Screening for Substance Abuse: Good Idea or Not Ready for Prime Time?

Format Publication ID Version Published
Multimedia, Case 9012 1 October 4, 2011

Description

This web-based module introduces the practice of screening for substance abuse in healthcare settings and considers the question of when to implement a screening program. It reviews existing standards of screening for substance abuse and asks whether health systems should expand current practices to ask about use of drugs besides alcohol and tobacco. In addition, the module provides in-depth teaching on the key concepts of sensitivity, specificity and predictive values.

Module Outline

  • Introductory Video Case
    Presents the case of a student screened for alcohol and tobacco use at a routine health visit. The student wonders if she should have been asked about illicit drug use by her provider, or divulged such information herself.

  • What is screening?
    Defines and distinguishes screening from assessment and diagnosis.

  • When to screen?
    Reviews the criteria for implementing a screening program including burden of disease and availability of an accurate, acceptable, and financially viable test.

  • Current recommendations for substance abuse screening
    Describes the current United States Preventive Services Task Force (USPSTF) recommendation to screen for tobacco and high risk alcohol use. Includes video of NYU expert in tobacco control (Dr D Shelley) who discusses the rationale for tobacco screening on the part of multiple members of the health care team, and Dr M Gourevitch who ponders the question of why we might screen for substance use beyond alcohol and tobacco.

  • How to evaluate a screening test
    Introduces the concepts of sensitivity, specificity, and positive and negative predictive values. Further offers students the opportunity to learn and practice calculation of these values and most importantly, how to interpret them.

  • Novel modalities to make screening better
    Includes a video interview with researcher Dr J McNeely about her study on whether a self-administered screening tool (computerized ASSIST) can improve current screening practices. Students can then themselves try out the computerized ASSIST or the Single Question Screen for alcohol use.

Media Used
The module is multimedia and delivers the above content through the use of video, text, graphics, and voiceover as well as questions followed by expert and peer feedback

Citation

Truncali A, McNeely J, Huben L, Kerr D, Naegle M, Gourevitch M. Screening for Substance Abuse: Good Idea or Not Ready for Prime Time? . MedEdPORTAL; 2011. Available from: www.mededportal.org/publication/9012

Educational Objectives

  1. To distinguish screening from assessment and diagnosis.
  2. To define current screening guidelines for substance use disorders and detail why the guidelines exist
  3. To identify and apply the criteria involved in determining whether to screen for a given condition
  4. To demonstrate understanding of concepts that describe a screening test including:
  • sensitivity
  • specificity
  • predictive values

5. To assess the pros and cons of novel approaches and expanded substance abuse screening.

Keywords

  • Screening, Drinking, Alcohol, Tobacco, Drugs

Specialty

  • Medical
    • Family Medicine
    • Internal Medicine
    • Preventive Medicine

Discipline

  • Dental
    • Preventive Dentistry
    • Preventive Medicine

Competencies Addressed

  • Medical
    • Patient Care
    • Practice-based Learning & Improvement

Academic Focus

  • Clinical Sciences
    • Clinical Skills/Doctoring

Professional Interest

  • Substance Abuse

Intended Audience

  • Professional School
    • Dental Student
    • Medical Student
    • Nursing Student

Instructional Methods

  • Problem-based Learning

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