Can a Single-Question Alcohol Screen Also Detect Drug Use?

Recent studies have validated a single-question screen* to detect unhealthy alcohol use. Researchers examined 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions data (N=43,093 adults) to determine whether this question could also identify individuals with drug use and drug use disorders (DUDs) in the following categories: any illicit drugs, marijuana, cocaine, and/or illicit prescription drugs. The criterion standard was a structured diagnostic interview delivered by a trained interviewer.

  • The prevalence of past-year drug use was as follows: any past-year use, 6.2%; past-year DUD, 2.0%; past year drug dependence, 0.6%.
  • For any drug use, DUD, or dependence, sensitivity ranged from 63–72% and specificity ranged from 77–79% using the best cutoff of drinking 5+/4+ drinks on 1 or more occasions per year.
  • For any marijuana use, sensitivity ranged from 72–78%, and specificity ranged from 77–78%.
  • For cocaine use, sensitivity was 77.6% and specificity was 84.5% using the best cutoff of drinking 5+/4+ drinks on 7 or more occasions per year.
  • The single-question screen did not achieve >60% sensitivity for illicit prescription drug use.
  • Across drug use categories, the proportion of people with positive screens who in fact had the condition (positive predictive values) ranged from 1.9–23.4% for any use, 0.9–9.6% for DUD, and 0.5–1.9% for dependence. The lowest values were for cocaine, followed by illicit prescription drugs, then marijuana, then any drug.

*“How many times in the past year have you had X or more drinks in a day?” where X was 5 drinks for men and 4 drinks for women (5+/4+).

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