Efficiency and validity of commonly used substance abuse screening instruments in public psychiatric patients.

BACKGROUND: The more commonly used screening instruments for substance abuse were largely developed for addictive populations. We compared several alcohol and drug abuse scales to determine their efficiency and validity for psychiatric patients. METHOD: The subjects were 100 consecutively admitted patients to a public psychiatric facility. DSM-III-R diagnoses, obtained from the alcohol and drug scales of the SCID-P, were the criterion measure. Methods of reliability included inter-rater agreement, estimates of internal consistency, and repeat test administration. Sensitivity, specificity and more infrequently used accuracy indices, such as likelihood ratios and Receiver Operating Characteristic (ROC) analysis, were utilized to assess scale validity. RESULTS: First, the reliability of all scales was high. Second, the instruments generally demonstrated highly acceptable levels of screening accuracy. Third, the intake evaluation was as reliable and valid as screening after admission on the unit. Finally, instruments were least discriminating for current problems (past 30 days). CONCLUSIONS: Lifetime measures were found to be reliable and valid for public psychiatric patients but further research is need on increasing the accuracy of screening for current substance abuse problems and the effectiveness of multiple screening approaches.

Implementation of CAGE alcohol screening in a primary care practice.

BACKGROUND AND OBJECTIVES: Alcoholism is a common problem in primary care. Although the four-question CAGE screening tool was developed for use by primary care physicians, studies show that the questionnaire is still not widely used in clinical practice. This study tested the effectiveness of an intervention to increase physicians' use of the CAGE questions. METHODS: We reviewed medical records charts completed by 15 family practice residents for documented alcoholism screening, both before and after an educational intervention. The intervention included modification of examination forms to include the CAGE questions, as well as written feedback from faculty members regarding residents' documentation of alcohol screening. RESULTS: We reviewed a total of 170 pre- and 227 post-intervention charts. Following educational intervention, documentation of quantity/frequency of alcohol beverage consumption increased from 26.5% to 93%. The use of CAGE screening increased from 5.9% to 76.7%. For post-intervention charts that documented using the four CAGE questions, 12.6% showed one or more positive responses. Of these charts, 27% documented physician intervention such as a warning or referral for treatment of alcohol-related problems. CONCLUSIONS: Our educational intervention was a successful way to improve physicians' use of CAGE questions to screen for alcoholism.

Correlation of buccal mucosal transudate collected with a buccal swab and urine levels of cocaine.

In this preliminary study, the level of Benzoyl Ecgonine (BE), a metabolite of cocaine, was compared in urine and buccal mucosal transudate collected by a salt impregnated swab in volunteers admitted for cocaine use. The presence of BE (specificity) was verified by the SYVA EMIT method and the urine and transudate levels measured using the Sigma ELISA methods. Results were confirmed using Gas Chromatography/Mass Spectrometry. In all, 44 patients volunteered, and BE in urine or saliva confirmed that each volunteer had in fact used cocaine. The salt-impregnated swab permitted detection of cocaine or its derivative in 27 of the 44 cases. The paper discusses the possibility of using buccal mucosal transudate as collected by salt-impregnated buccal swab as a minimally-invasive measure of cocaine use. This method would allow positive confirmation by a witness that the sample came from a given patient.

Screening for alcoholism in a community hospital.

A study was conducted in a community hospital to assess the prevalence of alcoholism, to identify physician referral patterns after being notified that their patients received positive scores on an alcoholism-screening questionnaire, and to address the validity of the administered patient-screening questionnaire. Of 396 patients who completed the questionnaire, 14 percent (56) had positive scores of the Michigan Alcoholism Screening Test (MAST). Men were more likely than women to have scores indicative or suggestive of alcoholism. The hospital services with the highest percentage of patients with MAST positive scores were orthopedics, 18 percent; surgery, 19 percent; and medicine, 14 percent. Nineteen percent of those who drank alcohol had positive MAST scores. Requests for alcoholism consultation were made for only 2 of the 56 patients. A chart audit revealed that the diagnosis of alcoholism was recorded in 5 of the 56 MAST-positive patients' charts. Results are compared with other similar studies.