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Can Two Questions Screen for Alcohol and Substance Abuse?

Am Fam Physician. 2001 Oct 1;64(7):1247.

There is a need for a brief, accurate screen for substance-use disorders in health care settings. Currently, many screening questionnaires focus only on alcohol abuse. The screening protocols for drug abuse are too lengthy and inaccurate to use in medical care settings. A possible solution is to develop a short screening tool that would inquire simultaneously about alcohol and drug abuse. These conjoint questions could provide valuable information and reduce the screening time requirement. Brown and associates looked at the validity of a two-item conjoint screen for alcohol and drug abuse in primary care settings.

The participants, who were a random sample of patients scheduled for routine visits in three different family practice centers, were between 18 and 59 years of age. After pilot testing, five conjoint questions were established as a screening tool. All participants were given these five questions and the Composite International Diagnostic Interview Substance Abuse Model (CIDI-SAM). After the interview, a urine drug screen was performed on a random sample of 25 percent of all participants.

The study found that a positive response to two items in the conjoint questions detected current substance-use disorders with nearly 80 percent sensitivity and specificity. The two questions were: “In the past year, have you ever drunk or used drugs more than you meant to?” and “Have you felt you wanted or needed to cut down on your drinking or drug abuse in the past year?” When considering participants involved in polysubstance abuse, the specificity and sensitivity improved.

The authors conclude that current alcohol or other drug abuse can be detected in nearly 80 percent of young and middle-aged adults by asking these two questions. These two questions can easily be incorporated into the clinical interview. The authors add that further studies would help to determine if these results can be generalized across different populations.

Brown RL, et al. A two-item conjoint screen for alcohol and other drug problems. J Am Board Fam Pract March-April. 2001;14:95–106.


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