Screening Questions Help Primary Care Physicians Detect Substance Abuse

Posted on September 4th, 2014

Primary care practitioners seldom encounter medical conditions they can’t identify. Backed by precise diagnostic tools such as X-ray machines, MRI scanners, computerized tomography and DNA testing, 21st century doctors, nurses and physician’s assistants are able to uncover a broad range of diseases, injuries, syndromes and conditions.

But despite modern medicine’s many advances, detecting substance abuse problems has continued to challenge primary care providers. Doctors might have suspicions, but suspicions are not the same as proof. This can be a big problem for medical professionals dedicated to giving their patients the best service possible, since substance abuse is a life-threatening condition that directly or indirectly claims the lives of more than 100,000 Americans every year.

Health care practitioners will frequently ask patients about their drug and alcohol habits. But the answers they receive must be honest and must be properly targeted if the information obtained is to be useful. Fortunately, research has shown that if the right questions are asked, the odds of successfully uncovering substance abuse in a general clinical setting can be improved significantly.

Two-Item Conjoint Screen Test for Addiction

A research study carried out several years ago produced some valuable data that has helped refine the methodology of addiction detection. As detailed in the March 2001 edition of the Journal of the American Board of Family Medicine, researchers from the University of Wisconsin Medical School tested five screening questions designed to expose drug and alcohol abuse problems. More than 1,100 individuals visiting primary care facilities for health problems unrelated to substance abuse were asked to give “yes” or “no” answers to each of these queries. Afterward, study participants were interviewed by a mental health professional to determine if they met the criteria for drug and/or alcohol use (as defined by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, or DSM-III).

Overall, approximately 23 percent of these medical patients were diagnosed with a substance abuse problem, representing 261 men and women in total. Out of this group, 207 people (79 percent) gave an affirmative response to at least one of the following two questions:

“In the last year, have you ever drunk or used drugs more than you meant to?”

“Have you felt you wanted or needed to cut down on your drinking or drug use in the last year?”

This percentage of detection was impressive and noteworthy, and the results of this 2001 study have influenced clinical screening methodology in the years since. However, there was a fly in the ointment. Among the 875 study participants who failed to register for a substance abuse problem, 193 had answered “yes” to at least one of the two most pertinent inquiries. This means that out of the 400 people who set off alarms for substance abuse based on their responses to the screening questions, almost half did not actually suffer from a drug or alcohol problem.

So even with the greater precision provided by what has come to be called the Two-Item Conjoint Screen test, the total hit-to-miss ratio is still only about 50/50. This reveals how difficult it is for primary care providers to make an accurate diagnosis of substance abuse even under the best of circumstances. This doesn’t negate the value of this screening test, but it does show how important the follow-up procedure is to determine if a serious problem really exists. All doctors will make referrals if patients need specialized help, and that includes sending suspected drug addicts and alcoholics to highly-trained treatment professionals who know how to make a definitive diagnosis.

Screening Questions for Life

While there is no foolproof way to uncover drug or alcohol addiction in a general clinical setting, with the right screening questions critically important information can be obtained. In addition to the Two-Item Conjoint Screen, the National Institute of Drug Abuse has also created a good quality screening test for primary care physicians. This test includes an eight-question survey that will produce a “substance involvement score,” allowing doctors to classify patients as low, moderate or high risk for problem drinking and/or drug use. Other sets of screening questions and follow-up exams have also been developed, and of course many doctors choose to follow their instincts and rely on their own personalized approach when broaching the subject of substance abuse with their clients.

Despite their limitations, screening questions for drug and alcohol abuse do have a positive role to play in clinical environments. Addiction and substance abuse damage human health in a number of significant ways, and it is clearly in the interest of primary care practitioners to track their patients’ drug and alcohol use as accurately as possible. Treatment and rehabilitation can give addicts new hope, but without referrals from the healthcare industry, treatment specialists may never get the opportunity to work with many of those who need their help the most.

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