A Brief Patient Self-administered Substance Use Screening Tool for Primary Care: Two-site Validation Study of the Substance Use Brief Screen (SUBS) - 17/06/15
, Shiela M. Strauss, PhD c, Richard Saitz, MD, MPH d, Charles M. Cleland, PhD c, Joseph J. Palamar, PhD, MPH a, John Rotrosen, MD e, Marc N. Gourevitch, MD, MPH a, bAbstract |
Background |
Substance use screening is widely encouraged in health care settings, but the lack of a screening approach that fits easily into clinical workflows has restricted its broad implementation. The Substance Use Brief Screen (SUBS) was developed as a brief, self-administered instrument to identify unhealthy use of tobacco, alcohol, illicit drugs, and prescription drugs. We evaluated the validity and test-retest reliability of the SUBS in adult primary care patients.
Methods |
Adults aged 18-65 years were enrolled from urban safety net primary care clinics to self-administer the SUBS using touch-screen tablet computers for a test-retest reliability study (n = 54) and a 2-site validation study (n = 586). In the test-retest reliability study, the SUBS was administered twice within a 2-week period. In the validation study, the SUBS was compared with reference standard measures, including self-reported measures and oral fluid drug tests. We measured test-retest reliability and diagnostic accuracy of the SUBS for detection of unhealthy use and substance use disorder for tobacco, alcohol, and drugs (illicit and prescription drug misuse).
Results |
Test-retest reliability was good or excellent for each substance class. For detection of unhealthy use, the SUBS had sensitivity and specificity of 97.8% (95% confidence interval [CI], 93.7-99.5) and 95.7% (95% CI, 92.4-97.8), respectively, for tobacco; and 85.2% (95% CI, 79.3-89.9) and 77.0% (95% CI, 72.6-81.1) for alcohol. For unhealthy use of illicit or prescription drugs, sensitivity was 82.5% (95% CI, 75.7-88.0) and specificity 91.1% (95% CI, 87.9-93.6). With respect to identifying a substance use disorder, the SUBS had sensitivity and specificity of 100.0% (95% CI, 92.7-100.0) and 72.1% (95% CI, 67.1-76.8) for tobacco; 93.5% (95% CI, 85.5-97.9) and 64.6% (95% CI, 60.2-68.7) for alcohol; and 85.7% (95% CI, 77.2-92.0) and 82.0% (95% CI, 78.2-85.3) for drugs. Analyses of area under the receiver operating curve (AUC) indicated good discrimination (AUC 0.74-0.97) for all substance classes. Assistance in completing the SUBS was requested by 11% of participants.
Conclusions |
The SUBS was feasible for self-administration and generated valid results in a diverse primary care patient population. The 4-item SUBS can be recommended for primary care settings that are seeking to implement substance use screening.
Le texte complet de cet article est disponible en PDF.Keywords : Alcohol, Illicit drugs, Screening, Substance use, Tobacco, Validation
Plan
| Funding: National Institute on Drug Abuse K23 DA030395; National Institutes of Health/National Center for Advancing Translational Sciences UL1 TR000038; P30 DA011041. Additional funding was provided by subcontract from the MITRE Corporation (McLean, VA; who were contracted by the White House Office of the National Coordinator for Health Information Technology and Substance Abuse and Mental Health Services Administration). |
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| Conflict of Interest: None of the authors have a conflict of interest to report. |
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| Authorship: JM had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. JM was the principal investigator (PI) of the test-retest reliability study and the validation study at Site A, and led the analysis and writing. RS was site PI at Site B, and contributed to the study design. SMS and JR assisted with study design and advised on the analysis. CMC and JJP conducted the statistical analysis and assisted with data management. MNG played an instrumental role in conception and design of the study. |
Vol 128 - N° 7
P. 784.e9-784.e19 - juillet 2015 Retour au numéro
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