New Screening Tool May Help Identify Substance Use Disorder

The Tobacco, Alcohol, Prescription medication, and other Substance use (TAPS) tool may be as effective as the gold standard for assessing substance use disorders, according to recent research.

Substance use disorders are a top concern and are a leading cause of illness and death in the United States. They are also underidentified in the primary care setting.

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Thus, the TAPS assessment tool—a 2-part questionnaire—was created to bridge the gap in screening for substance use disorders in primary care.

To assess the performance of the TAPS tool, the researchers consecutively recruited 2000 adult patients from 5 adult primary care clinics in the United States.

The patients completed the interviewer- and self-administered parts of the TAPS tool by scoring their substance use habits within the previous year. They also completed a reference standard questionnaire, the modified World Mental Health Composite International Diagnostic Interview (CIDI).

After comparing the results of the 2 questionnaires, the researchers found that the TAPS tool and CIDI had similar diagnostic characteristics.

For identifying problem use (at a cutoff of 1+), the TAPS tool had a sensitivity of 0.93 and specificity of 0.87 for tobacco and a sensitivity of 0.74 and specificity of 0.79 for alcohol. 

For problem use of illicit and prescription drugs, sensitivity ranged from 0.82 for marijuana to 0.63 for sedatives; specificity was 0.93 or higher. For identifying any substance use disorder (at a cutoff of 2+), sensitivity was lower.

“In a diverse population of adult primary care patients, the TAPS tool detected clinically relevant problem substance use,” the researchers concluded. “Although it also may detect tobacco, alcohol, and marijuana use disorders, further refinement is needed before it can be recommended broadly for [substance use disorder] screening.”

—Amanda Balbi

Reference:

McNeely J, Wu L-T, Subramaniam G, et al. Performance of the Tobacco, Alcohol, Prescription, and other Substance use (TAPS) tool for substance use screening in primary care patients [published online September 6, 2016]. Ann Intern Med. doi:10.7326/M16-0317.