A two-item screening test for alcohol and other drug problems

Area of Science:

• Addiction Medicine
• Psychiatry
• Primary Care Research

Background:

• Current substance use disorder (SUD) screening tools primarily focus on alcohol, neglecting other drug use.
• Nonmedical use of illicit and prescription drugs is prevalent among American adults.
• There is a need for validated screening instruments for broader SUD detection in primary care.

Purpose of the Study:

• To evaluate the criterion validity of a two-item conjoint screening (TICS) test for alcohol and other drug abuse or dependence.
• To assess the TICS's effectiveness in a primary care patient sample.

Main Methods:

• A random sample of 434 primary care patients (aged 18-59) completed nine screening items derived from a focus group.
• The Composite International Diagnostic Interview-Substance Abuse Module, based on DSM-III-R criteria, served as the criterion standard for SUDs.

Main Results:

• The TICS demonstrated approximately 81% sensitivity and specificity in discriminating current SUDs.
• A single positive response on the TICS indicated a 45% likelihood of a current SUD, while two positive responses indicated a 75% likelihood.
• The TICS showed particular sensitivity to polysubstance use disorders.

Conclusions:

• The TICS can identify over 80% of young and middle-aged patients with current alcohol or other drug problems.
• The TICS is a practical tool easily integrated into routine clinical interviews.
• This screening method offers a promising approach for early detection of SUDs in primary care.