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

Publication ID Published Volume
9012 October 4, 2011 7

Abstract

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.

This module is one in a series of six created for the New York University Substance Abuse Research Education and Training Program (SARET). SARET is a NIDA funded program whose aim is to enhance interest in substance abuse research among health professional students, including but not limited to students in medicine, nursing, and dentistry.
To date, we have delivered this particular module to two groups of students, those in our summer Substance Abuse Research mentorship program and to first year medical students in their "Practice of Medicine" course.

  1. Summer research students. Medical, dental and nursing students in our research mentorship program (n=9) were asked to complete the module as part of their summer experience. Evaluation of this pilot revealed that 80-90% of students thought the module: was easy to navigate, dealt with a subject of interest, covered most of the expected topics, was clear, logical and orderly, and had the right balance of multimedia. Students felt challenged by the material and stated that it raised questions they had not previously considered about the practice of screening and interpretation of screening test results.
  2. First year medical students. The module is being used as supplemental material in a first year medical school course that covers the topics of Screening and Prevention. For this assignment, students received information about how to access the module, along with description below which can be used and modified by other instructors. Of 160 students offered access to the module, 71 logged in, 45 completed half of the module and 36 completed through the post test. The majority of those who logged in without completing stopped at the pre-survey, before beginning the actual module.

Of the 36 completers, reviews were very positive, describing the module as ‘very informative’, elucidating more about ‘why we screen’ and ‘how to evaluate screening tests’. The main criticism was the unmet desire to learn more about HOW to screen for and follow up on substance use problems.

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 Publications. 2011;7:9012. http://dx.doi.org/10.15766/mep_2374-8265.9012

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

Keywords

  • Screening, Drinking, Alcohol, Tobacco, Drugs

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ISSN 2374-8265