title: Variations in Substance Use Prevalence Estimates and Need for Interventions among Adult Emergency Department Patients Based on Different Screening Strategies Using the ASSIST.
abstract: BACKGROUND
  Among adult emergency department (ED) patients, we sought to examine how estimates of substance use prevalence and the need for interventions can differ, based on the type of screening and assessment strategies employed.
  
  
  METHODS
  We estimated the prevalence of substance use and the need for interventions using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in a secondary analysis of data from two cross-sectional studies using random samples of English- or Spanish-speaking 18-64-year-old ED patients. In addition, the test performance characteristics of three simplified screening strategies consisting of selected questions from the ASSIST (lifetime use, past three-month use, and past three-month frequency of use) to identify patients in need of a possible intervention were compared against using the full ASSIST.
  
  
  RESULTS
  Of 6,432 adult ED patients, the median age was 37 years-old, 56.6% were female, and 61.6% were white. Estimated substance use prevalence among this population differed by how it was measured (lifetime use, past three-month use, past three-month frequency of use, or need for interventions). As compared to using the full ASSIST, the predictive value and accuracy to identify patients in need of any intervention was best for a simplified strategy asking about past three-month substance use. A strategy asking about daily/near-daily use was better in identifying patients needing intensive interventions. However, some patients needing interventions were missed when using these simplified strategies.
  
  
  CONCLUSIONS
  Substance use prevalence estimates and identification of ED patients needing interventions differ by screening strategies used. EDs should carefully select strategies to identify patients in need of substance use interventions.
authors.affiliation: Brown University, School of Public Health, Department of Epidemiology, Providence, Rhode Island; Brown University, Alpert Medical School, Department of Emergency Medicine, Providence, Rhode Island.
authors.forename: Roland C
authors.initials: RC
authors.lastname: Merchant
authors.affiliation: Brown University, School of Public Health, Center for Statistical Sciences, Department of Biostatistics, Providence, Rhode Island.
authors.forename: Tao
authors.initials: T
authors.lastname: Liu
authors.affiliation: Brown University, Alpert Medical School, Department of Emergency Medicine, Providence, Rhode Island.
authors.forename: Janette R
authors.initials: JR
authors.lastname: Baird
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D011050:Policy Making; D015995:Prevalence; D012737:Sex Factors; D015813:Substance Abuse Detection / Q000379:methods*; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000628:therapy; D014481:United States / Q000453:epidemiology