Screening for Nicotine and Drug Use Disorders

Abstract

Screening aims at detecting substance use, ideally at an early stage, with a view of providing subsequent treatment if required. It is most productively employed in populations in whom there is a high prevalence of use, such as general and emergency medical patients, those attending clinics for pain or sexually transmitted disorders, and people who have come into conflict with the law. It is of less value in well-staffed facilities that already routinely enquire about substance use during comprehensive clinical assessments.

Numerous screening instruments have been designed – those that screen for different substances in an aggregated or disaggregated way, those for one specific substance, and those for substance-related problems – but relatively few have satisfactory psychometric properties. Examples of instruments that screen for nicotine or drug use disorders or for multiple substances are the Alcohol, Smoking, and Substance Involvement Screening Test, CAGE-AID (mnemonic for items Cut down, Annoyed, Guilty, Eye-opener-Adapted to Include Drugs), Drug Abuse Screening Test, and the Fagerström Test for Nicotine Dependence. The choice of an instrument should depend on its psychometric properties, the population being screened, availability of staff to use it properly, and the practicality of introducing it into the facility.

Ethical aspects of the use of the instruments are important. Outside purely research settings, screening will have limited value unless follow-on treatment is available, and substance misusers are encouraged to accept it and adhere to it. The best test of the true value of screening will be in the prevention of Longer-term medical and psychosocial consequences of substance misuse.