Assessment of Drug Use Disorders

Substance use is common among primary care patients and often goes undiagnosed. Although randomized studies of single-session interventions have not found the interventions to be effective in decreasing substance use among primary care patients, diagnosing substance abuse disorders is important in the evaluation of many common symptoms (eg, headache, anxiety) and abnormalities (eg, cardiac arrhythmias, renal insufficiency). It is also possible that referral of patients with substance abuse disorders to more intensive interventions will be helpful.

However, diagnosing drug abuse is not easy, especially during hectic visits when we are trying to take a history, perform a physical examination, engage the patient in a discussion of preferences, provide treatment, and perform recommended prevention screening and counseling activities in 15 minutes. For this reason, the editors of JAMA Internal Medicine were impressed with the screening instrument for a substance abuse disorder, described in this issue by Tiet et al,¹ that has only 2 questions (and if the response to the first question is positive, the second question need not be asked). The instrument requires validation in a non–Veterans Affairs population, especially among women and young adults. But assuming it performs equally well in broader populations, it is easy to imagine the screening instrument being incorporated into the previsit work flow such that patients answer the questions before they are seen by their primary care physician, which will allow the physician to have the information when evaluating the patient.

Drug use disorders are difficult to treat. But you cannot try to treat them if you do not even know who has them. This screening instrument could help.

Conflict of Interest Disclosures: None reported.