title: Screening in Primary Care: What Is the Best Way to Identify At-Risk Youth for Substance Use?
abstract: It is important to improve primary care providers' capability to identify youth at risk for alcohol and other drug use. To our knowledge, this is the first study to use Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria to compare screeners for youth for both alcohol and marijuana, given that these are the most frequently used substances by this age group.
  
  
  
  We compared the psychometric performance of 4 screeners: the National Institute on Alcohol Abuse and Alcoholism Screening Guide (NIAAA SG), the Alcohol Use Disorders Identification Test, the Car-Relax-Alone-Forget-Family and Friends-Trouble (CRAFFT) screener, and the Personal Experience Screening Questionnaire Problem Severity Scale (PESQ-PS) in identifying alcohol and marijuana use outcomes. Youth age 12 through 18 (N = 1573; 27% black, 51% Hispanic) were screened with the NIAAA SG, followed by a Web survey that included the other screeners and outcomes.
  
  
  
  Sensitivity for alcohol outcomes indicated that the NIAAA SG (0.87) did not perform as well as the CRAFFT (0.97) or PESQ-PS (0.97) screeners but performed better than the Alcohol Use Disorders Identification Test (0.70). The pattern for sensitivity across screeners for marijuana outcomes was similar.
  
  
  
  An important tradeoff in primary care settings is precision versus practicality. Because of brevity and focus on frequency of drinking, the NIAAA SG offers ease of administration and is good at identifying youth with probably problematic drinking levels. The PESQ-PS and the CRAFFT correctly identify more at-risk youth for alcohol and marijuana than the NIAAA SG. Future work is needed to elucidate how to efficiently and accurately identify at-risk youth in the primary care setting, including determining the best cutoff points to use to increase sensitivity.
authors.affiliation: RAND Corporation, Santa Monica, California; and damico@rand.org.
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: D'Amico
authors.affiliation: RAND Corporation, Santa Monica, California; and.
authors.forename: Layla
authors.initials: L
authors.lastname: Parast
authors.affiliation: RAND Corporation, Santa Monica, California; and.
authors.forename: Lisa S
authors.initials: LS
authors.lastname: Meredith
authors.affiliation: RAND Corporation, Santa Monica, California; and.
authors.forename: Brett A
authors.initials: BA
authors.lastname: Ewing
authors.affiliation: RAND Corporation, Pittsburgh, Pennsylvania.
authors.forename: William G
authors.initials: WG
authors.lastname: Shadel
authors.affiliation: RAND Corporation, Pittsburgh, Pennsylvania.
authors.forename: Bradley D
authors.initials: BD
authors.lastname: Stein
mesh_terms: D000293:Adolescent; D000428:Alcohol Drinking / Q000453:epidemiology*; D002648:Child; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D008385:Marijuana Smoking / Q000453:epidemiology*; D008403:Mass Screening / Q000379:methods*; D011237:Predictive Value of Tests; D011320:Primary Health Care; D011594:Psychometrics; D012680:Sensitivity and Specificity; D015813:Substance Abuse Detection / Q000379:methods*; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology