Review Finds Diagnostic Interviews Most Reliable for Substance Use Disorders, Especially Opioid Use

A review study published in JAMA Network Open found that diagnostic interviews for mental disorders vary in reliability depending on the condition assessed. The study aggregated evidence from research on test-retest reliability conducted between February 2024 and September 2025.

Diagnostic interviews remain the most common method for identifying substance use and mental disorders, including depression, anxiety, bipolar disorder, and personality disorders.

She noted that they continue to be viewed as the best available approach, possibly due to the lack of better alternatives. The study’s authors used Cohen’s kappa coefficient to measure how often patients received the same diagnosis when interviewed twice. Average reliability was generally better for substance use disorders and highest overall for opioid use disorder.

Duncan said this pattern occurred because substance use disorder criteria are largely based on behavior, making it easier to estimate how many drinks a person consumed in a week than to count days of sadness or anxiety. The review included papers on the Structured Clinical Interview for DSM 5 (SCID), the Mini International Neuropsychiatric Interview (Mini), and the Clinically Administered PTSD Scale (CAPS).

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Michael First, a psychiatrist and professor at Columbia University who authored the SCID, said diagnostic interviews vary in reliability and too often fail to correctly diagnose people. ” He noted that if a patient gives a contradictory answer, the interviewer is not allowed to point out the contradiction.

These interviews are often used for epidemiological research on large populations and are designed for administrators with little training.