Substance Use Screening Tools for HIV Service Delivery Settings

Introduction

Between 2005 and 2010, the Substance Abuse and Mental Health Services Administration estimated that nearly one-third of individuals with HIV also used illicit drugs or engaged in binge drinking in the past 30 days.¹ While many people (with and without HIV) manage drug use without significant problems, some patterns of substance use can affect HIV viral suppression.²

HIV service delivery settings offer an opportunity to have conversations with clients about substance use. Supportive and dignified conversations about substance use between service providers and people with HIV can lead to referrals and connection to needed services, increased retention in care, and increased viral suppression.

By using validated substance use screening tools such as those included in this library, staff can identify substance use among clients, assess their risk of substance use related harms, and provide supportive linkages to harm reduction services and/or further assessment and treatment. The tools included have been studied to determine if they accurately measure what they were intended to measure. This is known as "validity." Each tool fact sheet contains information about its validity.

Definitions

Screening vs. Assessment: This library includes various substance use screening tools. These tools are intended to provide a valid and reliable snapshot of a client's substance use, which may point toward a need for further assessment and specialized support. When clients complete screening tools on their own or with the support of staff who are not trained in substance use or behavioral health treatment, the screening tools provide important preliminary information for trained clinicians to conduct follow-up assessments.

Substance Use vs. Substance Use Disorder (SUD): The tools included in this library are validated mechanisms to identify substance use among clients. It is important to remember that substance use does not equate to a SUD. A SUD is a diagnosis provided by a trained clinician. Many individuals use substances (including illicit drugs) in ways that reduce potential harms and that they define as supportive to their lives. In fact, when using universal screening, only about 14% of the U.S. population can be classified as having a SUD.⁷ It is essential that providers do not place judgments and biases about drug and alcohol use on those who are willing to disclose and discuss their substance use.

Sensitivity and Specificity: When selecting a screening tool, consider information on sensitivity and specificity. An ideal screening tool has both high sensitivity and high specificity. Sensitivity and specificity can change based on a number of factors including the substance in question and the population with whom the screening tool is administered. Each screening tool page provides this information.

• Sensitivity is the ability of a test to correctly classify an individual as having the health outcome of interest, or screening “positive.” A sensitivity percentage describes the probability of someone who screens positive, actually having the outcome of interest.⁸ For example, a fourth-generation laboratory HIV test with 99.5% sensitivity provides a 99.5% chance that someone who tests positive actually has HIV.⁹
• Specificity is the ability of a test to correctly classify an individual as not having the health outcome of interest. A specificity percentage describes the probability of someone testing negative, when the outcome truly is not present.³ For example, a fourth-generation laboratory HIV test with 99.5% specificity, provides a 99.5% chance that someone who tests negative truly does not have HIV.⁸

References

1. Hitch AE, Gause NK, Brown JL. Substance Use Screening in HIV Care Settings: a Review and Critique of the Literature. Curr HIV/AIDS Rep. 2019 Feb;16(1):7-16. doi: 10.1007/ s11904-019-00434-9. PMID: 30747409.
2. Nolan S, Walley AY, Heeren TC, Patts GJ, Ventura AS, Sullivan MM, Samet JH, Saitz R. HIV- infected individuals who use alcohol and other drugs, and virologic suppression. AIDS Care. 2017 Sep;29(9):1129-1136. doi: 10.1080/09540121.2017.1327646. Epub 2017 May 17. PMID: 28513200; PMCID: PMC5543330.
3. Durvasula R, Miller TR. Substance abuse treatment in persons with HIV/AIDS: challenges in managing triple diagnosis. Behav Med. 2014;40(2):43-52. doi: 10.1080/08964289.2013.866540. PMID: 24274175; PMCID: PMC3999248.
4. Saag LA, Tamhane AR, Batey DS, Mugavero MJ, Eaton EF. Mental health service utilization is associated with retention in care among persons living with HIV at a university-affiliated HIV clinic. AIDS Res Ther. 2018 Jan 16;15(1):1. doi: 10.1186/s12981-018-0188-9. PMID: 29338735; PMCID: PMC5771035.
5. New Hampshire S·BI·RT Initiative of the New Hampshire Charitable Foundation in partnership with the Conrad N. Hilton Foundation. Screen and Intervene: NH SBIRT Playbook. Version 2.1. July 2017.
6. Wakeman SE. Diagnosis and Treatment of Opioid Use Disorder in 2020. JAMA. 2020 May 26;323(20):2082-2083. doi: 10.1001/jama.2020.4104. PMID: 32329798.
7. Venner KL, Sánchez V, Garcia J, Williams RL, Sussman AL. Moving Away from the Tip of the Pyramid: Screening and Brief Intervention for Risky Alcohol and Opioid Use in Underserved Patients. J Am Board Fam Med. 2018 Mar-Apr;31(2):243-251. doi: 10.3122/ jabfm.2018.02.170134. PMID: 29535241; PMCID: PMC6014597.
8. Parikh R, Mathai A, Parikh S, Chandra Sekhar G, Thomas R. Understanding and using sensitivity, specificity and predictive values. Indian J Ophthalmol. 2008 Jan-Feb;56(1):45-50. doi: 10.4103/0301-4738.37595. PMID: 18158403; PMCID: PMC2636062.
9. Peabody R. Sensitivity and specificity of HIV tests. AIDSmap, June 2019. Accessed 12/8/2022.
10. Hitch AE, Gause NK, Brown JL. Substance Use Screening in HIV Care Settings: a Review and Critique of the Literature. Curr HIV/AIDS Rep. 2019 Feb;16(1):7-16. doi: 10.1007/ s11904-019-00434-9. PMID: 30747409.
11. US Preventive Services Task Force, Krist AH, Davidson KW, Mangione CM, Barry MJ, Cabana M, Caughey AB, Curry SJ, Donahue K, Doubeni CA, Epling JW Jr, Kubik M, Ogedegbe G, Pbert L, Silverstein M, Simon MA, Tseng CW, Wong JB. Screening for Unhealthy Drug Use: US Preventive Services Task Force Recommendation Statement. JAMA. 2020 Jun 9;323(22):2301-2309. doi: 10.1001/jama.2020.8020. PMID: 32515821.
12. Tourangeau, R., Smith, T. W. (1996). Asking sensitive questions: The impact of data collection mode, question format, and question context. Public opinion quarterly, 60(2), 275-304. https:// doi.org/10.1086/297751
13. Satre DD, Manuel JK, Larios S, Steiger S, Satterfield J. Cultural Adaptation of Screening, Brief Intervention and Referral to Treatment Using Motivational Interviewing. J Addict Med. 2015 Sep-Oct;9(5):352-7. doi: 10.1097/ADM.0000000000000149. PMID: 26428360; PMCID: PMC4825851.
14. Carrillo JE, Green AR, Betancourt JR. Cross-cultural primary care: a patient-based approach. Ann Intern Med. 1999 May 18;130(10):829-34. doi: 10.7326/0003-4819-130-10-199905180-00017. PMID: 10366373.
15. Humeniuk RE, Henry-Edwards S, Ali RL, Poznyak V and Monteiro M (2010). The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): manual for use in primary care. Geneva, World Health Organization.
16. Humeniuk R, Ali R & World Health Organization. ASSIST Phase II Study Group. (2006). Validation of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) and pilot brief intervention [electronic resource]: a technical report of phase II findings of the WHO ASSIST Project. World Health Organization.
17. Lanier D, Ko S. Screening in Primary Care Settings for Illicit Drug Use: Assessment of Screening Instruments: A Supplemental Evidence Update for the U.S. Preventive Services Task Force [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Jan. Report No.: 08-05108-EF-2. PMID: 20722154.
18. Assessment of Substance Abuse: Drug Abuse Screening Test (DAST). Encyclopedia of Drugs, Alcohol, and Addictive Behavior. Retrieved November 29, 2022 from Encyclopedia.com.
19. Parsons JT, Starks TJ, Millar BM, Boonrai K, Marcotte D. Patterns of substance use among HIV- positive adults over 50: implications for treatment and medication adherence. Drug Alcohol Depend. 2014 Jun 1;139:33-40. doi: 10.1016/j.drugalcdep.2014.02.704. Epub 2014 Mar 19. PMID: 24745475; PMCID: PMC4028151.
20. Shirinbayan P, Salavati M, Soleimani F, Saeedi A, Asghari-Jafarabadi M, Hemmati-Garakani S, Vameghi R. The Psychometric Properties of the Drug Abuse Screening Test. Addict Health. 2020 Jan;12(1):25-33. doi: 10.22122/ahj.v12i1.256. PMID: 32582412; PMCID: PMC7291903.
21. Dawson-Rose C, Shehadeh D, Hao J, Barnard J, Khoddam-Khorasani LL, Leonard A, Clark K, Kersey E, Mousseau H, Frank J, Miller A, Carrico A, Schustack A, Cuca YP. Trauma, substance use, and mental health symptoms in transitional age youth experiencing homelessness. Public Health Nurs. 2020 May;37(3):363-370. doi: 10.1111/phn.12727. Epub 2020 Mar 23. PMID: 32202664.
22. National Institute On Drug Abuse. (2010). Screening for Drug Use in general Medical Settings Resource Guide. U.S. Department of Health and Human Services National Institutes of Health. 0000000000000614
23. Oga EA, Mark K, Peters EN, Coleman-Cowger VH. Validation of the NIDA-modified ASSIST as a Screening Tool for Prenatal Drug Use in an Urban Setting in the United States. J Addict Med. 2020 Sep/Oct;14(5):423-430. doi: 10.1097/ADM.0000000000000614. PMID: 32032210; PMCID: PMC7415506.
24. Zgierska A, Amaza IP, Brown RL, Mundt M, Fleming MF. Unhealthy drug use: how to screen, when to intervene. J Fam Pract. 2014 Sep;63(9):524-30. PMID: 25353031; PMCID: PMC4532724.
25. Pence BW, Gaynes BN, Whetten K, Eron JJ Jr, Ryder RW, Miller WC. Validation of a brief screening instrument for substance abuse and mental illness in HIV-positive patients. J Acquir Immune Defic Syndr. 2005 Dec 1;40(4):434-44. doi: 10.1097/01.qai.0000177512.30576.9c. PMID: 16280698.
26. McNeely J, Wu LT, Subramaniam G, Sharma G, Cathers LA, Svikis D, Sleiter L, Russell L, Nordeck C, Sharma A, O'Grady KE, Bouk LB, Cushing C, King J, Wahle A, Schwartz RP. Performance of the Tobacco, Alcohol, Prescription Medication, and Other Substance Use (TAPS) Tool for Substance Use Screening in Primary Care Patients. Ann Intern Med. 2016 Nov 15;165(10):690-699. doi: 10.7326/M16-0317. Epub 2016 Sep 6. PMID: 27595276; PMCID: PMC5291717.
27. AUDIT translations. (2020). AUDIT Alcohol Use Disorders Identification Test.
28. Fredericksen R, Crane PK, Tufano J, Ralston J, Schmidt S, Brown T, Layman D, Harrington RD, Dhanireddy S, Stone T, Lober W, Kitahata MM, Crane HM. Integrating a web-based, patient- administered assessment into primary care for HIV-infected adults. J AIDS HIV Res. 2012 Feb;4(2):47-55. doi: 10.5897/jahr11.046. Epub 2012 Feb 28. PMID: 26561537; PMCID: PMC4638326.
29. Strauss SM, Rindskopf DM. Screening patients in busy hospital-based HIV care centers for hazardous and harmful drinking patterns: the identification of an optimal screening tool. J Int Assoc Physicians AIDS Care (Chic). 2009 Nov-Dec;8(6):347-53. doi: 10.1177/1545109709350509. Epub 2009 Oct 22. PMID: 19850861; PMCID: PMC2821745.
30. Surah S, Kieran J, O'Dea S, Shiel C, Raffee S, Mulcahy F, Keenan E, Lyons F. Use of the Alcohol Use Disorders Identification Test (AUDIT) to determine the prevalence of alcohol misuse among HIV- infected individuals. Int J STD AIDS. 2013 Jul;24(7):517-21. doi: 10.1177/0956462412473885. Epub 2013 Jul 19. PMID: 23970765.
31. AUDIT-C Screening Tool & Overview. (2013, December 12). IU School of Medicine.
32. Frank D, DeBenedetti AF, Volk RJ, Williams EC, Kivlahan DR, Bradley KA. Effectiveness of the AUDIT-C as a screening test for alcohol misuse in three race/ethnic groups. J Gen Intern Med. 2008 Jun;23(6):781-7. doi: 10.1007/s11606-008-0594-0. Epub 2008 Apr 18. PMID: 18421511; PMCID: PMC2517893.
33. McGinnis KA, Tate JP, Williams EC, Skanderson M, Bryant KJ, Gordon AJ, Kraemer KL, Maisto SA, Crystal S, Fiellin DA, Justice AC. Comparison of AUDIT-C collected via electronic medical record and self-administered research survey in HIV infected and uninfected patients. Drug Alcohol Depend. 2016 Nov 1;168:196-202. doi: 10.1016/j.drugalcdep.2016.09.015. Epub 2016 Sep 22. PMID: 27694059; PMCID: PMC5086273.
34. Strauss SM, Rindskopf DM. Screening patients in busy hospital-based HIV care centers for hazardous and harmful drinking patterns: the identification of an optimal screening tool. J Int Assoc Physicians AIDS Care (Chic). 2009 Nov-Dec;8(6):347-53. doi: 10.1177/1545109709350509. Epub 2009 Oct 22. PMID: 19850861; PMCID: PMC2821745.
35. Dhalla S, Kopec JA. The CAGE questionnaire for alcohol misuse: a review of reliability and validity studies. Clin Invest Med. 2007;30(1):33-41. doi: 10.25011/cim.v30i1.447. PMID: 17716538.
36. Samet JH, Phillips SJ, Horton NJ, Traphagen ET, Freedberg KA. Detecting alcohol problems in HIV- infected patients: use of the CAGE questionnaire. AIDS Res Hum Retroviruses. 2004 Feb;20(2):151-5. doi: 10.1089/088922204773004860. PMID: 15018702.
37. Wickersham JA, Azar MM, Cannon CM, Altice FL, Springer SA. Validation of a Brief Measure of Opioid Dependence: The Rapid Opioid Dependence Screen (RODS). J Correct Health Care. 2015 Jan;21(1):12-26. doi: 10.1177/1078345814557513. Erratum in: J Correct Health Care. 2020 Apr;26(2):194. PMID: 25559628; PMCID: PMC4435561.

Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST)

What substances does this tool screen for?

Tobacco, alcohol, cannabis, cocaine, amphetamines, sedatives, hallucinogens, inhalants, opioids, and other drugs.

Is this tool appropriate to use with people with HIV?

The ASSIST was developed by the World Health Organization and is recommended for universal screening. However, no study has specifically examined the use of the tool among people with HIV.

Who administers and scores the tool?

• A staff person or health care provider who has been trained to administer the ASSIST, reading questions as written and not providing any additional information until after completion.
• Scoring should be completed by a trained staff person or health care provider.

Has this tool been validated?

Yes, the ASSIST tool has been evaluated against multiple substance use screening tools (e.g., DAST, AUDIT). Sensitivity is found to range between 54% to 97%, and specificity between 50% and 96%, depending on substance.

References

• Humeniuk RE, Henry-Edwards S, Ali RL, Poznyak V and Monteiro M (2010). The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): manual for use in primary care. Geneva, World Health Organization.
• Humeniuk R, Ali R & World Health Organization. ASSIST Phase II Study Group. (2006). Validation of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) and pilot brief intervention [electronic resource]: a technical report of phase II findings of the WHO ASSIST Project. World Health Organization.

Alcohol Use Disorders Identification Test (AUDIT)

AUDIT is a 10 item tool that screens adults and adolescents for problem alcohol use and is optimally self-administered by clients.

What substance does this tool screen for?

Alcohol

Is this tool appropriate to use with people with HIV?

Yes, the AUDIT has been validated for use among people with HIV and used to screen:

• Individuals with HIV who identify as male, female, transgender, non-binary, and gender nonconforming.
• Gay and bisexual men with HIV of all ages, races, and ethnicities.
• Veterans with HIV.
• Individuals with HIV accessing services in outpatient and infectious disease clinics.
• Women with HIV and a history of childhood sexual abuse.
• Individuals currently taking HIV medications.

Who administers and scores the tool?

• Optimally self-administered by clients either electronically or on paper.
• If screening verbally, by a staff person or health care provider who has been trained to administer the AUDIT, reading questions as written and not providing any additional information until after completion.
• Any staff person or health care provider can be trained to score the AUDIT.

Has this tool been validated?

Yes, the AUDIT has been evaluated for sensitivity and specificity against the Diagnostic and Statistical Manual III-Revised criteria for alcohol use disorder. While results vary, most studies have found sensitivity and specificity to be 70% or more. Some have even found that use of the tool may result in as high as 96% sensitivity and specificity.

References

• AUDIT translations. (2020). AUDIT Alcohol Use Disorders Identification Test.
• Fredericksen R, Crane PK, Tufano J, Ralston J, Schmidt S, Brown T, Layman D, Harrington RD, Dhanireddy S, Stone T, Lober W, Kitahata MM, Crane HM. Integrating a web-based, patient- administered assessment into primary care for HIV-infected adults. J AIDS HIV Res. 2012 Feb;4(2):47-55. doi: 10.5897/jahr11.046. Epub 2012 Feb 28. PMID: 26561537; PMCID: PMC4638326.
• Strauss SM, Rindskopf DM. Screening patients in busy hospital-based HIV care centers for hazardous and harmful drinking patterns: the identification of an optimal screening tool. J Int Assoc Physicians AIDS Care (Chic). 2009 Nov-Dec;8(6):347-53. doi: 10.1177/1545109709350509. Epub 2009 Oct 22. PMID: 19850861; PMCID: PMC2821745.
• Surah S, Kieran J, O'Dea S, Shiel C, Raffee S, Mulcahy F, Keenan E, Lyons F. Use of the Alcohol Use Disorders Identification Test (AUDIT) to determine the prevalence of alcohol misuse among HIV- infected individuals. Int J STD AIDS. 2013 Jul;24(7):517-21. doi: 10.1177/0956462412473885. Epub 2013 Jul 19. PMID: 23970765.

Alcohol Use Disorders Identification Test-Consumption (AUDIT-C)

The AUDIT-C is a 3 item tool that screens adults and adolescents for problem alcohol use and is optimally self-administered by clients.

What substance does this tool screen for?

Alcohol

Is this tool appropriate to use with people with HIV?

Yes, research findings support the use of the AUDIT-C among individuals with HIV. It has been used in numerous studies including those examining:

• Individuals with HIV receiving care at a hospital-based program
• Individuals with HIV receiving outpatient care with the Veteran 's Service Administration

Who administers and scores the tool?

• Optimally self-administered by clients either electronically or on paper.
• If screening verbally, by a staff person or health care provider who has been trained to administer the AUDIT-C, reading questions as written and not providing any additional information until after completion.
• Any staff person or health care provider can be trained to score the AUDIT-C.

Has this tool been validated?

Yes. For men, a score of 4 or more indicates a positive screen. This usage has sensitivity of 89% and specificity of 91%. For women, a score of 3 indicates a positive screen. This usage has 96% sensitivity and 89% specificity. In addition, the AUDIT-C has been found to perform well across ethnically and racially diverse populations.

Note: AUDIT-C is the first three questions of the longer AUDIT tool, which is a more comprehensive assessment of problem drinking.

References

• AUDIT-C Screening Tool & Overview. (2013, December 12). IU School of Medicine.
• Frank D, DeBenedetti AF, Volk RJ, Williams EC, Kivlahan DR, Bradley KA. Effectiveness of the AUDIT-C as a screening test for alcohol misuse in three race/ethnic groups. J Gen Intern Med. 2008 Jun;23(6):781-7. doi: 10.1007/s11606-008-0594-0. Epub 2008 Apr 18. PMID: 18421511; PMCID: PMC2517893.
• McGinnis KA, Tate JP, Williams EC, Skanderson M, Bryant KJ, Gordon AJ, Kraemer KL, Maisto SA, Crystal S, Fiellin DA, Justice AC. Comparison of AUDIT-C collected via electronic medical record and self-administered research survey in HIV infected and uninfected patients. Drug Alcohol Depend. 2016 Nov 1;168:196-202. doi: 10.1016/j.drugalcdep.2016.09.015. Epub 2016 Sep 22. PMID: 27694059; PMCID: PMC5086273.
• Strauss SM, Rindskopf DM. Screening patients in busy hospital-based HIV care centers for hazardous and harmful drinking patterns: the identification of an optimal screening tool. J Int Assoc Physicians AIDS Care (Chic). 2009 Nov-Dec;8(6):347-53. doi: 10.1177/1545109709350509. Epub 2009 Oct 22. PMID: 19850861; PMCID: PMC2821745.

CAGE

The CAGE is a 4 item tool that screens adults and adolescents for problem alcohol use and is optimally self-administered by clients.

What substance does this tool screen for?

Alcohol

Note: the CAGE screens for alcohol only. If you are looking for a tool that screens for both alcohol and drugs, the CAGE-AID (below) was adapted for that purpose.

Is this tool appropriate to use with people with HIV?

The CAGE has been used in HIV care settings. Universal screening is appropriate.

Who administers and scores the tool?

• Optimally self-administered by clients either electronically or on paper.
• If screening verbally, by a staff person or health care provider who has been trained to administer the CAGE, reading questions as written and not providing any additional information until after completion.
• Any staff person or health care provider can be trained to score the CAGE.

Has this tool been validated?

While the CAGE has been used to detect heavy or hazardous drinking; findings have shown that it is less sensitive and specific than the AUDIT when used for these purposes. However, the CAGE has been found to be superior to the AUDIT for detecting individuals who may be found to have an alcohol use disorder following further assessment.

Note: CAGE is an acronym formed from the italicized words in the questionnaire.

References

• Dhalla S, Kopec JA. The CAGE questionnaire for alcohol misuse: a review of reliability and validity studies. Clin Invest Med. 2007;30(1):33-41. doi: 10.25011/cim.v30i1.447. PMID: 17716538.
• Samet JH, Phillips SJ, Horton NJ, Traphagen ET, Freedberg KA. Detecting alcohol problems in HIV- infected patients: use of the CAGE questionnaire. AIDS Res Hum Retroviruses. 2004 Feb;20(2):151-5. doi: 10.1089/088922204773004860. PMID: 15018702.

CAGE-AID

The CAGE-AID is a 4 item tool that screens adults and adolescents for alcohol and drugs and is optimally self-administered by clients.Note: "CAGE" is an acronym formed from the italicized words in the questionnaire. The CAGE-AID is a version of the CAGE (see above) that was adapted to include drugs and alcohol.

What substances does this tool screen for?

Alcohol, drugs (the CAGE-AID uses the general term drugs, rather than specifying particular substances)

Is this tool appropriate to use with people with HIV?

The CAGE-AID is recommended for universal screening. However, no study has specifically examined the use of the CAGE-AID among people with HIV.

Who administers and scores the tool?

• Optimally self-administered by clients either electronically or on paper.
• If screening verbally, by a staff person or health care provider who has been trained to administer the CAGE-AID, reading questions as written and not providing any additional information until after completion.
• Any staff person or health care provider can be trained to score the CAGE.

Has this tool been validated?

When one or more “Yes” responses are provided to the CAGE-AID, research has found that the sensitivity is 79% and specificity is 77%. When two or more “Yes” responses are provided, research has found that the sensitivity decreases to 70% and specificity increases to 85%.

References

• Lanier D, Ko S. Screening in Primary Care Settings for Illicit Drug Use: Assessment of Screening Instruments: A Supplemental Evidence Update for the U.S. Preventive Services Task Force [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Jan. Report No.: 08-05108-EF-2. PMID: 20722154.

Drug Abuse Screening Test (DAST-10)

The DAST-10 is a 10-item tool that screens adults for multiple drugs including cannabis, cocaine, heroin, narcotic pain medications, sedatives, and stimulants.

What substances does this tool screen for?

Cannabis, cocaine, heroin, narcotic pain medications, sedatives, stimulants.

Is this tool appropriate to use with people with HIV?

Yes, the DAST-10 has been administered to people with HIV and has been validated within this population.

Who administers and scores the tool?

• A staff person or health care provider who has been trained to administer the DAST-10, reading questions as written and not providing any additional information until after completion.
• Scoring should be completed by a trained staff person or healthcare provider.

Has this tool been validated?

Yes, the DAST-10 tool has been evaluated against the DAST-28 and DAST-20. While results vary, studies have found that sensitivity ranges from 41% to 95%, and specificity from 68% to 99%, depending on the positive cut-off used while scoring.

References

• Assessment of Substance Abuse: Drug Abuse Screening Test (DAST). Encyclopedia of Drugs, Alcohol, and Addictive Behavior. Retrieved November 29, 2022 from Encyclopedia.com.
• Parsons JT, Starks TJ, Millar BM, Boonrai K, Marcotte D. Patterns of substance use among HIV- positive adults over 50: implications for treatment and medication adherence. Drug Alcohol Depend. 2014 Jun 1;139:33-40. doi: 10.1016/j.drugalcdep.2014.02.704. Epub 2014 Mar 19. PMID: 24745475; PMCID: PMC4028151.
• Shirinbayan P, Salavati M, Soleimani F, Saeedi A, Asghari-Jafarabadi M, Hemmati-Garakani S, Vameghi R. The Psychometric Properties of the Drug Abuse Screening Test. Addict Health. 2020 Jan;12(1):25-33. doi: 10.22122/ahj.v12i1.256. PMID: 32582412; PMCID: PMC7291903.

NIDA Quick Screen & NIDA-Modified Alcohol, Smoking, and Substance Involvement Screening Test (NM-ASSIST)

The single item NIDA Quick Screen followed by the NM-ASSIST includes 9 items that screen adults and adolescents for multiple substances including tobacco, alcohol, opioids, and other drugs and is optimally self-administered by clients.

What substances do these tools screen for?

Tobacco, alcohol, cannabis, cocaine, amphetamines, sedatives, hallucinogens, inhalants, opioids, and other drugs.

The single-item NIDA Quick Screen tool should be used in combination with the NM-ASSIST. A “Yes” response to the NIDA Quick Screen should be followed by administration of the NM-ASSIST.

Are these tools appropriate to use with people with HIV?

The NIDA Quick Screen and NM-ASSIST are recommended for universal screening. However, no study has specifically examined their use among people with HIV.

Who administers and scores the tools?

• Optimally self-administered by clients either electronically or on paper.
• If screening verbally, by a staff person or health care provider who has been trained to administer the NIDA Quick Screen and NM-ASSIST, reading questions as written and not providing any additional information until after completion.
• Scoring should be completed by a trained staff person or healthcare provider.

Have these tools been validated?

Yes, the NIDA Quick Screen and NM-ASSIST tools have been evaluated against multiple substance use screening tools (e.g., CRAFFT, SURP). Sensitivity is found to range between 13% to 82%, and specificity between 85% and 99%, depending on substance.

References

• Dawson-Rose C, Shehadeh D, Hao J, Barnard J, Khoddam-Khorasani LL, Leonard A, Clark K, Kersey E, Mousseau H, Frank J, Miller A, Carrico A, Schustack A, Cuca YP. Trauma, substance use, and mental health symptoms in transitional age youth experiencing homelessness. Public Health Nurs. 2020 May;37(3):363-370. doi: 10.1111/phn.12727. Epub 2020 Mar 23. PMID: 32202664.
• National Institute On Drug Abuse. (2010). Screening for Drug Use in general Medical Settings Resource Guide. U.S. Department of Health and Human Services National Institutes of Health. 0000000000000614
• Oga EA, Mark K, Peters EN, Coleman-Cowger VH. Validation of the NIDA-modified ASSIST as a Screening Tool for Prenatal Drug Use in an Urban Setting in the United States. J Addict Med. 2020 Sep/Oct;14(5):423-430. doi: 10.1097/ADM.0000000000000614. PMID: 32032210; PMCID: PMC7415506.
• Zgierska A, Amaza IP, Brown RL, Mundt M, Fleming MF. Unhealthy drug use: how to screen, when to intervene. J Fam Pract. 2014 Sep;63(9):524-30. PMID: 25353031; PMCID: PMC4532724.

Rapid Opioid Dependence Screen (RODS)

The RODS is an 8 item tool that screens adults for opioid use.

What substances does this tool screen for?

Heroin, methadone, buprenorphine, morphine, MS-Contin, OxyContin, oxycodone, and other opioid analgesics.

Is this tool appropriate to use with people with HIV?

Yes, the RODS was originally developed to support rapid assessment of individuals experiencing incarceration with HIV to allow buprenorphine induction on the day of release, if necessary.

Who administers and scores the tool?

• A staff person or health care provider who has been trained to administer and score the RODS, reading questions as written and not providing any additional information until after completion.
• Can be administered as a stand-alone instrument or as part of a comprehensive interview.
• Scoring should be completed by a trained staff person or health care provider.

Has this tool been validated?

The RODS has shown good-to-strong sensitivity (97%) and specificity (76%) among clients with HIV. Researchers have suggested that it is an ideal first-line assessment tool for this reason, but validity tests were conducted specifically with individuals experiencing incarceration with a relatively small sample size.

References

• Wickersham JA, Azar MM, Cannon CM, Altice FL, Springer SA. Validation of a Brief Measure of Opioid Dependence: The Rapid Opioid Dependence Screen (RODS). J Correct Health Care. 2015 Jan;21(1):12-26. doi: 10.1177/1078345814557513. Erratum in: J Correct Health Care. 2020 Apr;26(2):194. PMID: 25559628; PMCID: PMC4435561.

Substance Abuse and Mental Illness Symptoms Screener (SAMISS)

The SAMISS is a 16 item tool that screens adults for alcohol and drugs.

What substances does this tool screen for?

Alcohol, drugs (the SAMISS uses the general term drugs, rather than specifying particular substances)

Is this tool appropriate to use with people with HIV?

Yes, the SAMISS was designed to identify substance use disorder and mental health conditions in people with HIV and has been validated within this population.

Who administers and scores the tool?

• A staff person or health care provider who has been trained to administer the SAMISS in a consistent manner, reading questions as written and not providing any additional information until after completion.
• Scoring should be completed by a trained staff person or healthcare provider.

Has this tool been validated?

Yes, the SAMISS tool has been evaluated for sensitivity and specificity against the Structured Clinical Interview for DSM Disorders for substance use and mental health conditions. While results vary, studies have found sensitivity and specificity of the substance use module to be 75% or higher, and the mental health condition module to have sensitivity as high as 95%, while the specificity was found to be 49%. A study found that the specificity of the mental health condition module decreased as the number of a person 's HIV-related symptoms increased.

References

• Pence BW, Gaynes BN, Whetten K, Eron JJ Jr, Ryder RW, Miller WC. Validation of a brief screening instrument for substance abuse and mental illness in HIV-positive patients. J Acquir Immune Defic Syndr. 2005 Dec 1;40(4):434-44. doi: 10.1097/01.qai.0000177512.30576.9c. PMID: 16280698.

Tobacco, Alcohol, Prescription Medication, and Other Substance Use Tools (TAPS-1, TAPS-2)

The 4 item TAPS-1 followed by the TAPS-2 screen adults for multiple substances including tobacco, alcohol, and other drugs and is optimally self-administered by clients.

What substances do these tools screen for?

TAPS-1 screens for tobacco, alcohol, illicit drugs, and non-medical use of prescription drugs. A positive TAPS-1 screening should be followed by the administration of TAPS-2, a substance-specific assessment.

Are these tools appropriate to use with people with HIV?

Yes, the TAPS-1 and TAPS-2 have been administered to people with HIV and validated within this population.

Who administers and scores the tools?

• It is recommended that the TAPS-1 and TAPS-2 (when indicated) be self-administered by clients either electronically or on paper.
• If screening verbally, a staff person or health care provider who has been trained to administer the TAPS-1 and TAPS-2 in a consistent manner, reading questions as written, and not providing any additional information until after completion.
• Any staff person or health care providers can be trained to score the TAPS-1 and TAPS-2.

Have these tools been validated?

Yes, the TAPS-1 and TAPS-2 tools have been evaluated for sensitivity and specificity. Sensitivity is found to range between 62% to 93% and specificity between 79% and 93% depending on substance.

References

• McNeely J, Wu LT, Subramaniam G, Sharma G, Cathers LA, Svikis D, Sleiter L, Russell L, Nordeck C, Sharma A, O'Grady KE, Bouk LB, Cushing C, King J, Wahle A, Schwartz RP. Performance of the Tobacco, Alcohol, Prescription Medication, and Other Substance Use (TAPS) Tool for Substance Use Screening in Primary Care Patients. Ann Intern Med. 2016 Nov 15;165(10):690-699. doi: 10.7326/M16-0317. Epub 2016 Sep 6. PMID: 27595276; PMCID: PMC5291717.