Substance Use Disorder Detection Rates Among Providers of General Medical Inpatients (original) (raw)
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Journal of general internal medicine, 2017
The Tobacco, Alcohol, Prescription Medication, and Other Substance use (TAPS) tool is a combined two-part screening and brief assessment developed for adult primary care patients. The tool's first-stage screening component (TAPS-1) consists of four items asking about past 12-month use for four substance categories, with response options of never, less than monthly, monthly, weekly, and daily or almost daily. To validate the TAPS-1 in primary care patients. Participants completed the TAPS tool in self- and interviewer-administered formats, in random order. In this secondary analysis, the TAPS-1 was evaluated against DSM-5 substance use disorder (SUD) criteria to determine optimal cut-points for identifying unhealthy substance use at three severity levels (problem use, mild SUD, and moderate-to-severe SUD). Two thousand adult patients at five primary care sites. DSM-5 SUD criteria were determined via the modified Composite International Diagnostic Interview. Oral fluid was used as...
Declared and undeclared substance use among emergency department patients: a population-based study
Addiction, 2006
Aims To estimate both self-reported and corrected prevalences of substance use in a population-based study of general hospital emergency department (ED) patients and predict undeclared use. Design A state-wide cross-sectional, two-stage probability sample survey that incorporates toxicological screening. Setting Seven Tennessee EDs in acute care, adult, civilian, non-psychiatric hospitals. Participants A total of 1502 Tennessee residents, 18 years of age and older, possessing intact cognition, able to give informed consent and not in police custody. Measurements Prevalence of self-reported current substance use by age, sex and type with correction for underreporting based on toxicological screening. Covariates in the multivariate analysis of undeclared use were sociodemographics, ED visit circumstances, health-care coverage, prior health status and treatment history and tobacco addiction. Findings Declared current use was highest for alcohol (females 26%, males 47%), marijuana (males 11%, females 6%) and benzodiazepines (females 10%, males 7%). After correction for under-reporting, overall use for any of the eight targeted substances rose from 44% to 56% for females and 61% to 69% for males. Largest absolute changes involved opioids, benzodiazepines, marijuana, amphetamines and/or methamphetamine, with little change for alcohol. Patients aged 65 years and older manifested excess undeclared use relative to patients aged 18-24 years, as did patients not reporting tobacco addiction or receiving substance abuse treatment. Conclusion Adjustment for under-reporting produced minimal change in the estimated prevalence of alcohol use. However, toxicological screening markedly increased estimates of other drug use, especially for the elderly, who may under-report medication use. Screening tests are useful tools for detecting undeclared substance use.
Journal of Studies on Alcohol and Drugs, 2021
Screening, Brief Intervention and Referral to Treatment (SBIRT) programs have been effective form oderate reductions of alcohol use among participants in universal settings. However, there has been limited evidence of effectiveness in referring individualst ospecialty care,a nd the literature nowo ften refers to screening and brief intervention (SBI). This study examines documentation of substance use disorder (SUD) diagnoses in al ow-income Medicaid population to evaluate the effect of universal SBIRTonhealthcare system recognition of SUDs, afirststep to obtaining areferraltotreatment (RT) for individuals with SUDs. Method: SBIp atientd ata from Wisconsin'sInitiative to Promote HealthyLifestyles (WIPHL) were linked to Wisconsin Medicaid claims data. Ac omparison group of Medicaid beneficiaries wasidentified from amatchedsampleofnon-SBIRTclinics(total study N =1 4,856). Hierarchical generalized linear modeling wasused to assess rates of SUD diagnosis in the 12 months following receipt of SBIRTinWIPHL clinics compared with rates in non-SBIRT clinics. Analysis controlled for clinic, individual patient'shealth status, demographics, and baseline substance use diagnoses. Results: SBIRT wasa ssociated with greater odds of being diagnosed with Diagnostic and Statistical Manual of Mental Disorders, Fo urth Edition (DSM-IV), alcohol abuse or dependence as well as drug abuse or dependence over the 12 months subsequent to receipt of the screen. The overall diagnostic rate for anyD SM-IV substance abuse or dependence was9 .9% at baseline and 12.2% during the follow-up year.SBIRTpatientshad 42% (p =.003) greater odds of being diagnosed with asubstance use disorder within 12 months relative to comparison clinic patients. However, there were very fewc laimsf or specialty SUD services. Conclusions: The presence of SBIRTinaprimarycare clinic appears to increase the awareness and recognition of patients with SUDs and agreater willingness of healthcare providers to diagnosepatients with an alcohol or drug use disorder on Medicaid claims.Furtherresearch is needed to determine if thisincrease in diagnosis reflects integrated carefor SUDs or if it leads to improvedaccess to specialty care, in which case abandonment of the RT component of SBIRTm ay be premature. (J. Stud. Alcohol Drugs,
Academic Emergency Medicine, 2009
This article is a product of a breakout session on injury prevention from the 2009 Academic Emergency Medicine consensus conference on ''Public Health in the ED: Screening, Surveillance, and Intervention.'' The emergency department (ED) is an important entry portal into the medical care system. Given the epidemiology of substance use among ED patients, the delivery of effective brief interventions (BIs) for alcohol, drug, and tobacco use in the ED has the potential to have a large public health impact. To date, the results of randomized controlled trials of interventional studies in the ED setting for substance use have been mixed in regard to alcohol and understudied in the area of tobacco and other drugs. As a result, there are more questions remaining than answered. The work group developed the following research recommendations that are essential for the field of screening and BI for alcohol, tobacco, and other drugs in the ED. 1) Screening-develop and validate brief and practical screening instruments for ED patients and determine the optimal method for the administration of screening instruments. 2) Key components and delivery methods for intervention-conduct research on the effectiveness of screening, brief intervention, and referral to treatment (SBIRT) in the ED on outcomes (e.g., consumption, associated risk behaviors, and medical psychosocial consequences) including minimum dose needed, key components, optimal delivery method, interventions focused on multiple risk behaviors and tailored based on assessment, and strategies for addressing polysubstance use. 3) Effectiveness among patient subgroups-conduct research to determine which patients are most likely to benefit from a BI for substance use, including research on moderators and mediators of intervention effectiveness, and examine special populations using culturally and developmentally appropriate interventions. 4) Referral strategiesa) promote prospective effectiveness trials to test best strategies to facilitate referrals and access from the ED to preventive services, community resources, and substance abuse and mental health treatment; b) examine impact of available community services; c) examine the role of stigma of referral and followup; and d) examine alternatives to specialized treatment referral. 5) Translation-conduct translational and cost-effectiveness research of proven efficacious interventions, with attention to fidelity, to move ED SBIRT from research to practice.
General Hospital Psychiatry, 2001
Previous research may have underestimated physicians' detection rates of alcohol dependence or abuse because case findings have been based on screening questionnaires instead of using in-depth diagnostic criteria and detection rates have been assessed by analyzing patient records instead of directly interviewing the physician. To test this hypothesis, consecutive patients of a general hospital (Nϭ436) and of 12 randomly selected general practices (Nϭ929) were examined. A two-step diagnostic procedure included screening questionnaires and a diagnostic interview (SCAN). The analysis compares detection rates based on methods used in previous studies to data using more precise methods. Physicians' detection rates ranged from 37.0% to 88.9% in the general hospital and from 11.1% to 74.7% in general practices depending on methods used. The physicians' detection rates could be improved by 10% (general hospital) and 20% (general practice) through the additional use of a screening questionnaire. Of those patients assessed by the physicians as problem drinkers in the general hospital, 13.9% were referred to an addiction consultation-liaison service. Data reveal that physicians' abilities to detect problem drinkers have been underestimated. Routine screening procedures could play a major role in improving detection rates and reminding the physician to intervene.
The western journal of emergency medicine, 2016
Among adult emergency department (ED) patients, we sought to examine how estimates of substance use prevalence and the need for interventions can differ, based on the type of screening and assessment strategies employed. We estimated the prevalence of substance use and the need for interventions using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in a secondary analysis of data from two cross-sectional studies using random samples of English- or Spanish-speaking 18-64-year-old ED patients. In addition, the test performance characteristics of three simplified screening strategies consisting of selected questions from the ASSIST (lifetime use, past three-month use, and past three-month frequency of use) to identify patients in need of a possible intervention were compared against using the full ASSIST. Of 6,432 adult ED patients, the median age was 37 years-old, 56.6% were female, and 61.6% were white. Estimated substance use prevalence among this population d...
Drug and Alcohol Dependence, 2009
Objectives: Alcohol screening and brief interventions in medical settings can significantly reduce alcohol use. Corresponding data for illicit drug use is sparse. A Federally funded screening, brief interventions, referral to treatment (SBIRT) service program, the largest of its kind to date, was initiated by the Substance Abuse and Mental Health Services Administration (SAMHSA) in a wide variety of medical settings. We compared illicit drug use at intake and 6 months after drug screening and interventions were administered. Design: SBIRT services were implemented in a range of medical settings across six states. A diverse patient population (Alaska Natives, American Indians, African-Americans, Caucasians, Hispanics), was screened and offered score-based progressive levels of intervention (brief intervention, brief treatment, referral to specialty treatment). In this secondary analysis of the SBIRT service program, drug use data was compared at intake and at a 6-month follow-up, in a sample of a randomly selected population (10%) that screened positive at baseline. Results: Of 459,599 patients screened, 22.7% screened positive for a spectrum of use (risky/problematic, abuse/addiction). The majority were recommended for a brief intervention (15.9%), with a smaller percentage recommended for brief treatment (3.2%) or referral to specialty treatment (3.7%). Among those reporting baseline illicit drug use, rates of drug use at 6-month follow-up (4 of 6 sites), were 67.7% lower (p < 0.001) and heavy alcohol use was 38.6% lower (p < 0.001), with comparable findings across sites, gender, race/ethnic, age subgroups. Among persons recommended for brief treatment or referral to specialty treatment, self-reported improvements in general health (p < 0.001), mental health (p < 0.001), employment (p < 0.001), housing status (p < 0.001), and criminal behavior (p < 0.001) were found. Conclusions: SBIRT was feasible to implement and the self-reported patient status at 6 months indicated significant improvements over baseline, for illicit drug use and heavy alcohol use, with functional domains improved, across a range of health care settings and a range of patients. Published by Elsevier Ireland Ltd.
Brief substance use screening instruments for primary care settings
Journal of Substance Abuse Treatment, 2000
Chemical dependence, including nicotine, alcohol, prescription drugs, and illicit drugs, is one of the leading causes of morbidity and mortality in the United States. Primary care physicians and nurses routinely provide preventive health care and rely on routine screening to detect diseases and promote wellness. These primary care practitioners are in a unique position to assess and detect such dependence at its earliest stages. However, previous research indicates that little such screening is actually conducted. This literature review gathered and examined substance use screening instruments in four categories to assess their feasibility for use in primary care settings. Although substance use screening tools are available, most are not appropriate for screening in a primary care setting. There clearly remains a need for the development of a valid, reliable screening instrument that can be easily incorporated into the practices and procedures found in primary care settings.