Screening and assessment of alcohol and other drug abuse

Studies in medical, surgical, and gynecologic practices indicate that the prevalence of alcohol and other substance abuse among patients ranges from 20% to 50%. Although physicians are in a unique position to detect alcohol or drug abuse in their patients, they often fail to do so. Physicians are particularly unlikely to identify substance abuse in its earliest stages, and thus miss major opportunities for intervening. Several screening questionnaires for early detection of alcohol and other substance abuse have been developed. Alcohol abuse questionnaires have been the most extensively validated and have good sensitivity and specificity. Those developed for nonalcohol drug abuse are not well validated, but may be useful in clinical populations. Early biological laboratory markers of alcohol abuse are routinely available but are not as sensitive or specific as the screening questionnaires. Early biological markers of nonalcohol drug abuse are not yet well defined.