title: A Brief Patient Self-administered Substance Use Screening Tool for Primary Care: Two-site Validation Study of the Substance Use Brief Screen (SUBS).
abstract: BACKGROUND
  Substance use screening is widely encouraged in health care settings, but the lack of a screening approach that fits easily into clinical workflows has restricted its broad implementation. The Substance Use Brief Screen (SUBS) was developed as a brief, self-administered instrument to identify unhealthy use of tobacco, alcohol, illicit drugs, and prescription drugs. We evaluated the validity and test-retest reliability of the SUBS in adult primary care patients.
  
  
  METHODS
  Adults aged 18-65 years were enrolled from urban safety net primary care clinics to self-administer the SUBS using touch-screen tablet computers for a test-retest reliability study (n = 54) and a 2-site validation study (n = 586). In the test-retest reliability study, the SUBS was administered twice within a 2-week period. In the validation study, the SUBS was compared with reference standard measures, including self-reported measures and oral fluid drug tests. We measured test-retest reliability and diagnostic accuracy of the SUBS for detection of unhealthy use and substance use disorder for tobacco, alcohol, and drugs (illicit and prescription drug misuse).
  
  
  RESULTS
  Test-retest reliability was good or excellent for each substance class. For detection of unhealthy use, the SUBS had sensitivity and specificity of 97.8% (95% confidence interval [CI], 93.7-99.5) and 95.7% (95% CI, 92.4-97.8), respectively, for tobacco; and 85.2% (95% CI, 79.3-89.9) and 77.0% (95% CI, 72.6-81.1) for alcohol. For unhealthy use of illicit or prescription drugs, sensitivity was 82.5% (95% CI, 75.7-88.0) and specificity 91.1% (95% CI, 87.9-93.6). With respect to identifying a substance use disorder, the SUBS had sensitivity and specificity of 100.0% (95% CI, 92.7-100.0) and 72.1% (95% CI, 67.1-76.8) for tobacco; 93.5% (95% CI, 85.5-97.9) and 64.6% (95% CI, 60.2-68.7) for alcohol; and 85.7% (95% CI, 77.2-92.0) and 82.0% (95% CI, 78.2-85.3) for drugs. Analyses of area under the receiver operating curve (AUC) indicated good discrimination (AUC 0.74-0.97) for all substance classes. Assistance in completing the SUBS was requested by 11% of participants.
  
  
  CONCLUSIONS
  The SUBS was feasible for self-administration and generated valid results in a diverse primary care patient population. The 4-item SUBS can be recommended for primary care settings that are seeking to implement substance use screening.
authors.affiliation: Department of Population Health, New York University (NYU) School of Medicine, New York; Department of Medicine, New York University (NYU) School of Medicine, New York. Electronic address: jennifer.mcneely@nyumc.org.
authors.forename: Jennifer
authors.initials: J
authors.lastname: McNeely
authors.affiliation: NYU College of Nursing, New York.
authors.forename: Shiela M
authors.initials: SM
authors.lastname: Strauss
authors.affiliation: Department of Community Health Sciences, School of Public Health and Clinical Research and Education Unit, Section of General Internal Medicine, Boston Medical Center, Boston, Mass.
authors.forename: Richard
authors.initials: R
authors.lastname: Saitz
authors.affiliation: NYU College of Nursing, New York.
authors.forename: Charles M
authors.initials: CM
authors.lastname: Cleland
authors.affiliation: Department of Population Health, New York University (NYU) School of Medicine, New York.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Palamar
authors.affiliation: Department of Psychiatry, NYU School of Medicine, New York.
authors.forename: John
authors.initials: J
authors.lastname: Rotrosen
authors.affiliation: Department of Population Health, New York University (NYU) School of Medicine, New York; Department of Medicine, New York University (NYU) School of Medicine, New York.
authors.forename: Marc N
authors.initials: MN
authors.lastname: Gourevitch
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000437:Alcoholism / Q000453:epidemiology; D000554:Ambulatory Care Facilities; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D013287:Illicit Drugs / Q000009:adverse effects; D015994:Incidence; D020407:Internet / Q000706:statistics & numerical data*; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D063487:Prescription Drug Misuse / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000379:methods*; D015203:Reproducibility of Results; D018570:Risk Assessment; D057566:Self Report; D012680:Sensitivity and Specificity; D012737:Sex Factors; D012907:Smoking / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014481:United States; D014505:Urban Population; D055815:Young Adult
chemical_list: D013287:Illicit Drugs
keywords: Alcohol; Illicit drugs; Screening; Substance use; Tobacco; Validation