Performance of the Tobacco, Alcohol, Prescription Medication, and Other Substance Use (TAPS) Tool for Substance Use Screening in Primary Care Patients.
BACKGROUND
Substance use, a leading cause of illness and death, is underidentified in medical practice.


OBJECTIVE
The Tobacco, Alcohol, Prescription medication, and other Substance use (TAPS) tool was developed to address the need for a brief screening and assessment instrument that includes all commonly used substances and fits into clinical workflows. The goal of this study was to assess the performance of the TAPS tool in primary care patients.


METHODS
Multisite study, conducted within the National Drug Abuse Treatment Clinical Trials Network, comparing the TAPS tool with a reference standard measure. (ClinicalTrials.gov: NCT02110693).


METHODS
5 adult primary care clinics.


METHODS
2000 adult patients consecutively recruited from clinic waiting areas.


METHODS
Interviewer- and self-administered versions of the TAPS tool were compared with a reference standard, the modified World Mental Health Composite International Diagnostic Interview (CIDI), which measures problem use and substance use disorder (SUD).


RESULTS
Interviewer- and self-administered versions of the TAPS tool had similar diagnostic characteristics. For identifying problem use (at a cutoff of 1+), the TAPS tool had a sensitivity of 0.93 (95% CI, 0.90 to 0.95) and specificity of 0.87 (CI, 0.85 to 0.89) for tobacco and a sensitivity of 0.74 (CI, 0.70 to 0.78) and specificity of 0.79 (CI, 0.76 to 0.81) for alcohol. For problem use of illicit and prescription drugs, sensitivity ranged from 0.82 (CI, 0.76 to 0.87) for marijuana to 0.63 (CI, 0.47 to 0.78) for sedatives; specificity was 0.93 or higher. For identifying any SUD (at a cutoff of 2+), sensitivity was lower.


CONCLUSIONS
The low prevalence of some drug classes led to poor precision in some estimates. Research assistants were not blinded to participants' TAPS tool responses when they administered the CIDI.


CONCLUSIONS
In a diverse population of adult primary care patients, the TAPS tool detected clinically relevant problem substance use. Although it also may detect tobacco, alcohol, and marijuana use disorders, further refinement is needed before it can be recommended broadly for SUD screening.


BACKGROUND
National Institute on Drug Abuse.
From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina.
Jennifer
J
McNeely
From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina.
Li-Tzy
LT
Wu
From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina.
Geetha
G
Subramaniam
From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina.
Gaurav
G
Sharma
From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina.
Lauretta A
LA
Cathers
From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina.
Dace
D
Svikis
From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina.
Luke
L
Sleiter
From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina.
Linnea
L
Russell
From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina.
Courtney
C
Nordeck
From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina.
Anjalee
A
Sharma
From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina.
Kevin E
KE
O'Grady
From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina.
Leah B
LB
Bouk
From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina.
Carol
C
Cushing
From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina.
Jacqueline
J
King
From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina.
Aimee
A
Wahle
From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina.
Robert P
RP
Schwartz
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019973:Alcohol-Related Disorders / Q000175:diagnosis; D005260:Female; D006801:Humans; D008297:Male; D002189:Marijuana Abuse / Q000175:diagnosis; D008403:Mass Screening; D008875:Middle Aged; D055553:Prescription Drugs; D011320:Primary Health Care / Q000379:methods*; D012680:Sensitivity and Specificity; D019966:Substance-Related Disorders / Q000175:diagnosis*; D011795:Surveys and Questionnaires; D014029:Tobacco Use Disorder / Q000175:diagnosis; D055815:Young Adult
D055553:Prescription Drugs