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Presenter: Luis R. Torres, Ph.D., Washington University in St. Louis
Discussant / Mentor: Michael Escamilla, M.D., University of Texas, San Antonio

Diagnosing Co-Occurring Substance Related Disorders: Agreement Between SCID, Hispanic and Non-Hispanic Clinicians

Background:
The mental health and substance abuse workforce in the United States is such that Hispanic immigrants are very likely to be assigned to non-Hispanic, English-speaking clinicians. The ensuing challenges in communication and understanding linguistic and cultural nuances greatly impacts the accuracy of diagnoses and the delivery of appropriate services. With the inception of objective criteria into the diagnostic process, clinician-to-clinician agreement ought not to be impacted by the ethnicity of the client nor the clinician. Both practice and research, however, suggest that this is not the case. We conducted a pilot study to explore the degree to which Hispanic and non-Hispanic clinicians agreed with each other and with the SCID on their diagnoses, symptom-severity ratings, and functional assessment ratings of Latino clients. We report here the frequency with which Hispanic and non-Hispanic clinicians agreed on a co-occurring Substance-Related diagnosis.

Method:
Eighty-eight adult clients were videotaped in diagnostic interviews with Hispanic or non-Hispanic clinicians. Videotapes were then viewed and rated by clinicians ethnically cross-matched to those on tape. Clients were also administered the SCID.

Results: 
Forty-two clients (48%) were identified by the SCID as having a Substance Use Disorder. Hispanic clinicians assigned the diagnosis 23 times (26%) versus 31 times (35%) by non-Hispanic clinicians. Both Hispanic and non-Hispanic clinicians agreed on the diagnosis 22 times (25%). For Alcohol Use, while the SCID identified 34 clients (39%) as having the disorder, Hispanic clinicians diagnosed it 11 times (13%) versus 9 times (10%) by non-Hispanic clinicians. The number of clients identified by both groups of clinicians was 0 (0%).

Conclusions:
Both Hispanic and non-Hispanic clinicians under-diagnosed co-occurring Substance-Related Disorders. Clinicians had very low agreement (25%) when diagnosing Substance Abuse, and none when diagnosing Alcohol Use. Implications for the assessment, diagnosis and treatment of co-occurring substance-related disorders are discussed.