Journal of General Internal Medicine 2017;32(9):990-996. [doi: 10.1007/s11606-017-4079-x]
Jan Gryczynski, PhD (Friends Research Institute, MA Node), Jennifer McNeely, MD, MS (NY University School of Medicine, GNY Node), Li-Tzy Wu, ScD (Duke University Medical Center, MS Node), Geetha A. Subramaniam, MD (NIDA Center for the Clinical Trials Network), Dace S. Svikis, PhD (Virginia Commonwealth University, MA Node), Lauretta A. Cathers, PhD (Virginia Commonwealth University, MA Node), Gaurav Sharma, PhD (Emmes, CTN Data & Statistics Center), Jacqueline King, MD (Emmes, CTN Data & Statistics Center), Eve Jelstrom, MBA (Emmes, CTN Clinical Coordinating Center), Courtney D. Nordeck, BA (Friends Research Institute, MA Node), Anjalee Sharma, MSW (Friends Research Institute, MA Node), Shannon G. Mitchell, PhD (Friends Research Institute, MA Node), Kevin E. O'Grady, PhD (University of Maryland, MA Node), Robert P. Schwartz, MD (Friends Research Institute, MA Node).
The Tobacco, Alcohol, Prescription Medication, and Other Substance use (TAPS) tool is a combined two-part screening and brief assessment developed for adult primary care patients. The tool's first-stage screening component (TAPS-1) consists of four items asking about past 12-month use for four substance categories, with response options of never, less than monthly, monthly, weekly, and daily or almost daily.
The TAPS tool was recently validated in primary care by the National Drug Abuse Treatment Clinical Trials Network (NIDA CTN-0059). The purpose of the present study was to examine the ability of the TAPS-1, using the dataset from the original study, as a standalone screener to identify adult primary care patients with unhealthy substance use.
Two thousand adult patients at 5 primary care sites completed the TAPS tool in self- and interviewer-administered formats, in random order. In this secondary analysis, the TAPS-1 was evaluated against DSM-5 substance use disorder (SUD) criteria to determine optimal cut-points for identifying unhealthy substance use at there severity levels (problem use, mild SUD, and moderate-to-severe DUS).
Results found that optimal frequency-of-use cut-points on the self-administered TAPS-1 for identifying SUDs were less-than-or-equal-to monthly use for tobacco and alcohol (sensitivity = 0.92 and 0.71, specificity = 0.80 and 0.85, AUC = 0.86 and 0.78, respectively) and any reported use for illicit drugs and prescription medication misuse (sensitivity = 0.93 and 0.89, specificity = 0.85 and 0.91, AUC = 0.89 and 0.90, respectively). The performance of the interviewer-administered format was similar. When administered first, the self-administered format yielded higher disclosure rates for past 12-month alcohol use, illicit drug use, and prescription medication misuse. Frequency of use alone did not provide sufficient information to discriminate between gradations of substance use problem severity. Among those who denied drug use on the TAPS-1, less than 4% had a drug-positive biomarker.
Conclusions: This study demonstrated the validity of the TAPS-1 in both interviewer- and self-administered formats, with the self-administered format demonstrating slightly higher levels of disclosure of substance use. The findings from the current study support the use of the TAPS-1 for rapid patient triage to help inform a more detailed clinical assessment. (Article (Peer-Reviewed), PDF, English, 2017)
Keywords: Alcohol | CTN platform/ancillary study | Prescription-type opiates | Primary care | Screening and assessment instruments | Smoking | Tobacco, Alcohol, Prescription Medication, and Other Substance Use tool (TAPS tool) | Journal of General Internal Medicine (journal)
Document No: 1293, PMID: 28550609, PMCID: PMC5570743 (available 12/8/2017).
Submitted by CTN Dissemination Librarians, 12/8/2017.