Frequency of 5+/4+ Drinks as a Screener for Drug Use and Drug-Use Disorders

Purpose The NESARC, a “third generation” psychiatric epidemiologic survey that integrated detailed measures of alcohol and drug use and problems, has been the data source for over >850 publications. A comprehensive review of NESARC findings and their implications is lacking. Method NESARC was a survey of 43,093 participants that covered alcohol, drug and psychiatric disorders, risk factors, and consequences. Wave 1 of the NESARC was conducted in 2001-2002. Three years later, Wave 2 follow-up re-interviews were conducted with 34,653 of the original participants. Scopus and Pubmed were used to search for NESARC papers, which were sorted into topic areas and summarized. Result The most common disorders were alcohol and post-traumatic stress disorders, and major depression. Females had more internalizing disorders and males had more externalizing disorders, although the preponderance of males with alcohol disorders (the “gender gap”) is less pronounced than it was in previous decades. A race/ethnic “paradox” (lower risk among disadvantaged minorities than whites) remains unexplained. Younger participants had higher risk for substance and personality disorders, but not unipolar depressive or anxiety disorders. Psychiatric comorbidity was extensive and often formed latent trans-diagnostic domains. Since 1991-1992, risk for marijuana and prescription drug disorders increased, while smoking decreased, although smoking decreases were less pronounced among those with comorbidity. A nexus of comorbidity, social support, and stress predicted transitions in diagnostic status between Waves 1 and 2. Childhood maltreatment predicted psychopathology. Alcohol and drug use disorders were seldom treated; attitudinal barriers (little perceived need, perceived alcoholism stigma, pessimism about efficacy) were more important in predicting non-treatment than financial barriers. Conclusions Understanding comorbidity and the effects of early stressors will require research incorporating biologic components, e.g., genetic variants and brain imaging. The lack of treatment for alcohol and drug disorders, predicted by attitudinal rather than financial variables, suggests urgent need for public and professional education to reduce the stigma associated with these disorders, and increase knowledge of treatment options.

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“…Screening, including for psychiatric [409,512-517], alcohol [195,518-526], and substance disorders [527];…”

Section: Resultsmentioning

confidence: 99%

The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Waves 1 and 2: review and summary of findings

Hasin

Grant

2015

Soc Psychiatry Psychiatr Epidemiol

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394

293

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“…An SSQ that queried frequency of heavy drinking in the past month among men also was associated with dependence, with greater frequency associated with a greater likelihood of dependence (e.g., 3-10 times in the past month associated with a likelihood ratio of 5.21 and a probability of dependence of 42%; 14-30 times associated with a likelihood ratio 35.83 and a probability of 83%). Dawson et al (2010) used an alcohol SSQ to detect drug use and disorders. Areas under the ROC curve showed good discrimination for drug dependence, and, for example, the optimal cutoff was once a month or more heavy alcohol use for the detection of cocaine dependence, but positive predictive value was poor (<1%).…”

Section: Discussionmentioning

confidence: 99%

“…Among recognized barriers are questionnaires that are too long to be incorporated into routine practice (Survey Research Laboratory, University of Illinois at Chicago, 2000). To address that barrier, single screening questions (SSQs) have been developed and validated, and some are recommended by national organizations (Canagasaby and Vinson, 2005;Dawson et al, 2010; National Institute on Alcohol Abuse and Alcoholism, 2007; National Institute on Drug Abuse, n.d.; Seale et al, 2006;Smith et al, 2009Smith et al, , 2010Taj et al, 1998;Williams and Vinson, 2001). …”

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confidence: 99%

The Ability of Single Screening Questions for Unhealthy Alcohol and Other Drug Use to Identify Substance Dependence in Primary Care

Saitz

Cheng

Allensworth-Davies

et al. 2014

J. Stud. Alcohol Drugs

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ABSTRACT. Objective: Single screening questions (SSQs) are recommended for the evaluation of unhealthy alcohol use and other drug use (risky use through dependence). In addition, SSQs could provide information on severity that is necessary for brief intervention, information thought to be available only from longer questionnaires. We assessed SSQ accuracy for identifying dependence. Method: In a cross-sectional study, 286 primary care patients were administered SSQs for alcohol and for other drugs (each asks how many times they were used in the past year), the Alcohol Use Disorders Identifi cation Test-Consumption (AUDIT-C), the Drug Abuse Screening Test (DAST), and a diagnostic interview reference standard for dependence. For each test, we calculated area under the receiver operating characteristic (ROC) curve and the ability to discriminate dependence at an optimal cutoff. Results: The prevalence of alcohol and other drug dependence was 9% and 12%, respectively. Optimal cut points were eight or more times for the alcohol SSQ, a score of three or more for AUDIT-C, three or more times for the other drug SSQ, and a score of four or more for the DAST. The areas under the ROC curve ranged from 0.87 to 0.96. Sensitivity, specifi city, and positive and negative likelihood ratios at optimal cut points for the alcohol SSQ were 88%, 84%, 5.6, and 0.1, respectively; for the other drug SSQ were 97%, 79%, 4.6, 0.04, respectively; for the AUDIT-C were 92%, 71%, 3.2, 0.1, respectively; and for the DAST were 100%, 84%, 6.3, 0, respectively. Alcohol SSQ and AUDIT-C positive likelihood ratio 95% confi dence intervals did not overlap. Conclusions: SSQs can identify substance dependence as well as and sometimes better than longer screening tools. SSQs may be useful for both screening and preliminary assessment, thus overcoming a barrier (seen with lengthy questionnaires) to dissemination of screening and brief intervention in primary care settings. (J. Stud. Alcohol Drugs, 75, 153-157, 2014) Received: March 5, 2013. Revision: June 4, 2013. This research was supported by National Institute on Alcohol Abuse and Alcoholism Grant R01 AA10870 and National Institute on Drug Abuse Grants R01 DA10019 and R01 DA025068. *Correspondence may be sent to Richard Saitz at the Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Fourth Floor, Boston, MA 02118, or via email at: rsaitz@bu.edu. S CREENING FOR UNHEALTHY ALCOHOL USE (the spectrum from risky use through dependence) is recommended in primary care settings (Jonas et al., 2012; U.S. Preventive Services Task Force, 2004). Screening for other drug use is not recommended universally but should be considered when patients are at high risk, when evaluating symptoms that could be related to drug use, and when prescribing medications, particularly psychoactive medications and medications likely to be misused (U.S. Preventive Services Task Force, 2008). Identifi cation of unhealthy use should be followed by a brief counseling intervent...

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“…The committee responsible for GD in DSM-5 decided that a simple count of the criteria was sufficient to determine level of severity, given that this approach had been successfully applied to substance use disorder risk factors and consequences [5][6][7]. Thus, this simple criteria sum as an overall severity indicator was used for substance use disorders and then extension for GD: mild (four to five criteria), moderate (six to seven), and severe (eight or nine).…”

Section: Introductionmentioning

confidence: 99%