Primary care providers are challenged with screening patients for multiple substances and assessing for substance use disorder, but current methods are cumbersome and time-consuming. Researchers developed the Tobacco, Alcohol, Prescription medication, and other Substance use (TAPS) tool, comprised of a 4-item initial screen and, if screen is positive for ≥1 substances, substance-specific follow-up assessment questions. The TAPS—either self or interviewer-administered—and reference standard Composite International Diagnostic Interview (CIDI) were completed in 2000 adult patients (mean age 46 years, 56% female, 12% Hispanic, 56% black) in 5 primary care clinics and compared.
- Performance of interviewer-administered TAPS tool:
|Problem Use*||Substance Use Disorder**|
|Substance||Past Year Use (%)||Sensitivity||Specificity||Sensitivity||Specificity|
* Defined as meeting ≥1 CIDI criteria. ** Defined as meeting ≥2 CIDI criteria.
- TAPS performance did not differ by mode of administration.
Comments: This is a well-done study in a diverse primary care population. The TAPS tool has reasonable performance characteristics, especially for problem use, but is less sensitive for the lower-prevalence substance use disorders. Although administration time of the interviewer-administered version is a potential limitation in busy primary care settings, the similar performance characteristics of the self-administered version is a strength. While it shows promise, I agree with the authors that the TAPS tool needs further refinement before broad implementation.
Kevin L. Kraemer, MD, MSc
Reference: McNeely J, Wu L, Subramaniam G, et al. Performance of the Tobacco, Alcohol, Prescription medication, and other Substance use (TAPS) tool for substance use screening in primary care patients. Ann Intern Med. 2016;165:690–699.