Screening tools typically are brief and easy to
administer and are to be implemented with a
relatively broad population to identify
indications of risk involving smoking, drinking
or using other drugs. Screening tools typically
include written or oral questionnaires and, less
frequently, clinical and laboratory tests. (See
Appendix H for a description of commonly-used
screening instruments.)
An instrument that can be used to screen for
risky use of all addictive substances--rather than
separately for each substance--and that makes
appropriate distinctions for young people and by
gender has yet to be developed.
In recent years, attempts have been made to
develop and validate more simple screening
tools that can be used in primary care settings.
For example:
A single-item measure of current tobacco
use* has been validated on adult populations
for use in research protocols^37 but also can
be used clinically to determine if a patient is
a current smoker.
The National Institute on Alcohol Abuse and
Alcoholism (NIAAA) recommends a single-
question screening test for unhealthy alcohol
- Have you smoked one or more cigarettes in the past
month?
use† to be asked of patients of all ages who
admit to sometimes drinking alcohol.^39 The NIAAA, in collaboration with the
American Academy of Pediatrics (AAP)
recently introduced a simple screening tool
for identifying early signs of risky alcohol
use in young people ages 9-18. The
screener begins with two simple questions
assessing the child’s own alcohol use and
that of his or her friends. Depending on the
patient’s age, positive responses to these
items would be followed by more in-depth
questions assessing the level of the patient’s
risk and the provision of appropriate brief
interventions.^40 A recent study found that a single-question
screening test to identify other drug use‡ in a
diverse sample of adult primary care patients
was effective in accurately identifying other
drug use and may be beneficial in helping
physicians identify potential medication
interactions and associated risks of
prescribing specific medications.^41Single-item screening tools can help narrow the
patient population that requires further
assessment for the identification of addiction.^42
However, most instruments focus on specific
substances rather than the range of addictive
substances that pose a risk for addiction. The
National Institute on Drug Abuse (NIDA) has
begun to move in the direction of a more unified
look at risky use and addiction with the
development of a “quick screen” for use in
general medical settings. The instrument
actually contains four separate screens and asks
patients about the frequency of their past-year
use of each of the following types of substances:
(1) tobacco, (2) alcohol,§ (3) prescription drugs† How many times in the past year have you had 5 or
more drinks in a day (for men)/4 or more drinks in a
day (for women)?
‡ How many times in the past year have you used an
illegal drug or used a prescription medication for
nonmedical reasons?
§ With separate measures of risk for males and
females--the frequency of having five or more drinks
in a day for men and four or more drinks in a day for
women.It’s like taking a blood pressure. You don’t just
take the pressure of patients you suspect of
having high blood pressure. You take
everyone’s blood pressure. And, with public
health screening, you’re typically not shooting
for a diagnosis, but just an initial measure of a
patient’s level of risk.^38--Dan Hungerford, DrPH
Epidemiologist
National Center for Injury
Prevention and Control
Centers for Disease Control and Prevention