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Prevalence and Correlates of Positive Follow-up Screens in Primary Care for Unhealthy Alcohol and Other Drug Use
Daniel P Alford1, Theresa W Kim, Jeffrey H Samet
1From the Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA (DPA, TWK, JHS, ABC, CWS, RS); Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA (JHS, RS); Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA (MFB).
Objective:
To determine the proportion and characteristics of adults in primary care (PC) who screen positive for unhealthy substance use (SU) (alcohol and/or other drug) 1 year or more after screening negative.
Methods:
Screening consisted of single-item questions for unhealthy use of alcohol and other drugs (illicit drugs and prescription medications). Health educators conducted in-person screening of patients presenting for a PC appointment. SU severity (low, moderate, high) was assessed with the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). Multivariate logistic regression models estimated predictors of a positive follow-up screen.
Results:
Among 9215 patients who previously screened negative, 237 (2.6%) screened positive for unhealthy SU (42% alcohol only, 43% other drug only, 15% alcohol and other drug). The mean interval between screens was 19 months. Most alcohol use was low risk (ASSIST score ≤10) (81%), whereas most drug use was moderate risk (ASSIST score 4-26) (77%). Patients between ages of 18 to 25 had a higher proportion of positive follow-up screens (7.4% [33/ 443]) as well as those with a self-identified history of SU problems (9.4% [40/421]). Patients with a higher odds of a positive follow-up screen were male (adjusted odds ratio [AOR] 2.64; 95% CI: 2.02-3.45), used tobacco (AOR 2.38; 95% CI: 1.75-3.23), had a longer interval between screenings (AOR 3.26; 95% CI: 1.84-5.75).
Conclusions:
Screening for unhealthy SU 1 year or more after screening negative identified additional patients at-risk. These findings highlight the need to empirically determine the incremental benefits of screening all PC patients annually.
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