Psychiatric Symptoms and Impulsivity in Patients with Substance Use Disorders: Associations with an Aggregate ASI Interviewer Severity Score

Abstract

Background and Objectives: Psychiatric symptoms and multidimensional impulsivity may be associated with the clinical and functional heterogeneity of substance use disorders (SUDs), but evidence from Saudi Arabian treatment populations remains limited. This study examined concurrent associations with a study-specific aggregate of Addiction Severity Index (ASI-5) interviewer severity ratings. Materials and Methods: This cross-sectional study included 204 adults receiving inpatient detoxification or residential rehabilitation services in Najran, Saudi Arabia. The seven ASI interviewer ratings were summed as an aggregate score. Psychiatric symptoms were assessed using the Brief Psychiatric Rating Scale (BPRS), and impulsiveness using the Barratt Impulsiveness Scale-11 (BIS-11). Analyses included age- and sex-adjusted analyses of covariance, false-discovery-rate correction, bootstrap Spearman correlations, an a priori multivariable model with HC3 robust confidence intervals, and sensitivity analyses addressing content overlap, multicollinearity, influential observations, functional form, and the bounded outcome distribution. Results: The mean age was 34.4 ± 7.3 years; 78.9% were male. The aggregate score was 26.33 ± 4.15. It correlated strongly with BPRS total (ρ = 0.874, 95% CI 0.827–0.908) and moderately with BIS-11 total (ρ = 0.590, 95% CI 0.494–0.669). In the primary model (adjusted R2 = 0.864), age, BPRS total, motor impulsiveness, and non-planning impulsiveness were conditional correlates of greater aggregate burden; male sex was inversely associated, and polysubstance use was not. BPRS remained associated after exclusion of the ASI psychiatric domain. Separate impulsivity-domain and BIS-11 total models, 5000-resample bootstrap analysis, median regression, and fractional-logit analysis retained the principal psychiatric and impulsivity directions. The polysubstance coefficient varied across sensitivity models. Conclusions: Psychiatric symptom burden and selected impulsivity dimensions were concurrently associated with higher study-specific aggregate ASI interviewer severity scores. Integrated psychiatric and impulsivity assessment may help characterize patients with greater concurrent multidomain clinical burden; the aggregate score should not be interpreted as a validated global severity or prediction measure.