Substance Use Prevalence and Screening Instrument Comparisons in Urban Primary Care

ABSTRACT

Substance use screening in a primary care setting compared the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST version 3.0), Two-Item Conjoint Screen (TICS), National Institute on Alcohol Abuse and Alcoholism (NIAAA) daily limit single item, and electronic medical record (EMR). Among 236 consecutive adults, ASSIST moderate- to high-risk substance use prevalence was tobacco, 15.3%; alcohol, 8.5%; cannabis, 5.1%; cocaine, 2.5%; and opioids, 2.5%. Compared to ASSIST, a positive TICS was 45% (95% confidence interval [CI], 27–64%) sensitive, 99% (95–100%) specific; the NIAAA single-item screen was 80% (56–94%) sensitive, 87% (82–91%) specific. The NIAAA single item correlated closely with alcohol ASSIST. TICS and EMR were less sensitive for any nontobacco substance use.

KEYWORDS:

• Addiction screening
• prevalence
• primary care
• substance use disorders

Notes

^a The Alcohol, Smoking and Substance Involvement Test (ASSIST); 90-day point prevalence.

^b Any disorder is an ASSIST score within moderate- or high-risk ranges, which correspond to chemical abuse and dependence classifications, respectively.

^c Self-reported substance-specific treatment, last 14 days (Treatment Service Review), among moderate- to high-risk patients.

^a Two-Item Conjoint Screen: In the last year, have you ever drunk or used drugs more than you meant to? Have you felt you wanted or needed to cut down on your drinking or drug use in the last year?

^b NIAAA single-item screen: In the last 12 months how many times have you had more than 5 or more [if male]/4 or more [if female] drinks in a day?

^c EMR = electronic medical record.