Underdiagnosis of Disorders Due to Substance Use in an Academic Psychiatric Hospital

INTRODUCTION: Substance use disorders (SUDs) are common but often go undiagnosed in psychiatric settings, leading to poorer outcomes for patients. In Iran, there is limited research on the extent of this issue, making it essential to investigate and address diagnostic gaps in mental health care. METHODS: This study, conducted at Roozbeh Hospital in Tehran, used both retrospective and prospective approaches. The retrospective arm comprised 289 patients, with data drawn from their medical records, while the prospective arm included 297 patients who were assessed through direct interviews, structured questionnaires, and urine drug tests. RESULTS: The findings revealed a substantial difference in diagnosis rates: 22.6% of patients in the prospective arm received SUD diagnoses, compared to just 5.5% in the retrospective arm. Additionally, 15.8% of prospective patients were diagnosed with substance-induced mental disorders, versus 8.6% in the retrospective arm. Male patients, those referred for aggression, and those with substance-related referrals were more likely to be diagnosed with substance-induced mental disorders. DISCUSSION: These findings suggest that routine psychiatric assessments may substantially underestimate SUDs, even in academic settings with access to addiction expertise. Context-sensitive, structured screening approaches are needed, particularly where stigma and legal concerns may affect disclosure.