The Psychiatric Research Interview for Substance and Mental Disorders (PRISM) was developed and put into use for clinical and research-oriented assessment for those with co-occurring disorders (COD) when no such tools were available. According to Hasin, Trautman, Miele, Samet, Smith & Endicott (1996), “Rather than offering guidelines on taking a clinical history, DSM-III-R suggests using biologically oriented tests such as urine and blood tests and ‘challenges with a known intoxicant.” (p. 1195) Biological testing at the time would not have been helpful for those suffering from severe and persistent mental illnesses, such as bipolar disorder or schizophrenia, nor for those identified as suffering from COD. One response came in the form of PRISM, which could then be utilized by clinicians and researchers alike (Hasin, et al., 1996).
However, PRISM was primarily meant as a tool used in research efforts when determining new treatment strategies for those suffering from either COD or substance use disorders, but still was found efficacious for COD sufferers with depression. The following provides a description of PRISM, reasons for its use, how it is typically administered, and how test results are interpreted and then used in treatment.
The PRISM was developed in the mid-1990s due to a dearth of assessment tools used for those suffering from COD. Utilizing existing criteria found in the third publication of the Diagnostic and Statistical Manual of Mental Disorders (DSM), the PRISM was developed for both the clinician and researcher as a reliable assessment tool used during the course of interviewing adult clients suspected as suffering from COD (Hasin, et al., 1996). The test is administered through clinician-guided, semi-structured interviews, and measures current and past DSM Axis I issues related to psychiatric and substance abuse disorders, but is also used with Antisocial Personality Disorder and Borderline Personality Disorder which are Axis II disorders. The PRISM includes guidelines that assist in differentiating between a client’s primary psychiatric disorder when combined with the effects of substance-induced disorders, withdrawal and intoxication (Allen & Wilson, 2003).
As stated previously, PRISM is used to differentiate between the effects of substance abuse and related disorders, with the individual’s psychiatric issues. Meaning there tends to be some confusion when discerning symptoms, where behaviors related to intoxication may mimic those found with psychiatric disorders. The PRISM was developed in order to better understand the differences between these issues, and to improve treatment targeting the needs of those with COD (Hasin, Samet, Nunes, Meydan, Matseoane & Waxman, 2006). According to Substance abuse treatment for persons with co-occurring disorders: A treatment improvement protocol, or TIP 42, the PRISM was essentially designed for research due to its high reliability, found to be quite useful when developing treatment strategies (Sacks & Ries, 2005). In test-retest reliability studies which have involved both clients with COD as well as those reported as substance abusing, the reliability of PRISM has been found to be good to excellent in diagnoses ranging from, substance use disorders, eating disorders, anxiety disorders and primary affective disorders (Hasin, 2006). Its high reliability has also been found to be quite useful in the clinical setting with clients suffering from depression and alcoholism.
PRISM is administered by a graduate-level clinician during a semi-structure interview period lasting between 1 to 3 hours. It is used on adults and can be administered either manually or via the computer, with scores or interpretation achieved immediately (Allen & Wilson, 2003; Sacks & Ries, 2005). The PRISM may also be used with past iterations of the DSM, beginning with the third edition. Written questions are termed “probes” and are asked by the clinician as they are written. Follow-up probing is utilized in an unstructured manner for purposes of clarification. The range of information culled through the probing covers an expansive range of diagnoses while medical conditions that may affect psychiatric conditions are also probed (Hasin, et al., 2006). The PRISM provides a selection of diagnostic modules for specific diagnoses which are used for purposes of more specified research efforts. The PRISM appears to be an assessment instrument that is quite flexible and adaptable depending on either research or client need (Hasin, et al., 2006).
Used as a clinical tool test results tend to be used specifically to identify substance-induced psychiatric disorders (Hasin, et al., 2006). The range of probes, which have to do with issues related to psycho-social demographics, substance abuse-related behaviors and psychiatric symptoms, are interpreted by first using a Likert-type scale in order to determine symptom acuity. Once determined, treatments may be rendered based upon specific needs discovered during the assessment. For example, in cases where depression is prevalent, the clinician would first make a diagnosis based upon the scale that determines whether depression is actually not present, subclinical (symptoms are not observable and may not be treatable) or positive (Hasin, et.al, 1996). Through probing, client’s substance use is recorded to determine such items as type(s), duration, withdrawal, and environment (to include others). At the close of an assessment period the clinician is then provided with a better understanding of how to differentiate between psychiatric symptoms and substance use-related issues, and also how each is aggravated by the other. This allows for targeted approaches to treatment which are both specific and appropriate for individual psychiatric disorders and substance use/abuse and related disorders (Hasin, et al., 1996). Yet, it should be reiterated that PRISM is primarily used in research efforts and when determining the extent by which the correlation of psychiatric symptoms and substance abuse are identified in each subject. It is only afterward that treatment strategies are developed.
- Allen, J. P. (ed.), & Wilson, V. B. (ed.) (2003). Assessing alcohol problems: A guide for
clinicians and researchers (NIH Publication No. 03–3745). Bathesda, MD: U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute on Alcohol Abuse and Alcoholism. - Hasin, D., Samet, S., Nunes, E., Meydan, J., Matseoane, K., & Waxman, R. (2006). Diagnosis of comorbid psychiatric disorders in substance users assessed with the psychiatric research interview for substance and mental disorders for DSM-IV. American Journal of Psychiatry, 163(4), 689-696.
- Hasin, D. S., Trautman, K. D., Miele, G. M., Samet, S., Smith, M., & Endicott, J. (1996).
Psychiatric research interview for substance and mental disorders (PRISM): Reliability for substance abusers. American Journal of Psychiatry, 153(9), 1195-1201. - Sacks, S., & Ries, R. (2005). Substance abuse treatment for persons with co-occurring disorders: A treatment improvement protocol (TIP 42) (SMA 05-3992). Rockville, MD: U.S. Dept. of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment.
