FPs Can Get New Online Drug Use Screening Tool

The NIH's National Institute on Drug Abuse, or NIDA, is offering physicians and other health care professionals an online screening tool and other free resources intended to help them assess patients' tobacco, alcohol, and illicit and nonmedical prescription drug use and to intervene with those at high risk of abusing these substances.

NIDA's first Physicians' Outreach Initiative, called NIDAMED, includes an online screening tool, a comprehensive resource guide for clinicians, a quick reference guide and a patient-tested postcard. NIDA said in an April 20 news release that the initiative stresses the importance of the patient-doctor relationship in identifying unhealthy behaviors before they evolve into life-threatening conditions.

The institute said the NIDAMED tools, which target primary care clinicians, were developed because research shows that screening, brief intervention and referral to treatment can promote reductions in patients' alcohol and tobacco use. In addition, there's growing evidence that reductions in illegal and nonmedical prescription drug use also can be achieved.

"Not only will these tools potentially help clinicians identify the use of drugs such as cocaine and heroin, they can also identify patients who are misusing prescription medications," said Acting Surgeon General Steven Galson, M.D., who participated in the recent unveiling of the initiative.

The online screening tool was adapted from the Alcohol, Smoking and Substance Involvement Screening Test, or ASSIST, which was developed by the World Health Organization to identify substance use. The tool guides clinicians through a short series of questions. Based on a patient's responses, it generates a substance involvement score that suggests the level of intervention needed.

FP Thomas Houston, M.D., of Columbus, Ohio, chairman of the Academy's Tobacco Cessation Advisory Committee and a member of its Commission on Health of the Public and Science, said he tried out the screening tool and liked it.

"It's quite good for physicians who are not well trained in alcohol or drug screening or treatment. It's an easy way to learn patients' use of these substances, and it links to very good resources," he told AAFP News Now.

Houston said he entered fabricated information about fictitious patients in answer to questions on how much alcohol the patients drank each day and whether the drinking ever resulted in injuries or trouble with the law. The tool categorized the so-called patients as problem drinkers and determined that they needed to seek assistance. A similarly performed assessment of at-risk smokers yielded a link to smoking cessation guidelines from HHS.

Family physicians underdiagnose these problems, Houston explained. "We ask about tobacco use frequently but not about these other substance problems. They don't bubble to the surface in an office visit to treat hypertension, diabetes and other problems, even though these substances can add to other illnesses," he said.

In addition to the online screening tool, NIDAMED offers a comprehensive resource guide with detailed instructions on how to implement the screening tool, discuss screening results, offer a brief intervention and make referrals. The quick reference guide (7-page PDF; About PDFs) serves as a prompt to medical professionals to initiate screening, and it provides a snapshot of the NIDA-modified ASSIST tool, briefly summarizing the questions, scoring schema and next steps.

The NIDAMED physician toolkit also boasts a patient-tested postcard -- one of a series that focuses on the dangers related to substance abuse -- that encourages patients to communicate with their doctors about all the drugs they use and offers Web links for more information. The cards can be distributed in physicians' offices or clinic waiting rooms.