Two-Item Screening Test for Substance Abuse Problems

Direct questioning usually eli-cits accurate responses on nicotine use but may not detect adequate information on use of other drugs. Alcohol has received particular focus in screening protocols, but tools to screen for other substances may have been too inaccurate or too lengthy to be routinely employed.

Randomly selected patients (n = 494) from outpatient clinics in Madison, WI, were administered a nine-question, two-item conjoint screening test. An example of two-item conjoint questions used is: "Have you ever felt guilty about your drinking or drug use?" A positive response to either "In the last year, have you ever drunk or used drugs more than you meant to?" or "Have you felt you wanted or needed to cut down on your drinking or drug use in the last year?" yielded a sensitivity and specificity of approximately 81% for substance use disorders.

Use of these questions in patients 30-49 years of age was associated with somewhat lesser specificity, compared with other age groups. Sensitivity was highest (96.2%) in those individuals using alcohol and at least one other drug. The authors caution that although false-positive responses can occur, use of two screening two-item conjoint questions can identify more than 80% of young and middle-aged adults with substance use disorders. Among the group as a whole, a single positive response indicated a 45% chance of substance use, and two positive responses yielded a 75% chance. Only 7.4% of those with a negative screening test have a substance use disorder. A simple two-question inquiry may be of great value in uncovering substance use.

Brown R, et al. J Fam Pract 1997; 44:151-160.