Single Screening Questions Can be Used to Assess for Substance Dependence in Primary Care

Single screening questions (SSQs) can help identify individuals with unhealthy alcohol or other drug use, but their utility in providing more information about severity is less clear. In this study, 303 primary care patients were asked SSQs followed by the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), the Drug Abuse Screening Test (DAST-10), and lastly the Composite International Diagnostic Interview (CIDI), to establish a diagnosis of alcohol or other drug dependence. The SSQs were: “How many times in the past year have you had X or more drinks in a day?” and “How many times in the past year have you used an illegal drug or used a prescription medication for nonmedical reasons?”

• The alcohol SSQ had a sensitivity of 88% and specificity of 84% for dependence and performed better than the AUDIT-C.
• The SSQ for other drugs had a sensitivity of 97% and specificity of 79% for dependence; this was similar to the performance of the DAST.
• The optimal cutoffs for dependence were 8 or more times for alcohol and 3 or more times for other drugs in the past year.

Comments:

This study shows that SSQs can be an effective tool in primary care for identifying alcohol and drug dependence, not just at-risk use. Like longer screening tools, they can provide an initial severity assessment that should be confirmed with more extensive interviews. One caution, however, is that participants in the study were interviewed anonymously by research staff and these questions may not perform as well when used by clinicians who record the results in medical records.

Darius A. Rastegar, MD

Reference:

Saitz R, Cheng D, Allensworth-Davies D, et al. The Ability of Single Screening Questions for Unhealthy Alcohol and Other Drug Use to Identify Substance Dependence in Primary Care. J Stud Alcohol Drugs. 2014;75(1):153–157.