Substance Use Disorder: Primary Care Screening

Substance use disorder is a significant problem in the United States causing considerable distress and cost to the healthcare system as well as familial, community, and societal resources. Based on evidence-based research, a statement by the United States Preventive Services Task Force in 2015, recommends substance use disorder screening for adults in the primary care setting. A review of the literature concerning screening tools for substance use disorder resulted in twelve studies being included. The purpose of this project is to determine if the more comprehensive substance use disorder screening tool, ASSIST, identifies more at risk patients than the current CAGE-AID screening tool in order to improve early identification and intervention. The ASSIST questionnaire consists of 8 questions that investigate past and current use of substances. Developed by the World Health Organization (WHO), it has been shown to be reliable and valid. Patients 21-55 years from one primary care clinic in NJ were asked to voluntarily participate in a substance use disorder screening using the ASSIST screening tool. This tool was administered at well and follow up visits. The results were compared to the results of the CAGE-AID screening tool which is already part of the intake. Results showed that of the 36 people interviewed, ASSIST (n=14, 38.8%) identified more people at moderate or high risk compared to CAGE-AID (n=1, 2.7%). While this was a small study, more investigation is warranted as the results suggest that a more comprehensive screening tool is identifying those at risk more often especially for those in the medium risk category. Those patients in need of intervention are more likely to be identified with ASSIST and intervention can be begun as early as possible. Keywords: primary care, screening tools, substance use disorde

Process Improvement for Implementation of a Verified Substance Use Screening Tool for all Patients in a General Medicine Inpatient Unit

Introduction: As of 2017, an estimated 21 million US adults, equivalent to 1 in 13 people, had a substance use disorder. Of those with a substance use disorder it was estimated that only 2.2 million received treatment. In 2015, New Mexico had the 8th highest overdose death rate in the nation with the highest number of overall deaths attributed to Bernalillo County. The most common drugs used in overdose related deaths included heroin, benzodiazepines and prescription opioids. At the time of this study, it was found that the University of New Mexico Hospital did not have an identification tool for patients with Substance Use Disorder (SUD) as part of their intake protocols. The DAST-10 (Drug Abuse Screening Tool 10 question) is a verified screening tool that has been shown to be an accurate predictor with good specific identification of substance use. This screening tool is a short and efficient and has been easily integrated into clinical flow and is also highly sensitive in other studies. Similar studies conducted previously found that important factors to success and implementation included comprehensive education and training, intra and inter-organization communication and collaboration, host site and practitioner support, and champions to lead and direct management of the program. Methods: This pilot was conducted on 4 West, the largest inpatient adult medical-surgical unit at UNMH, over a 14 day period in 2019. All patients admitted to the unit over the course of the pilot were screened for eligibility. Exclusion criteria included non-English speaking, encephalopathic or if otherwise deemed inappropriate for screening by the surveyor (e.g. clinically inappropriate). Eligible patients were then consented for willingness to participate. For eligible and willing patients, the validated SUD screening tool, DAST-10, was performed. In the result of a positive screen, patients were assessed for interest in treatment and offered a compilation of local resources for support. Results: A total of 67 patients admitted to the unit were reviewed. Of the 67 patients, 33 patients (49.2%) were eligible for screening. Main identified reasons for ineligibility included inappropriate for screening based on surveyor judgment (27.3%), non-English speaking (21.2%), and patient were encephalopathic (15.2%). In total, 22 patients agreed to participate in the survey, while 11 patients declined. Of the 22 willing participants, there were 3 (13.6%) who screened positive on the DAST-10. Of the patients who screened positive for substance use, one patient was interested in receiving resources. Conclusions: The inpatient hospitalization can serve as a critical time to engage patients with SUD in treatment discussions. This pilot demonstrated that ability of a validated screening tool to identify a large portion of patients with SUD in an adult inpatient unit at UNMH. Additionally the screening process itself facilitated linkage to treatment resources. Barriers to screening included patient clinical status and language barriers, the latter of which may improve with translating the tool into other languages. Further efforts to improve tool utilization are being considered including inclusion of the tool within the electronic health record

Screening Adults with Substance Use Disorder for Adverse Childhood Experiences

Background and purpose-Exposure to adverse childhood experiences results in increased morbidity and mortality among individuals with substance use disorders. Screening for histories of childhood trauma, and integration of trauma-informed care is lacking among health care practitioners. Integrating screening for histories of childhood abuse in person’s seeking treatment for substance abuse disorders can facilitate identification of individuals interested in additional support and resources to support their recovery. The purpose of this study was to assess the effectiveness and feasibility of a screening interview protocol for ACEs and to determine the presence of ACEs among individuals with substance use disorder (SUD) who participate in an intensive outpatient program. Methods: The screening interview was administered to subjects who met the inclusion, exclusion criteria. ACEs scores, and demographics were analyzed by descriptive statistics. Bivariate statistics were used to examine relationships between ACE scores, time to administer screening, follow-up referrals and the nurse practitioner’s comfort and confidence level. Results: Over half of the participants had ACE score of six or above, with all having experienced at least one ACE. The comfort level of the interviewer with the screening process positively correlated to the confidence level. There was a negative correlation between time to administer the screening as comfort and confidence levels increased. Conclusions: The NP using the screening interview effectively and efficiently identified clients with ACEs. The ACE level was extraordinarily high, 6 or above, which supports the necessity of screening all SUD patients participating in treatment to capture those individuals interested in additional support and resources to facilitate their recovery

Substance Use Initiation among Mexican Children: An Examination of Individual and Ecological Factors

Mexico is experiencing increased rates of substance use among children and adolescents. This is concerning as early substance use is associated with an increased risk for developing mental and physical health problems during adulthood. These outcomes may be prevented through early identification and intervention before individuals encounter the negative consequences of substance use/abuse. The current dissertation sought to improve our knowledge regarding factors associated with substance use and intention for first time use among Mexican children. Three manuscripts examined child individual characteristics and aspects of their environment. The first manuscript examined demographic characteristics to determine whether particular groups of children were at increased risk for substance use and intensions for first time use. We found that being a boy, of indigenous background, non-religious, and over developmental age for grade were all associated with risk. The second manuscript focuses on examining parent characteristics and practices on substance use and intention for first time use. We found that parental illicit substance use was associated with the largest increases in risk and positive parenting was a protective factor. The third manuscript utilized machine learning, an algorithmic approach that predicts membership in one of two groups, to assist in the identification of high value factors that distinguish between substance users and non-users. Findings from this research identified factors associated with childhood substance use at individual and environmental levels. Being a boy and having a best friend or father that used illicit substances were the key indicators that could provide valuable information as screening questions. These findings provide valuable information needed to inform the development of early substance use prevention programs in Mexico. Results also suggest that machine learning may be an important tool in uncovering information that could bolster prevention efforts by improving our ability to identify children at risk for substance use. This research was supported by the Utah State University Psychology Department and School of Graduate Studies

Evaluation of a Substance Abuse Screening Tool in the Pediatric Emergency Room

Abstract Background: Substance abuse among adolescents is one of the most serious social health problems in the United States. The prevalence of alcohol use in adolescents is as high as 80%, while opioid overdose deaths among adolescents have risen by greater than 50% in the last 10 years. Alcohol, tobacco, and other substance use has also increased among youth and is not being properly evaluated in the pediatric hospital setting. The purpose of this project was to evaluate the use of a substance abuse screening tool with SBIRT trained staff in the pediatric emergency room setting. Methods: The CRAFFT substance abuse screening tool was administered to a convenience sample of adolescent patients aged 12 to 17 years old, seeking care in the pediatric emergency department from Feb-April 2023. Quantitative data was collected via prospective chart review during the emergency department visit. Data collected included number of CRAFFT screenings administered, number of positive CRAFFT screenings, screenings done by SBIRT trained staff, and referrals to treatment needed. The Iowa Model of Evidence-Based Practice served as the framework. Results: CRAFFT screenings were offered to (N=76) patients and (n=62) screenings were completed. Of those screened, 25% (n=16) screened positive with a CRAFFT score of two or higher and were offered a referral to treatment. Of those who were offered a referral to treatment, 44% (n=7) accepted the referral. Implications for practice: Widespread utilization of the CRAFFT substance abuse screening tool in the pediatric emergency department setting may provide early identification of adolescents at risk for substance abuse and offer them referrals to appropriate treatment

Substance use disorders in adolescents with attention deficit hyperactivity disorder: a 4-year follow-up study

Aim To examine the relationship between a childhood diagnosis of attention deficit hyperactivity disorder (ADHD) with or without oppositional defiant disorder (ODD)/conduct disorder (CD) and the development of later alcohol/drug use disorder [psychoactive substance use disorder (PSUD)] and nicotine dependence in a large European sample of ADHD probands, their siblings and healthy control subjects. Participants design and settingSubjects (n=1017) were participants in the Belgian, Dutch and German part of the International Multicenter ADHD Genetics (IMAGE) study. IMAGE families were identified through ADHD probands aged 5-17 years attending out-patient clinics, and control subjects from the same geographic areas. After a follow-up period (mean: 4.4 years) this subsample was re-assessed at a mean age of 16.4 years. Measurements PSUD and nicotine dependence were assessed using the Diagnostic Interview Schedule for Children, Alcohol Use Disorders Identification Test, Drug Abuse Screening Test and Fagerstrom test for Nicotine Dependence. Findings The ADHD sample was at higher risk of developing PSUD [hazard ratio (HR)=1.77, 95% confidence interval (CI)=1.05-3.00] and nicotine dependence (HR=8.61, 95% CI=2.44-30.34) than healthy controls. The rates of these disorders were highest for ADHD youth who also had CD, but could not be accounted for by this comorbidity. We did not find an increased risk of developing PSUD (HR=1.18, 95% CI=0.62-2.27) or nicotine dependence (HR=1.89, 95% CI=0.46-7.77) among unaffected siblings of ADHD youth. Conclusions A childhood diagnosis of attention deficit hyperactivity disorder is a risk factor for psychoactive substance use disorder and nicotine dependence in adolescence and comorbid conduct disorder, but not oppositional defiant disorder, further increases the risk of developing psychoactive substance use disorder and nicotine dependence

Adolescents, online gambling, problematic internet use and substance consumption

Recent research has warned of the growing participation of minors in online gambling, an illegal behaviour with an enormous addictive potential. The present study was proposed with a double objective: (1) having updated data about online gambling among adolescents and, (2) analysing its relationship with substance use and Proble-matic Internet Use [PIU]. For this purpose, a sample of 3188 Spanish adolescents between 12 and 17 years of age (Mean=14.44; SD=1.67) was gathered, to whom was applied an ad hoc questionnaire with items regarding their internet use and substance consumption, as well as specific screening instruments (Alcohol Use Disorders Identification Test -AUDIT-, Cannabis Abuse Screening Test -CAST-, the Substance Use and Abuse subscale of the Problem Oriented Screening Instrument for Teenagers -POSITuas-, and the Problematic Internet Use Scale for Ado-lescents-PIUSa-). The results showed that 8.4% of the sample had participated in online gambling during the prior year. It was also found that those who gambled on the Internet had higher rates of PIU and different online risky behaviours, as well as higher rates of substance consumption. Therefore, these are not isolated problems, making it necessary to employ an integral preventive approach to address them.Recientes investigaciones han alertado de la creciente participación de los menores en el juego online, una conducta ilegal con un enorme potencial adictivo. El presente estudio se planteó con un doble objetivo (1) disponer de datos actualizados sobre el juego online entre los adolescentes y, (2) analizar su relación con el consumo de sustancias y el Uso Problemático de Internet [UIP]. Para ello, se recogió una muestra de 3188 adolescentes españoles de entre 12 y 17 años (Media=14.44; DT=1.67), a los que se les aplicó un cuestionario ad hoc con ítems relativos al uso de Internet y consumo de sustancias, así como instrumentos de cribado específicos (Alcohol Use Disorders Identification Test -AUDIT-, Cannabis Abuse Screening Test -CAST-, Substance Use and Abuse subscale of the Problem Oriented Scree-ning Instrument for Teenagers -POSITuas- y la Escala de Uso Problemático de Internet para Adolescentes -EUPIa-). Los resultados mostraron que el 8.4% de la muestra había participado en juegos de azar en línea durante el año anterior. También se comprobó que los que jugaban a través de Internet presentaban tasas más elevadas de PIU y de diferentes comportamientos de riesgo online, así como tasas más elevadas de consumo de sustancias. Por tanto, no se trata de problemas aislados, por lo que es necesario emplear un enfoque preventivo integral para abordarlos

Adolescent Substance Abuse Screening

Adolescent substance use is a key public health problem in rural Ohio. Primary care nurses lack substance use screening knowledge and skills. Early screening and detection of possible substance use issues aids in directing patients to appropriate health services. This project involved the implementation of an educational intervention on the CRAFFT screening tool for primary care nurses in rural Ohio. Guided by Kurt Lewin\u27s 3-step model to emphasize prevalence of substance use and need for screening among adolescents, the purpose of this project was to provide training on the CRAFFT screening approach and share guidelines to implement routine substance abuse screening for adolescents seen in this rural primary healthcare setting. The project, based on a pretest and posttest design, was implemented among a sample of 7 nurses to evaluate whether the educational intervention had a significant impact on nurses\u27 knowledge on using the CRAFFT screening tool. Data were collected using a questionnaire and were analyzed using descriptive and inferential statistics. The results showed a significant increase in the pretest scores (M =51.43, SD = 19.51) and the posttest score (M =94.29, SD = 7.868); t(6)=7.039, p = .000). The project findings support that the benefit of this educational intervention to improve the nurses\u27 substance use screening knowledge using a lunchtime educational training to ensure that vulnerable adolescent patients with substance use receive early and appropriate preventive and treatment measures. For positive social change, early identification of substance use among adolescents may inform the adoption of preventive and treatment measures such as referral to mental health specialists, thereby improving adolescent health outcomes

Variations in Suicidal Ideation Among Substance Users

Research suggests that substance use is a risk factor for increased suicidal ideation. This study explored the relationship between substance use, suicidal ideation, and impulsivity in a sample of college students and individuals seeking outpatient treatment. Participants were interviewed for information on severity of suicidal ideation and substance use. Participants completed the Psychiatric Diagnostic Screening Questionnaire, the substance use section of the Structured Clinical Interview for the DSM-IV, the Alcohol Use Disorders Identification Test, the Scale for Suicide Ideation, and the UPPS-P Impulsivity Behavior Scale. These measures were used to determine the amount of variance in suicidal ideation accounted for by substance use. Variables reflecting substance use classification, frequency, and severity were used to predict severity of suicidal ideation

Stigma, Substance Use, and Help-Seeking Attitudes Among Rural and Urban Individuals

The current study examined the differences between public stigma, self-stigma, substance use (i.e., alcohol and/or drugs), and attitudes toward psychological help-seeking among rural and urban individuals, and found meaningful differences in public stigma by alcohol use. Two hundred and sixty participants recruited via Amazon Mechanical Turk completed an online survey that included the Perceptions of Stigmatization by Others for Seeking Help scale, the Self-Stigma of Seeking Help scale, the Attitudes Toward Seeking Professional Psychological Help scale, the Alcohol Use Disorders Identification Test, the Drug Abuse Screening Test–10, and demographics. The authors found significant between-groups differences in public stigma for individuals who screened positive for an alcohol use disorder compared to those who used alcohol but did not meet the screening threshold. This finding suggested that there may be differences in stigmatization between individuals who only occasionally use alcohol and those with an alcohol use disorder. There were no significant differences in self-stigma or attitudes toward psychological help-seeking. Moreover, there were no significant between-groups differences based on DAST-10 scores for individuals who did not report drug use, individuals who reported using drugs, and those who screened positive for a substance use disorder on public stigma, self-stigma, or attitudes toward psychological help-seeking. Contrary to the authors’ hypothesis, the results did not demonstrate any significant differences between public stigma, self-stigma, or attitudes toward psychological help-seeking based on rurality (i.e., rural or urban). The authors highlight areas for future research focus and considerations when further examining stigma, substance use, and help-seeking attitudes among rural and urban individuals