Screening and Ongoing Assessment for Substance Abuse in HIV
Screening and Ongoing Assessment for Substance Abuse in HIV
Screening instruments, such as those shown in Appendix II, can be effective in assessing whether a given patient has a problem with substance use, but the informal or expanded history taking illustrated in the section on General Approach to Screening for Substance Use often yields important information as well. The screening tools were developed with a strict adherence to scripted questions in order to improve the validity of the scoring. Patients' responses to the scripted questions often provide useful prompts for further exploration by clinicians.
Many attempts have been made to develop a sensitive and efficient screening tool to identify patients with alcohol and substance use problems. No single set of questions has been shown to be better than any other, and there are no large studies examining or comparing these tools in HIV-infected patients. Clinicians should adapt their questions to the individual patient and his/her situation and needs; some familiar tools, such as the CAGE questionnaire, are not as sensitive in younger patients. Appendix II lists examples of screening tools commonly used in primary care settings and includes target populations for each tool. A Quick Reference Substance Use Screening Card is also available.
Some screening tools for substance use/abuse have adopted many of the same questions as those used for screening alcohol problems. Some clinicians find it helpful to modify screening tools that have been validated using alcohol questions to also include other drugs. For example, How often do you have a drink containing alcohol or use drugs?
Use of Screening Instruments
Screening instruments, such as those shown in Appendix II, can be effective in assessing whether a given patient has a problem with substance use, but the informal or expanded history taking illustrated in the section on General Approach to Screening for Substance Use often yields important information as well. The screening tools were developed with a strict adherence to scripted questions in order to improve the validity of the scoring. Patients' responses to the scripted questions often provide useful prompts for further exploration by clinicians.
Many attempts have been made to develop a sensitive and efficient screening tool to identify patients with alcohol and substance use problems. No single set of questions has been shown to be better than any other, and there are no large studies examining or comparing these tools in HIV-infected patients. Clinicians should adapt their questions to the individual patient and his/her situation and needs; some familiar tools, such as the CAGE questionnaire, are not as sensitive in younger patients. Appendix II lists examples of screening tools commonly used in primary care settings and includes target populations for each tool. A Quick Reference Substance Use Screening Card is also available.
Some screening tools for substance use/abuse have adopted many of the same questions as those used for screening alcohol problems. Some clinicians find it helpful to modify screening tools that have been validated using alcohol questions to also include other drugs. For example, How often do you have a drink containing alcohol or use drugs?