A simple, fast screening questionnaire for substance use could have several benefits, say researchers from New York University and Boston Medical Center, such as streamlining workflow for primary care practitioners and staff and affording patients the privacy to report possibly stigmatizing behavior.
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But there wasn’t such a tool, so the researchers developed the Substance Use Brief Screen (SUBS). They based it on the National Institute on Drug Abuse Quick Screen V1.0, which has not yet been validated. Then they tested their screen for reliability in 54 primary care patients and conducted another study to validate it in 586 more.
The questionnaire has 4 questions: In the past 12 months, how many days did you use tobacco; have 4 or more alcoholic drinks in a day; use illegal drug(s); or use prescription medication(s) “recreationally”?
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The SUBS had high sensitivity and moderate-to-high specificity for detecting unhealthy use of tobacco, alcohol, and other drugs. Sensitivity was lower for prescription drugs alone but increased when they were combined into a single “any drug” category. The researchers say this may reflect drug users’ lack of clarity about what constitutes illicit vs prescription drug misuse.
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The test was well accepted among a diverse patient population (although 11% in the reliability study needed some help with questions or technical assistance) and easily used on a tablet computer. It compared favorably with other widely recommended brief substance use screening tools—all of which are interviewer administered, the researchers point out. They add that a self-administered tool may put patients at greater ease about reporting substance use and thus be more consistently accurate in real-world practice.
McNeely J, Strauss SM, Saitz R, et al. Am J Med. 2015;128(7):784.e9-784.e19.