10 Apr Can Doctors Shorten Screening Procedures for Drug and Alcohol Abuse?
Primary care doctors can play a vital role in preventing and treating alcohol abuse and drug abuse by routinely screening their patients for signs of these issues. The screening procedures currently in use require doctors to ask a series of specific questions designed to uncover substance abuse-related issues. According to the results of a study published in January 2014 in the Journal of Studies on Alcohol and Drugs, primary care physicians can potentially make patient screenings easier by asking only one key question regarding alcohol abuse or drug abuse.
Current Alcohol Screening
Doctors can choose from a range of screening procedures when trying to uncover dangerous patterns of alcohol or drug intake. One of the most commonly used procedures for detecting problematic alcohol intake is the Alcohol Use Disorders Identification Test (AUDIT), which can help identify people at-risk for alcohol abuse and alcoholism, as well as people who already qualify for a diagnosis of these conditions (now known collectively as alcohol use disorder). The full version of AUDIT contains 10 questions designed to elicit information on risky patterns of drinking. A shorter version of the procedure, called AUDIT-C, reduces the 10-question screening down to three questions. The full version of the procedure can correctly identify people affected by alcoholism 95 percent of the time. The AUDIT-C procedure has a slightly lower rate of accuracy.
Current Drug Screening
One of the most commonly used procedures for detecting problematic drug intake is the Drug Abuse Screen Test (DAST). The full version of this test contains 28 questions designed to identify people affected by various diagnosable drug use disorders or at-risk for developing those disorders. Two shorter versions of the test contain 20 questions and 10 questions, respectively. Some doctors prefer the shortest version of the procedure, known as DAST-10. Unlike the AUDIT procedures, which ask patients to answer multiple-choice questions, the DAST procedures rely on a simplified yes/no format. Most physicians can complete a DAST-10 screening in roughly seven minutes.
In the study published in the Journal of Studies on Alcohol and Drugs, researchers from the Boston University School of Public Health compared the effectiveness of the AUDIT-C and DAST screening procedures to the effectiveness of shorter, single-item questionnaires designed to detect the same types of problems with alcohol use or drug use. The single question used to detect alcohol-related problems differed slightly for men and women. For men, the question was “How many times in the past year have you consumed five or more drinks in a day?” For women, the question was “How many times in the past year have you consumed four or more drinks in a day?” The single question used to detect drug-related problems was “How many times in the past year have you used an illegal drug or used a prescription medication for nonmedical reasons?”
The researchers conducted their comparisons with the help of a group of 286 adults seeking routine medical care from Boston Medical Center. They concluded that the gender-appropriate single screening question for alcohol-related problems accurately identified people with these problems 88 percent of the time; by comparison, AUDIT-C correctly identified these people 92 percent of the time. They also concluded that the single screening question for drug-related problems accurately identified people with these problems 97 percent of the time; by comparison, DAST correctly identified these people a full 100 percent of the time. In addition, the researchers concluded that the single-question screenings for both alcohol and drugs accurately identified people unaffected by serious problems at a slightly higher rate than either AUDIT-C or DAST.
Significance and Considerations
The authors of the study published in the Journal of Studies on Alcohol and Drugs believe that the single-question screening procedures for both alcohol and drugs are accurate enough to work as effective substitutes for the longer AUDIT-C and DAST procedures. They also believe that doctors may be more likely to administer these shorter tests on a regular basis. This last point is critically important, since current evidence suggests that primary care physicians only rarely ask their patients questions regarding drug and alcohol use, even though public health guidelines clearly recommend that they do so. For example, a report published by the Centers for Disease Control and Prevention in January 2014 indicates that only about 17 percent of doctors across the U.S. ever seek information on their patients’ regular drinking habits.
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