title: Validation of Self-Administered Single-Item Screening Questions (SISQs) for Unhealthy Alcohol and Drug Use in Primary Care Patients.
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.
  
  
  METHODS
  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.
  
  
  METHODS
  Adult patients aged 21-65 years were consecutively enrolled from two urban safety-net primary care clinics.
  
  
  METHODS
  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.
  
  
  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.
authors.affiliation: Department of Population Health, New York University School of Medicine, 550 1st Ave., VZ30 6th Floor, New York, NY, 10016, USA. Jennifer.mcneely@nyumc.org.|Department of Medicine, Division of General Internal Medicine, New York, NY, USA. Jennifer.mcneely@nyumc.org.|Center for Drug Use and HIV Research, New York, NY, USA. Jennifer.mcneely@nyumc.org.
authors.forename: Jennifer
authors.initials: J
authors.lastname: McNeely
authors.affiliation: Center for Drug Use and HIV Research, New York, NY, USA.|NYU College of Nursing, New York, NY, USA.
authors.forename: Charles M
authors.initials: CM
authors.lastname: Cleland
authors.affiliation: Center for Drug Use and HIV Research, New York, NY, USA.|NYU College of Nursing, New York, NY, USA.
authors.forename: Shiela M
authors.initials: SM
authors.lastname: Strauss
authors.affiliation: Department of Population Health, New York University School of Medicine, 550 1st Ave., VZ30 6th Floor, New York, NY, 10016, USA.|Center for Drug Use and HIV Research, New York, NY, USA.
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Palamar
authors.affiliation: Department of Psychiatry, NYU School of Medicine, New York, NY, USA.
authors.forename: John
authors.initials: J
authors.lastname: Rotrosen
authors.affiliation: Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.|Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Saitz
mesh_terms: D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000175:diagnosis / Q000453:epidemiology; D034201:Computers, Handheld; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D015995:Prevalence; D011320:Primary Health Care / Q000379:methods*; D015203:Reproducibility of Results; D057566:Self Report; D012680:Sensitivity and Specificity; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000453:epidemiology; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Alcohol; Illicit drugs; Screening; Substance use; Validation