Can a Single Question Detect Drug Use and Drug Use Disorders?

A short accurate screening test for drug use and drug use disorders would be useful in primary care. In this study, researchers asked 286 adult primary-care patients the following question: “How many times in the past year have you used an illegal drug or used a prescription medication for nonmedical reasons?” A positive response was “at least 1 time.” Participants also completed the 10-item Drug Abuse Screening Test (DAST). Responses were compared with oral fluid testing for illegal drugs and the Composite International Diagnostic Interview—Substance Abuse Module (reference standard).

• The single-question screen was 85% sensitive and 96% specific for current drug use (either self-reported or confirmed by positive oral fluid test). It was 100% sensitive and 74% specific for a drug use disorder (abuse or dependence).

• The test characteristics of the single-question screen were similar to the 10- item DAST and were not substantially affected by patient demographic characteristics.

Comments:

This study indicates that a brief single-question screen for drug use and drug use disorders has sensitivity and specificity comparable to longer screening tools. Although the results support the use of the single question in primary-care settings, its ultimate value will depend on whether clinicians follow up positive screens with skillful assessment, intervention, and/or referral to specialized treatment.

Kevin L. Kraemer, MD, MSc

Reference:

Smith PC, Schmidt SM, Allensworth- Davies D, et al. A single-question screening test for drug use in primary care. Arch Intern Med. 2010;170(13):1155–1160.