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Journal of General Internal Medicine
Published in: Journal of General Internal Medicine 12/2015

01-12-2015 | Original Research

Validation of Self-Administered Single-Item Screening Questions (SISQs) for Unhealthy Alcohol and Drug Use in Primary Care Patients

Authors: Jennifer McNeely, MD, MS, Charles M. Cleland, PhD, Shiela M. Strauss, PhD, Joseph J. Palamar, PhD, MPH, John Rotrosen, MD, Richard Saitz, MD, MPH

Published in: Journal of General Internal Medicine | Issue 12/2015

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ABSTRACT

Background

Very brief single-item screening questions (SISQs) for alcohol and other drug use can facilitate screening in health care settings, but are not widely used. Self-administered versions of the SISQs could ease barriers to their implementation.

Objective

We sought to validate SISQs for self-administration in primary care patients.

Design

Participants completed SISQs for alcohol and drugs (illicit and prescription misuse) on touchscreen tablet computers. Self-reported reference standard measures of unhealthy use, and more specifically of risky consumption, problem use, and substance use disorders, were then administered by an interviewer, and saliva drug tests were collected.

Participants

Adult patients aged 21–65 years were consecutively enrolled from two urban safety-net primary care clinics.

Main Measures

The SISQs were compared against reference standards to determine sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) for alcohol and drug use.

Key Results

Among the 459 participants, 22 % reported unhealthy alcohol use and 25 % reported drug use in the past year. The SISQ-alcohol had sensitivity of 73.3 % (95 % CI 65.3–80.3) and specificity of 84.7 % (95 % CI 80.2–88.5), AUC = 0.79 (95 % CI 0.75–0.83), for detecting unhealthy alcohol use, and sensitivity of 86.7 % (95 % CI 75.4–94.1) and specificity of 74.2 % (95 % CI 69.6–78.4), AUC = 0.80 (95 % CI 0.76–0.85), for alcohol use disorder. The SISQ-drug had sensitivity of 71.3 % (95 % CI 62.4–79.1) and specificity of 94.3 % (95 % CI 91.3–96.6), AUC = 0.83 (95 % CI 0.79–0.87), for detecting unhealthy drug use, and sensitivity of 85.1 (95 % CI 75.0–92.3) and specificity of 88.6 % (95 % CI 85.0–91.6), AUC = 0.87 (95 % CI 0.83–0.91), for drug use disorder.

Conclusions

The self-administered SISQs are a valid approach to detecting unhealthy alcohol and other drug use in primary care patients. Although self-administered SISQs may be less accurate than the previously validated interviewer-administered versions, they are potentially easier to implement and more likely to retain their fidelity in real-world practice settings.
Literature
1.
Maciosek MV, Coffield AB, Edwards NM, Flottemesch TJ, Goodman MJ, Solberg LI. Priorities among effective clinical preventive services: results of a systematic review and analysis. Am J Prev Med. 2006;31(1):52–61.CrossRefPubMed
2.
Moyer VA. Screening and behavioral counseling interventions in primary care to reduce alcohol misuse: U.S. preventive services task force recommendation statement. Ann Intern Med. 2013;159(3):210–218.PubMed
3.
Solberg LI, Maciosek MV, Edwards NM. Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness. Am J Prev Med. 2008;34(2):143–152.CrossRefPubMed
4.
Whitlock EP, Polen MR, Green CA, Orleans T, Klein J. Behavioral counseling interventions in primary care to reduce risky/harmful alcohol use by adults: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2004;140(7):557–568.CrossRefPubMed
5.
6.
Substance Abuse and Mental Health Services Administration (SAMHSA). In: Center for Substance Abuse Treatment, ed. A guide to substance abuse services for primary care clinicians. Rockville: Substance Abuse and Mental Health Services Administration; 1997.
7.
8.
Roy-Byrne P, Bumgardner K, Krupski A, Dunn C, Ries R, Donovan D, et al. Brief intervention for problem drug use in safety-net primary care settings a randomized clinical trial. JAMA-J Am Med Assoc. 2014;312(5):492–501.CrossRef
9.
Saitz R, Palfai TPA, Cheng DM, Alford DP, Bernstein JA, Lloyd-Travaglini CA, et al. Screening and brief intervention for drug use in primary care the ASPIRE randomized clinical trial. JAMA-J Am Med Assoc. 2014;312(5):502–513.CrossRef
10.
Saitz R, Alford DP, Bernstein J, Cheng DM, Samet J, Palfai T. Screening and brief intervention for unhealthy drug use in primary care settings: randomized clinical trials are needed. J Addict Med. 2010;4(3):123–130.PubMedCentralCrossRefPubMed
11.
12.
Danaei G, Ding EL, Mozaffarian D, Taylor B, Rehm J, Murray CJ, et al. The preventable causes of death in the United States: comparative risk assessment of dietary, lifestyle, and metabolic risk factors. PLoS Med. 2009;6(4):e1000058.PubMedCentralCrossRefPubMed
13.
Antoniou T, Tseng AL. Interactions between recreational drugs and antiretroviral agents. Ann Pharmacother. 2002;36(10):1598–1613.CrossRefPubMed
14.
Lindsey WT, Stewart D, Childress D. Drug interactions between common illicit drugs and prescription therapies. Am J Drug Alcohol Abus. 2012;38(4):334–343.CrossRef
15.
Malta M, Strathdee SA, Magnanini MM, Bastos FI. Adherence to antiretroviral therapy for human immunodeficiency virus/acquired immune deficiency syndrome among drug users: a systematic review. Addiction. 2008;103(8):1242–1257.CrossRefPubMed
16.
Arnsten JH, Demas PA, Grant RW, Gourevitch MN, Farzadegan H, Howard AA, et al. Impact of active drug use on antiretroviral therapy adherence and viral suppression in HIV-infected drug users. J Gen Intern Med. 2002;17(5):377–381.PubMedCentralCrossRefPubMed
17.
Centers for Disease Control and Prevention. Unintentional poisoning deaths–United States, 1999–2004. MMWR Morb Mortal Wkly Rep. 2007;56(5):93–96.
18.
19.
Williams EC, Johnson ML, Lapham GT, Caldeiro RM, Chew L, Fletcher GS, et al. Strategies to implement alcohol screening and brief intervention in primary care settings: a structured literature review. Psychol Addict Behav: J Soc Psychol Addicti Behav. 2011;25(2):206–214.CrossRef
20.
Kaner E. Brief alcohol intervention: time for translational research. Addiction. 2010;105(6):960–961. discussion 4–5.CrossRefPubMed
21.
Nilsen P. Brief alcohol intervention–where to from here? Challenges remain for research and practice. Addiction. 2010;105(6):954–959.CrossRefPubMed
22.
Smith PC, Schmidt SM, Allensworth-Davies D, Saitz R. Primary care validation of a single-question alcohol screening test. J Gen Intern Med. 2009;24(7):783–788.PubMedCentralCrossRefPubMed
23.
Smith PC, Schmidt SM, Allensworth-Davies D, Saitz R. A single-question screening test for drug use in primary care. Arch Intern Med. 2010;170(13):1155–1160.PubMedCentralCrossRefPubMed
24.
Saitz R, Cheng DM, Allensworth-Davies D, Winter MR, Smith PC. The ability of single screening questions for unhealthy alcohol and other drug use to identify substance dependence in primary care. J Stud Alcohol Drugs. 2014;75(1):153–157.PubMedCentralCrossRefPubMed
25.
Bradley KA, Lapham GT, Hawkins EJ, Achtmeyer CE, Williams EC, Thomas RM, et al. Quality concerns with routine alcohol screening in VA clinical settings. J Gen Intern Med. 2011;26(3):299–306.PubMedCentralCrossRefPubMed
26.
Williams EC, Achtmeyer CE, Thomas RM, Grossbard JR, Lapham GT, Chavez LJ, et al. Factors underlying quality problems with alcohol screening prompted by a clinical reminder in primary care: A multi-site qualitative study. J Gen Intern Med. 2015 doi:10.​1007/​s11606-015-3248-z
27.
Johnson M, Jackson R, Guillaume L, Meier P, Goyder E. Barriers and facilitators to implementing screening and brief intervention for alcohol misuse: a systematic review of qualitative evidence. J Publ Health (Oxf). 2011;33(3):412–421.CrossRef
28.
Sterling S, Kline-Simon AH, Wibbelsman C, Wong A, Weisner C. Screening for adolescent alcohol and drug use in pediatric health-care settings: predictors and implications for practice and policy. Addict Sci Clin Pract. 2012;7(1):13.PubMedCentralCrossRefPubMed
29.
Spear SS, M, Gilberti B, Fiellin M, McNeely J. Usability and acceptability of an audio guided computer-assisted self-interview (ACASI) version of the Alcohol, Smoking, and Substance Involvement Screening Test. Presented at Addiction Health Services Research Conference 2013.
30.
Tourangeau R, Smith TW. Asking sensitive questions - the impact of data collection mode, question format, and question context. Publ Opin Q. 1996;60(2):275–304.CrossRef
31.
Wight RG, Rotheram-Borus MJ, Klosinski L, Ramos B, Calabro M, Smith R. Screening for transmission behaviors among HIV-infected adults. Aids Educ Prev. 2000;12(5):431–441.PubMed
32.
Substance Abuse and Mental Health Services Administration. Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013 NSDUH Series H-46, HHS Publication No.(SMA) 13–4795.
33.
Lee JD, Delbanco B, Wu E, Gourevitch MN. Substance use prevalence and screening instrument comparisons in urban primary care. Subst Abus: Off Publ Assoc Med Educ Res Subst Abus. 2011;32(3):128–134.CrossRef
34.
Arozullah AM, Yarnold PR, Bennett CL, Soltysik RC, Wolf MS, Ferreira RM, et al. Development and validation of a short-form, rapid estimate of adult literacy in medicine. Med Care. 2007;45(11):1026–1033.CrossRefPubMed
35.
Alonzo TA, Pepe MS. Using a combination of reference tests to assess the accuracy of a new diagnostic test. Stat Med. 1999;18(22):2987–3003.CrossRefPubMed
36.
Sobell LC, Sobell MB. Timeline follow-back. Measuring alcohol consumption. New York: Springer; 1992:41–72.CrossRef
37.
38.
Cooke F, Bullen C, Whittaker R, McRobbie H, Chen MH, Walker N. Diagnostic accuracy of NicAlert cotinine test strips in saliva for verifying smoking status. Nicotine Tob Res: Off J Soc Res Nicotine Tob. 2008;10(4):607–612.CrossRef
39.
Heltsley R, DePriest A, Black DL, Robert T, Marshall L, Meadors VM, et al. Oral fluid drug testing of chronic pain patients. I. Positive prevalence rates of licit and illicit drugs. J Anal Toxicol. 2011;35(8):529–540.CrossRefPubMed
40.
Cone EJ, Presley L, Lehrer M, Seiter W, Smith M, Kardos KW, et al. Oral fluid testing for drugs of abuse: positive prevalence rates by Intercept immunoassay screening and GC-MS-MS confirmation and suggested cutoff concentrations. J Anal Toxicol. 2002;26(8):541–546.CrossRefPubMed
41.
Lecrubier Y, Sheehan D, Weiller E, Amorim P, Bonora I, Harnett Sheehan K, et al. The Mini International Neuropsychiatric Interview (MINI). A short diagnostic structured interview: reliability and validity according to the CIDI. Eur Psychiatr. 1997;12(5):224–231.CrossRef
42.
Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, et al. The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatr. 1998;59(Suppl 20):22–33. quiz 4–57.
43.
Allensworth-Davies D, Cheng DM, Smith PC, Samet JH, Saitz R. The Short Inventory of Problems-Modified for Drug Use (SIP-DU): validity in a primary care sample. Am J Addict/Am Acad Psychiatr Alcohol Addict. 2012;21(3):257–262.CrossRef
44.
Feinn R, Tennen H, Kranzler HR. Psychometric properties of the short index of problems as a measure of recent alcohol-related problems. Alcohol Clin Exp Res. 2003;27(9):1436–1441.CrossRefPubMed
45.
Simel DL, Samsa GP, Matchar DB. Likelihood ratios with confidence: sample size estimation for diagnostic test studies. J Clin Epidemiol. 1991;44(8):763–770.CrossRefPubMed
46.
Satre D, Wolfe W, Eisendrath S, Weisner C. Computerized screening for alcohol and drug use among adults seeking outpatient psychiatric services. Psychiatr Serv. 2008;59(4):441–444.PubMedCentralCrossRefPubMed
47.
Butler SFCE, Bromberg JI, Budman SH, Buono DP. Computer-assisted screening and intervention for alcohol problems in primary care. J Technol Hum Serv. 2003;21(3):1–19.CrossRef
48.
Reichmann WM, Losina E, Seage GR, Arbelaez C, Safren SA, Katz JN, et al. Does modality of survey administration impact data quality: audio computer assisted self interview (ACASI) versus self-administered pen and paper? PLoS One. 2010;5(1):e8728.PubMedCentralCrossRefPubMed
49.
50.
Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology. 1982;143(1):29–36.CrossRefPubMed
51.
Newman JC, Des Jarlais DC, Turner CF, Gribble J, Cooley P, Paone D. The differential effects of face-to-face and computer interview modes. Am J Public Health. 2002;92(2):294–297.PubMedCentralCrossRefPubMed
52.
Rogers SM, Willis G, Al-Tayyib A, Villarroel MA, Turner CF, Ganapathi L, et al. Audio computer assisted interviewing to measure HIV risk behaviours in a clinic population. Sex Transm Infect. 2005;81(6):501–507.PubMedCentralCrossRefPubMed
53.
Turner CF, Al-Tayyib A, Rogers SM, Eggleston E, Villarroel MA, Roman AM, et al. Improving epidemiological surveys of sexual behaviour conducted by telephone. Int J Epidemiol. 2009;38(4):1118–1127.PubMedCentralCrossRefPubMed
54.
Reinert DF, Allen JP. The alcohol use disorders identification test: an update of research findings. Alcohol Clin Exp Res. 2007;31(2):185–199.CrossRefPubMed
55.
Bradley KA, Bush KR, Epler AJ, Dobie DJ, Davis TM, Sporleder JL, et al. Two brief alcohol-screening tests From the Alcohol Use Disorders Identification Test (AUDIT): validation in a female Veterans Affairs patient population. Arch Intern Med. 2003;163(7):821–829.CrossRefPubMed
56.
Grekin ER, Svikis DS, Lam P, Connors V, Lebreton JM, Streiner DL, et al. Drug use during pregnancy: validating the Drug Abuse Screening Test against physiological measures. Psychol Addict Behav: J Soc Psychol Addict Behav. 2010;24(4):719–723.CrossRef
Metadata
Title
Validation of Self-Administered Single-Item Screening Questions (SISQs) for Unhealthy Alcohol and Drug Use in Primary Care Patients
Authors
Jennifer McNeely, MD, MS
Charles M. Cleland, PhD
Shiela M. Strauss, PhD
Joseph J. Palamar, PhD, MPH
John Rotrosen, MD
Richard Saitz, MD, MPH
Publication date
01-12-2015
Publisher
Springer US
Published in
Journal of General Internal Medicine / Issue 12/2015
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-015-3391-6

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