Drug dependence Addiction Substance abuse Mental health, Instruments
Damian Smith, Duffy R, Darran Flynn, Luke Quirke, Stephen Monks, Harry G Kennedy, DUNDRUM-D: Developmental Understanding of Drug Misuse & Dependence, 2012
Developmental Understanding of Drug Misuse and Dependence DUNDRUM-D
This instrument has grown out of the series of prison psychiatric morbidity studies
carried out by the National Forensic Mental Health Service in the population of the Irish
Prison Service. The DUNDRUM-D is distinguished from other screening and diagnostic
instruments by the developmental perspective it takes on life time careers of substance
use, misuse and dependence. We recognise that those with substance misuse problems
commonly begin using intoxicants such as solvents very early, typically before the age of
12 and progress through other substances as they get older and are able to access more
expensive intoxicants. Some will have patterns of binge use, others are continuously
intoxicated. Some will use only one or two substances of choice; others will use many
different types of drug almost indiscriminately. It is not uncommon for a person to make
the transition from dependence on one drug to substitution for another, followed some
time later by further changes in type of intoxicant or pattern of use. All such patterns shift
and change over time, and recovery is always possible. Indeed spontaneous recovery is
the most common outcome for most substance misuse problems.
The purpose of this form of instrument is to record these patterns as an exercise in
contemplation for those who are not yet at the contemplative stage or recovery. While
questions are asked about harmful use and abuse, these are deliberately reserved until
towards the end of the interview. We believe the regular use of this instrument is also a
way of learning from one's patients/clients. The substances used, the language, patterns
and practices of use all change constantly and rapidly from month to month and from city
We have found that this instrument can be used in its short form as a screening tool e.g.
with the SADS-L or with the CAARMS. In forensic mental health practice, it is
'substance abuse' as defined in the DSM system that is the best guide to harmful use.
The form of the instrument lends itself to the assessment of other problem behaviours
such as gambling, binging and purging food, and repetitive self-harm to relieve tension
The DUNDRUM-D can be used by any professionally qualified clinician.
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