetime diagnoses among clinical
and community samples, college students and
the homeless.^116 An adolescent version of the
SCID has been developed.^117 Clinicians or
trained mental health professionals may
administer the SCID, and the developer
recommends that clinicians should spend at least
20 hours learning how to administer the
instrument.^118 The SCID is available for a fee.^119
Administering the interview takes an average of
90 minutes.^120

Clinical Utility. Addiction researchers and
community-based addiction treatment providers
in NIDA’s Clinical Trials Network (CTN) rated
the SCID as the preferred instrument for
diagnosing addiction.† 121 The SCID has
demonstrated good reliability and validity in
diagnosing addiction.^122 Compared to other
diagnostic instruments, the SCID is less
structured, allowing interviewers to ask follow-
up questions based on their judgment.^123
Reliability of assessments may vary depending
on the clinical judgment of the interviewer in
modifying and asking follow-up questions.^124
Among adolescents, the SCID showed high
inter-rater reliability for DSM-IV diagnoses of

• Axis I includes major mental disorders, addiction

and learning disorders, whereas Axis II includes
personality disorders and intellectual disabilities.
The other three axes include related medical,
psychosocial and environmental factors, as well as
assessments of functioning for children.
† Compared to other diagnostic instruments including

the addiction-related sections of the Composite
International Diagnostic Interview, the Diagnostic
Interview Schedule for DSM-IV Diagnosis, the
Diagnostic Statistical Manual-IV Checklist and the
Substance Dependence Severity Scale.

alcohol and other drug addiction.^125 The SCID

has been less accurate in identifying co-

occurring disorders than in identifying

addiction.^126

Composite International Diagnostic

Interview (CIDI)

The Composite International Diagnostic

Interview was developed by the WHO in 1988

for assessing lifetime and past-year addiction in

accordance with DSM-IV and ICD-10

classification systems.^127 The CIDI is composed

of 20 questions and 59 sub-questions. Another

version, CIDI-SAM, focuses specifically on the

substance use section of the CIDI in a more

detailed and expansive manner than the original

instrument.^128 The substance-specific sections

of the CIDI generally take 20 to 30 minutes to

administer,^129 and can be self-administered via

paper or computer or by a trained interviewer.^130

The information collected is useful for treatment

planning.^131 NIDA has adopted a version of the

CIDI for use among clinicians and investigators

in the CTN.^132

Populations and Settings Served. The CIDI

has been used with adults and adolescents and

with individuals with co-occurring disorders.^133

Clinical Utility. Reviews have found that the

CIDI and CIDI-SAM are reliable and valid

instruments for assessing mental health disorders

and addiction.^134 However, potential barriers to

using the CIDI are the length of time required

for administration and training costs: the

instrument takes 75 minutes to administer and

the scoring program is available only to those

who have attended a WHO-authorized CIDI

training session (a four-day training session that

costs approximately $1,100).^135