Identifying substance misuse in primary care: TAPS Tool compared to the WHO ASSIST.
There is a need for screening and brief assessment instruments to identify primary care patients with substance use problems. This study's aim was to examine the performance of a two-step screening and brief assessment instrument, the TAPS Tool, compared to the WHO ASSIST.



Two thousand adult primary care patients recruited from five primary care clinics in four Eastern US states completed the TAPS Tool followed by the ASSIST. The ability of the TAPS Tool to identify moderate- and high-risk use scores on the ASSIST was examined using sensitivity and specificity analyses.



The interviewer and self-administered computer tablet versions of the TAPS Tool generated similar results. The interviewer-administered version (at cut-off of 2), had acceptable sensitivity and specificity for high-risk tobacco (0.90 and 0.77) and alcohol (0.87 and 0.80) use. For illicit drugs, sensitivities were >0.82 and specificities >0.92. The TAPS (at a cut-off of 1) had good sensitivity and specificity for moderate-risk tobacco use (0.83 and 0.97) and alcohol (0.83 and 0.74). Among illicit drugs, sensitivity was acceptable for moderate-risk of marijuana (0.71), while it was low for all other illicit drugs and non-medical use of prescription medications. Specificities were 0.97 or higher for all illicit drugs and prescription medications.



The TAPS Tool identified adult primary care patients with high-risk ASSIST scores for all substances as well moderate-risk users of tobacco, alcohol, and marijuana, although it did not perform well in identifying patients with moderate-risk use of other drugs or non-medical use of prescription medications. The advantages of the TAPS Tool over the ASSIST are its more limited number of items and focus solely on substance use in the past 3months.
Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA. Electronic address: Rschwartz@friendsresearch.org.
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Schwartz
New York University School of Medicine, Department of Population Health, 550 First Avenue, VZ30 6th floor, New York, NY 10016, USA. Electronic address: Jennifer.McNeely@nyumc.org.
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McNeely
Duke University, Department of Psychiatry and Behavioral Sciences and Department of Medicine, Duke University Medical Center, Durham, NC, USA. Electronic address: Litzy.wu@duke.edu.
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Wu
Emmes Corporation, 401 North Washington Street, Suite 700, Rockville, MD 20850, USA. Electronic address: gsharma@emmes.com.
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Sharma
Emmes Corporation, 401 North Washington Street, Suite 700, Rockville, MD 20850, USA.
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Wahle
National Institute on Drug Abuse, 6001 Executive Boulevard, Rockville, MD 20852, USA.
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Cushing
Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA.
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Nordeck
Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA.
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Sharma
University of Maryland, College Park, Department of Psychology, 4094 Campus Dr., College Park, MD 20742, USA.
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O'Grady
Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA.
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Gryczynski
Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201, USA.
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Mitchell
University of Adelaide, Department of Pharmacology, Frome Road, Level 5, Medical School North Bldg, The University of Adelaide, Adelaide, SA 5005, Australia. Electronic address: robert.ali@adelaide.edu.au.
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Ali
Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Addiction Sciences Building, 4 Windsor Walk, Denmark Hill, SE5 8BB London, United Kingdom. Electronic address: john.marsden@kcl.ac.uk.
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Marsden
National Institute on Drug Abuse, 6001 Executive Boulevard, Rockville, MD 20852, USA. Electronic address: subramaniamga@mail.nih.gov.
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Subramaniam
D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000453:epidemiology; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008385:Marijuana Smoking; D008403:Mass Screening; D008875:Middle Aged; D063487:Prescription Drug Misuse; D011320:Primary Health Care; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D015813:Substance Abuse Detection; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000523:psychology; D011795:Surveys and Questionnaires; D014029:Tobacco Use Disorder / Q000175:diagnosis
ASSIST; Primary care; Substance abuse assessment; Substance abuse screening