Validation of a Self-Administered DSM-5 Substance Use Disorder Checklist used in a Nigerian Psychiatric Outpatient Clinic

Background: Traditional clinician-administered interviews for diagnosing substance use disorders (SUD) face operational barriers, such as severe time constraints and interviewer bias. This study validates a self-administered DSM-5 SUD checklist against gold-standard clinical interviews in a West African psychiatric setting. Methods: A cross-sectional validation study included 116 stable outpatients attending a psychiatric facility in Calabar, Nigeria. The standard 11-item DSM-5 SUD criteria were adapted into a culturally refined, plain-language checklist via a patient focus group discussion. Participants completed this self-administered checklist, followed immediately by a blinded, semi-structured clinical interview conducted by a resident doctor. Concurrent validity (Spearman’s rho), diagnostic agreement (Cohen’s Kappa), internal consistency (Cronbach’s alpha), and the Area Under the Receiver Operating Characteristic Curve (AUROC) were evaluated. Results: The checklist demonstrated high overall diagnostic accuracy for detecting “Any SUD” (AUROC = 0.971) and strong diagnostic agreement with the clinical interview (Kappa = 0.896, p < 0.001). At the mild SUD threshold of ≥ 2 symptoms, sensitivity was 95.2% and specificity was 94.3%. Internal consistency for checklist items was excellent (Cronbach’s alpha > 0.92). Concurrent validity was strong for Cannabis (rho = 0.916), Alcohol (rho = 0.787), and Nicotine (rho = 0.788) SUDs. The self-administered tool yielded a slightly higher positive disclosure rate (n=63) than face-to-face interviews (n=60). Conclusion: The culturally adapted self-administered DSM-5 SUD Checklist is a valid, reliable screening tool for Nigerian psychiatric outpatients. Its integration into routine clinical triage safely enhances diagnostic efficiency and improves case detection for comorbid addiction.