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Routine Assessment of Symptoms of Substance Use Disorders in Primary Care: Prevalence and Severity of Reported Symptoms

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ARTICLE DOWNLOAD

Routine Assessment of Symptoms of Substance Use Disorders in Primary Care: Prevalence and Severity of Reported Symptoms

10$

Mikko Sayre BS, Gwen T. Lapham PhD, MPH, MSW, Amy K. Lee MPH, Malia Oliver BA, Jennifer F. Bobb PhD, Ryan M. Caldeiro MD & Katharine A. Bradley MD, MPH 

Abstract

Background

Most patients with substance use disorders (SUDs) never receive treatment and SUDs are under-recognized in primary care (PC) where patients can be treated or linked to treatment. Asking PC patients to directly report SUD symptoms on questionnaires might help identify SUDs but to our knowledge, this approach is previously untested.

Objective

To describe the prevalence and severity of DSM-5 SUD symptoms reported by PC patients as part of routine care.

Design

Cross-sectional study using secondary data.

Participants

A total of 241,265 adult patients who visited one of 25 PC sites in an integrated health system in Washington state and had alcohol, cannabis, or other drug use screening documented in their EHRs (March 2015–July 2018) were included in main analyses if they had a positive screen for high-risk substance use defined as AUDIT-C score 7–12 points, or report of past-year daily cannabis use or any other drug use.

Main Measures

The main outcome was number of SUD symptoms based on Diagnostic and Statistical Manual, 5th edition (DSM-5), reported on Symptom Checklists (0–11) for alcohol or other drugs: 2–3 mild; 4–5 moderate; 6–11 severe.

Results

Of screened patients, 16,776 (5.7%) reported high-risk use of alcohol (2.4%), cannabis (3.9%), and/or other drugs (1.7%), and 65.0–69.9% of those completed Symptom Checklists. Of those with high-risk alcohol use, 52.5% (95% CI 50.9–54.0%) reported ≥ 2 symptoms consistent with mild-severe alcohol use disorders. Of those reporting daily cannabis use, 29.8% (28.6–30.9%) reported ≥ 2 symptoms consistent with mild-severe SUDs. Of those reporting any other drug use, 37.5% (35.7–39.3%) reported ≥ 2 symptoms consistent with mild-severe SUDs.

Conclusions and Relevance

Many PC patients who screened positive for high-risk substance use reported symptoms consistent with DSM-5 SUDs on self-report Symptom Checklists. Use of SUD Symptom Checklists could support PC providers in making SUD diagnoses and initiating discussions of substance use.

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Year 2020
Language English
Format PDF
DOI 10.1007/s11606-020-05650-3