The principal barriers to universal screening for the cooccurring disorders of mental illness and substance abuse are training, time, cost, and a reliable and valid screen. Although many of the barriers to universal screening still remain intact, the lack of a cooccurring screen that is effective and can be administered in a cost efficient way is no longer an obstacle. This study examined the reliability, factor structure, and convergent validity of the 15-item AC-OK Cooccurring Screen. A total of 2,968 AC-OK Cooccurring Screens administrated to individuals who called or went to one of the nine participating mental health and substance abuse treatment facilities were administrated and analyzed. Principal axis factor (PAF) analysis was used in the confirmatory factor analysis to identify the common variance among the items in the scales while excluding unique variance. Cronbach's Alpha was used to establish internal consistency (reliability) of each subscale. Finally, the findings from the AC-OK Cooccurring Screen were compared to individual scores on two standardized reference measures, the addiction severity index and the Client assessment record (a measure of mental health status) to determine sensitivity and specificity. This analysis of the AC-OK Cooccurring Screen found the subscales to have excellent reliability, very good convergent validity, excellent sensitivity, and sufficient specificity to be highly useful in screening for cooccurring disorders in behavioral health settings. In this study, the AC-OK Cooccurring Screen had a Cronbach's Alpha of .92 on the substance abuse subscale and a Cronbach's Alpha of .80 on the mental health subscale. 1. Introduction The knowledge that the cooccurring disorders of addiction or mental illness are widespread in the treatment population and are more complicated to treat has long been the accepted reality among practitioners and researchers. These assumptions are well founded. Estimates based on the 2009 National Survey on Drug Use and Health in the United States suggest that among the 45.1 million adults 18 years of age or older who experienced a mental illness in the year before the survey 8.9 million adults (19.7%) met criteria for substance dependence or abuse (a cooccurring disorder) in that period compared with 6.5% (11.9 million adults) who did not have mental illness in the past year. Based on these numbers, an important finding for alcohol and drug treatment programs is that among the 20.8 million adults who were identified with a substance use disorder, 4 out of 10 (43%) will also have a mental
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