Validation of Self-Administered Single-Item Screening Questions (SISQs) for Unhealthy Alcohol and Drug Use in Primary Care Patients

Jennifer McNeely, Charles M. Cleland, Shiela M. Strauss, Joseph J. Palamar, John Rotrosen, Richard Saitz

Research output: Contribution to journalArticle

Abstract

Background: Very brief single-item screening questions (SISQs) for alcohol and other drug use can facilitate screening in health care settings, but are not widely used. Self-administered versions of the SISQs could ease barriers to their implementation. Objective: We sought to validate SISQs for self-administration in primary care patients. Design: Participants completed SISQs for alcohol and drugs (illicit and prescription misuse) on touchscreen tablet computers. Self-reported reference standard measures of unhealthy use, and more specifically of risky consumption, problem use, and substance use disorders, were then administered by an interviewer, and saliva drug tests were collected. Participants: Adult patients aged 21–65 years were consecutively enrolled from two urban safety-net primary care clinics. Main Measures: The SISQs were compared against reference standards to determine sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) for alcohol and drug use. Key Results: Among the 459 participants, 22 % reported unhealthy alcohol use and 25 % reported drug use in the past year. The SISQ-alcohol had sensitivity of 73.3 % (95 % CI 65.3–80.3) and specificity of 84.7 % (95 % CI 80.2–88.5), AUC = 0.79 (95 % CI 0.75–0.83), for detecting unhealthy alcohol use, and sensitivity of 86.7 % (95 % CI 75.4–94.1) and specificity of 74.2 % (95 % CI 69.6–78.4), AUC = 0.80 (95 % CI 0.76–0.85), for alcohol use disorder. The SISQ-drug had sensitivity of 71.3 % (95 % CI 62.4–79.1) and specificity of 94.3 % (95 % CI 91.3–96.6), AUC = 0.83 (95 % CI 0.79–0.87), for detecting unhealthy drug use, and sensitivity of 85.1 (95 % CI 75.0–92.3) and specificity of 88.6 % (95 % CI 85.0–91.6), AUC = 0.87 (95 % CI 0.83–0.91), for drug use disorder. Conclusions: The self-administered SISQs are a valid approach to detecting unhealthy alcohol and other drug use in primary care patients. Although self-administered SISQs may be less accurate than the previously validated interviewer-administered versions, they are potentially easier to implement and more likely to retain their fidelity in real-world practice settings.

Original languageEnglish (US)
Pages (from-to)1757-1764
Number of pages8
JournalJournal of General Internal Medicine
Volume30
Issue number12
DOIs
StatePublished - Dec 1 2015

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Primary Health Care
Alcohols
Area Under Curve
Pharmaceutical Preparations
Substance-Related Disorders
Prescription Drug Misuse
Interviews
Handheld Computers
Preclinical Drug Evaluations
Self Administration
Saliva
ROC Curve
Delivery of Health Care
Safety
Sensitivity and Specificity

Keywords

  • Alcohol
  • Illicit drugs
  • Screening
  • Substance use
  • Validation

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Validation of Self-Administered Single-Item Screening Questions (SISQs) for Unhealthy Alcohol and Drug Use in Primary Care Patients. / McNeely, Jennifer; Cleland, Charles M.; Strauss, Shiela M.; Palamar, Joseph J.; Rotrosen, John; Saitz, Richard.

In: Journal of General Internal Medicine, Vol. 30, No. 12, 01.12.2015, p. 1757-1764.

Research output: Contribution to journalArticle

McNeely, Jennifer ; Cleland, Charles M. ; Strauss, Shiela M. ; Palamar, Joseph J. ; Rotrosen, John ; Saitz, Richard. / Validation of Self-Administered Single-Item Screening Questions (SISQs) for Unhealthy Alcohol and Drug Use in Primary Care Patients. In: Journal of General Internal Medicine. 2015 ; Vol. 30, No. 12. pp. 1757-1764.
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abstract = "Background: Very brief single-item screening questions (SISQs) for alcohol and other drug use can facilitate screening in health care settings, but are not widely used. Self-administered versions of the SISQs could ease barriers to their implementation. Objective: We sought to validate SISQs for self-administration in primary care patients. Design: Participants completed SISQs for alcohol and drugs (illicit and prescription misuse) on touchscreen tablet computers. Self-reported reference standard measures of unhealthy use, and more specifically of risky consumption, problem use, and substance use disorders, were then administered by an interviewer, and saliva drug tests were collected. Participants: Adult patients aged 21–65 years were consecutively enrolled from two urban safety-net primary care clinics. Main Measures: The SISQs were compared against reference standards to determine sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) for alcohol and drug use. Key Results: Among the 459 participants, 22 {\%} reported unhealthy alcohol use and 25 {\%} reported drug use in the past year. The SISQ-alcohol had sensitivity of 73.3 {\%} (95 {\%} CI 65.3–80.3) and specificity of 84.7 {\%} (95 {\%} CI 80.2–88.5), AUC = 0.79 (95 {\%} CI 0.75–0.83), for detecting unhealthy alcohol use, and sensitivity of 86.7 {\%} (95 {\%} CI 75.4–94.1) and specificity of 74.2 {\%} (95 {\%} CI 69.6–78.4), AUC = 0.80 (95 {\%} CI 0.76–0.85), for alcohol use disorder. The SISQ-drug had sensitivity of 71.3 {\%} (95 {\%} CI 62.4–79.1) and specificity of 94.3 {\%} (95 {\%} CI 91.3–96.6), AUC = 0.83 (95 {\%} CI 0.79–0.87), for detecting unhealthy drug use, and sensitivity of 85.1 (95 {\%} CI 75.0–92.3) and specificity of 88.6 {\%} (95 {\%} CI 85.0–91.6), AUC = 0.87 (95 {\%} CI 0.83–0.91), for drug use disorder. Conclusions: The self-administered SISQs are a valid approach to detecting unhealthy alcohol and other drug use in primary care patients. Although self-administered SISQs may be less accurate than the previously validated interviewer-administered versions, they are potentially easier to implement and more likely to retain their fidelity in real-world practice settings.",
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T1 - Validation of Self-Administered Single-Item Screening Questions (SISQs) for Unhealthy Alcohol and Drug Use in Primary Care Patients

AU - McNeely, Jennifer

AU - Cleland, Charles M.

AU - Strauss, Shiela M.

AU - Palamar, Joseph J.

AU - Rotrosen, John

AU - Saitz, Richard

PY - 2015/12/1

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N2 - Background: Very brief single-item screening questions (SISQs) for alcohol and other drug use can facilitate screening in health care settings, but are not widely used. Self-administered versions of the SISQs could ease barriers to their implementation. Objective: We sought to validate SISQs for self-administration in primary care patients. Design: Participants completed SISQs for alcohol and drugs (illicit and prescription misuse) on touchscreen tablet computers. Self-reported reference standard measures of unhealthy use, and more specifically of risky consumption, problem use, and substance use disorders, were then administered by an interviewer, and saliva drug tests were collected. Participants: Adult patients aged 21–65 years were consecutively enrolled from two urban safety-net primary care clinics. Main Measures: The SISQs were compared against reference standards to determine sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) for alcohol and drug use. Key Results: Among the 459 participants, 22 % reported unhealthy alcohol use and 25 % reported drug use in the past year. The SISQ-alcohol had sensitivity of 73.3 % (95 % CI 65.3–80.3) and specificity of 84.7 % (95 % CI 80.2–88.5), AUC = 0.79 (95 % CI 0.75–0.83), for detecting unhealthy alcohol use, and sensitivity of 86.7 % (95 % CI 75.4–94.1) and specificity of 74.2 % (95 % CI 69.6–78.4), AUC = 0.80 (95 % CI 0.76–0.85), for alcohol use disorder. The SISQ-drug had sensitivity of 71.3 % (95 % CI 62.4–79.1) and specificity of 94.3 % (95 % CI 91.3–96.6), AUC = 0.83 (95 % CI 0.79–0.87), for detecting unhealthy drug use, and sensitivity of 85.1 (95 % CI 75.0–92.3) and specificity of 88.6 % (95 % CI 85.0–91.6), AUC = 0.87 (95 % CI 0.83–0.91), for drug use disorder. Conclusions: The self-administered SISQs are a valid approach to detecting unhealthy alcohol and other drug use in primary care patients. Although self-administered SISQs may be less accurate than the previously validated interviewer-administered versions, they are potentially easier to implement and more likely to retain their fidelity in real-world practice settings.

AB - Background: Very brief single-item screening questions (SISQs) for alcohol and other drug use can facilitate screening in health care settings, but are not widely used. Self-administered versions of the SISQs could ease barriers to their implementation. Objective: We sought to validate SISQs for self-administration in primary care patients. Design: Participants completed SISQs for alcohol and drugs (illicit and prescription misuse) on touchscreen tablet computers. Self-reported reference standard measures of unhealthy use, and more specifically of risky consumption, problem use, and substance use disorders, were then administered by an interviewer, and saliva drug tests were collected. Participants: Adult patients aged 21–65 years were consecutively enrolled from two urban safety-net primary care clinics. Main Measures: The SISQs were compared against reference standards to determine sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) for alcohol and drug use. Key Results: Among the 459 participants, 22 % reported unhealthy alcohol use and 25 % reported drug use in the past year. The SISQ-alcohol had sensitivity of 73.3 % (95 % CI 65.3–80.3) and specificity of 84.7 % (95 % CI 80.2–88.5), AUC = 0.79 (95 % CI 0.75–0.83), for detecting unhealthy alcohol use, and sensitivity of 86.7 % (95 % CI 75.4–94.1) and specificity of 74.2 % (95 % CI 69.6–78.4), AUC = 0.80 (95 % CI 0.76–0.85), for alcohol use disorder. The SISQ-drug had sensitivity of 71.3 % (95 % CI 62.4–79.1) and specificity of 94.3 % (95 % CI 91.3–96.6), AUC = 0.83 (95 % CI 0.79–0.87), for detecting unhealthy drug use, and sensitivity of 85.1 (95 % CI 75.0–92.3) and specificity of 88.6 % (95 % CI 85.0–91.6), AUC = 0.87 (95 % CI 0.83–0.91), for drug use disorder. Conclusions: The self-administered SISQs are a valid approach to detecting unhealthy alcohol and other drug use in primary care patients. Although self-administered SISQs may be less accurate than the previously validated interviewer-administered versions, they are potentially easier to implement and more likely to retain their fidelity in real-world practice settings.

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KW - Illicit drugs

KW - Screening

KW - Substance use

KW - Validation

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