The Psychiatric Research Interview for Substance and Mental Disorders (PRISM) is a semi-structured, (differential) diagnostic interview based on the DSM-5, which is specifically designed to help you distinguish substance-induced mental disorders from independent mental disorders.
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This page is a short version of the Norwegian page about PRISM-5, for those are interested in use and availability of PRISM-5 in Norway and can't read Norwegian.
PRISM-5 is a differential diagnostic interview specifically designed to help you with differentiating substance induced mental disorders from independent mental disorders.
PRISM has guidelines/instructions for how responses should be evaluated in many parts of the interview, including frequency and duration requirements for symptoms, explicit exclusion criteria, and decision rules for common sources of uncertainty. This includes follow-up questions and guidelines for differentiating between independent disorders and substance-induced symptoms / expected effects of intoxication and withdrawal.
This distinguishes PRISM-5 from other content-wise comparable interviews available in Norwegian, namely SCID-5-CV and MINI 7.0.2.
The interview is programmed to explore relevant substances (used above cut off) for the specific mental disorders being assessed (i.e., substances whose effects may produce symptoms similar to the mental disorder assessed).
Substance screening is placed at the beginning of the interview, before the sections covering the various mental disorders, so that substances used above the cut off are integrated into the mental disorder sections, in order to differentiate between what is “technically” an independent disorder and what is a substance-induced disorder.
It is the interview itself that evaluates diagnoses and determines which questions are relevant, based on what is entered, thereby limiting or avoiding clinician bias in the assessments. Furthermore, this thorough exploration (the totality of the information, as well as the suggested diagnoses) is used together with other information in the diagnostic evaluations and the broader framework of understanding the patient's suffering, symptoms and impaired level of functioning.
The sections that are underlined are those in which the interview is designed to conduct differential diagnosis in accordance with DSM-5, for relevant substances used above the cut-off. These are the sections that differential diagnostically stand out compared to comparable interviews (SCID-5-CV and MINI 7.0.2).
Substance Use Disorder (mild, moderate, severe)
Major Depressive Disorder (with mixed features or with anxious distress)
Persistent Depressive Disorder
Mania and Hypomania (with mixed features)
Cyclothymic Disorder
Psychotic Disorders (Schizophrenia, Schizophreniform Disorder, Schizoaffective Disorder, Psychotic Disorder [NOS], Psychotic Disorder Due to Another Medical Condition, Delusional Disorder, Brief Psychotic Episode)
Mood Disorder with Psychotic features
Panic Disorder
Agoraphobia
Social Anxiety Disorder
Specific Phobia
Generalized Anxiety Disorder
Obsessive-Compulsive Disorder
PTSD (with dissociative features)
Eating Disorders (Anorexia Nervosa and Bulimia Nervosa)
Personality Disorders (Antisocial and Borderline)
ADHD
Gambling Disorder
The main target group for the interview is psychiatrists and psychologists who do assessments in specialist services. Other health personell with at least three or four years of relevant higher education (e.g., in Norway: bachelors degree + further education) who do assessments, can also participate and become certified users. People who eventually want to use the interview in research have to take the same course.
Before you can use the interview clinically or in research, you need to attend a two day course and afterwards send a fictional clinical interview (sound file) to the course holder for evaluation, in order to become a certified PRISM user.
Psychiatrists and psychologists who want to do PRISM-5 courses and certify other users can then also become a certified course holder.
The implementability of PRISM-5 depends on a number of factors, including:
…motivation to change/improve one’s own differential diagnostic practice, including a desire for more “stringent” assessments of the possible relationship between extensive substance use and symptoms (reduced level of functioning).
…motivation, capacity, and time to become familiar with the interview after the course (to achieve a satisfactory practical workflow with something that is relatively large and new). The interview should be used more than just a couple of times per year in order to establish a good workflow.
…time available in daily clinical work to thoroughly examine all relevant aspects of patients’ lives associated with differential diagnosis.
That is, sufficiently thorough assessments (i.e., relevant information gathered from multiple sources). A statement for reflection regarding the assessment of co-occurring substance use and mental disorders: “It is better to be a little too thorough sometimes than to be inconsistent about when you are thorough enough - given feasibility.” It may be wiser to “maximize” multidisciplinary content and interventions in the assessment package and then evaluate what may appear unnecessary, redundant, or not feasible in the individual case, rather than having a minimal assessment package - where speculation and various biases may largely determine the type of information collected (randomness, misjudgments).
…willingness and readiness to increase competence in differential diagnostic practice, including facilitating implementation—i.e., enabling staff to become certified and to become sufficiently familiar with the interview (prior to clinical use).
…if current structural conditions are insufficient: improving clinicians’ working conditions with regard to time available for implementation and assessment. The assessment of co-occurring substance use and mental disorders is usually not a “quick fix” or an "assembly-line activity".
…professionally upgrading/revising the unit’s assessment package (routines, procedures).
…willingness (and ability) to pay for user licenses for Blaise, the software in which PRISM is developed - if its not available in any other digital software in the respective country.
Comprehensive assessments of co-occurring substance use and mental disorders can be time consuming, especially in complex cases (with long-standing conditions and varying expressions of illness), and in a number of cases involving different types of implementation challenges during the assessment process.
In this context, PRISM’s thoroughness and systematic structure are its greatest strengths, especially in the sections that enable differentiation. However, this may involve a certain amount of time in some cases. This can threaten feasibility for some clinicians and units in terms of working conditions—which may vary greatly among staff holding the same type of position, for example in an outpatient setting. For some clinicians this works well; for others it is very problematic.
Another aspect is that unstructured and more ad hoc assessments of dual diagnosis may yield poorer or insufficient information and take longer than if PRISM had been used for the same purpose. In other cases, willingness to implement may be influenced by other factors, such as personal beliefs and preferences or habits.
For individuals with substance use problems who have a planned admission to an inpatient unit, for purposes that include—or are limited to—assessment, there are, in my judgment, significantly fewer arguments for why PRISM should not be part of the assessment package, either as a standard interview or used selectively depending on the issues in the individual case.
Time requirements are a vulnerability with regard to feasibility, primarily in outpatient assessments and to some extent in outreach services. In such contexts, it is important to obtain sufficient information to determine which sections (diagnoses) you will not cover in a given interview, as this can substantially reduce total interview time. In this regard, ROP screening, together with other information gathering, can be a useful approach for improving precision in deciding which sections you wish to cover in PRISM.
Implementation considerations from a physician related to this, after having attended the course:
“My own view is that to a large extent one can use Dual Diagnosis Screening Interview (DDSI) in the initial part of the assessment … and then make an overall decision about which modules of PRISM-5 to proceed with in order to conduct good differential diagnostis. I believe that any difference in time use is compensated for by better quality in the assessment.”
If you choose to go through all sections (diagnoses) of the interview with a patient who has had extensive substance use problems throughout life (e.g., use of three or more substance categories above cut-off in the substance screening), the interview typically takes 140–200 minutes (usually over 3-5 sessions), and sometimes more or less time (there can be considerable variation from case to case, and it also depends, for example, on the number of confirmations, as these may trigger additional relevant questions).
You decide which sections to include in each interview, which can greatly influence time use.
Assessment of substance use disorders (SUD): You will often save considerable time by excluding the section that deals exclusively with the assessment of substance use diagnoses (Section 3), as mentioned above. This section covers diagnostic assessment for both the past 12 months and lifetime for all substances above cut off in Section 2. Therefore, this section is potentially the largest “time sink” (both in general and in terms of cost–benefit) if the respondent has used substances across many different substance categories, for example across multiple periods in life. This section is also not necessary to complete the differential diagnostic assessment within the interview. Assessment of substance use diagnoses for the past 12 months can often be managed adequately without using this section of PRISM.
Two personality disorders: The sections on borderline and antisocial personality disorder are assumed to be unnecessary if you are conducting a proper, broad assessment of personality functioning and personality disorders, including the use of screening tools such as PDS–ICD-11 and diagnostic interviews such as SCID-5-PD or SCID-5-AMPD Module 1 - until the ICD-11 PD interview DIPP-11 is available in 2026.
Suicide: There is a small section with questions about suicide (Section 9), which is also considered unnecessary to use, as such issues should be followed up elsewhere in a professionally appropriate manner, without having to “suddenly” address them explicitly in the middle of the interview.
Gambling: The gambling section has a low cut-off for being screened into the section. Ask about possible gambling problems prior to starting the interview, including - if indicated - using the GDIT, to determine whether the section should be included.
An important aspect related to perceived usability: Certified interviewers are recommended to spend some time becoming thoroughly familiar with the interview (its overview and structure) in order to achieve a good practical workflow.
If you are interested in using the English version of PRISM-5 in clinical work or research, translating it, or adding it in an instrument software, contact Eliana Greenstein (Columbia University): eliana.greenstein@nyspi.columbia.edu
Diagnosing Prescription Opioid Use Disorder in Patients Using Prescribed Opioids for Chronic Pain (2022)
Test-retest reliability of DSM-5 substance disorder measures as assessed with the PRISM-5 (2020)
Å skille rus og psykopatologi (2016, in Norwegian)
Criteria and Concurrent Validity of Adult ADHD Section of the PRISM-IV (2015)
Feasibility of the PRISM-IV in a Norwegian acute psychiatric ward (2012)
Diagnosis of Comorbid Psychiatric Disorders in Substance Users Assessed With the PRISM-IV (2006)
Diagnosing comorbidity: concepts, criteria, and methods (2004)
PRISM-IV: phenomenologically based diagnosis in patients who abuse alcohol or drugs (1998)