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Single-Question Screening Can Help Identify Teens with Substance Misuse — Physician’s First Watch

Medical News |
July 29, 2014

Single-Question Screening Can Help Identify Teens with Substance Misuse

By Amy Orciari Herman

Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD

A screening tool based on a single question can accurately identify substance use disorders among teens, according to a study in JAMA Pediatrics.

Some 200 adolescents aged 12 to 17 at two outpatient primary care centers and one outpatient substance abuse treatment center completed an electronic screening tool that began with, "In the past year, how many times have you used [x]?" Use of eight substances, including alcohol, marijuana, and illegal drugs, was assessed. Participants who reported some use were asked follow-up questions based on their frequency of use. All participants also completed a structured diagnostic interview as the gold standard.

The screening tool took an average of 32 seconds to complete. It had a sensitivity of 100% and specificity of 84% for identifying nontobacco substance use; 90% and 94% respectively for substance use disorders; 100% and 94% for severe substance use disorders; and 75% and 98% for nicotine dependence. The screening tool was similarly accurate whether self- or staff-administered.

Alain Joffe of NEJM Journal Watch Pediatrics and Adolescent Medicine commented: "The importance of this study lies in its simplicity. Simply by asking a series of "How often have you used...?" questions and noting the frequency of use (if any) identifies the degree of concern a provider should have and what level of intervention the adolescent needs. Other than tobacco, monthly use of any substance is equivalent to a mild-moderate substance use disorder that could effectively be managed in a primary care physician's office while weekly use would require a more aggressive intervention."

Reader Comments (3)

Carol A Vassar, MD Physician, Internal Medicine, private practice, Vermont

Interesting that adolescents are more likely to deny tobacco than alcohol. Perhaps the first has negative social implications and the second does not.

ARTHUR HAMMER Physician, Pulmonary Medicine, Mount Sinai Medical Center

Useful, will begin screening my younger patients

JOEL WOLKOWICZ

Weekly use of marihuana requires more aggressive intervention? Are you serious?

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