The National Institute on Drug Abuse (NIDA) recently published an online screening tool intended to quickly and accurately identify patients with previously unidentified problem substance use.
The Tobacco, Alcohol, Prescription Medication, and Other Substance Use (TAPS) Tool consists of two questionnaires. TAPS-1 is an initial screen containing four items that correspond to four substances: tobacco, alcohol, illicit drugs, and the nonmedical use of prescription drugs. People who screen negative for the first four questions do not continue with further screening. However, a positive result in any of the four initial TAPS-1 items sends the patient seamlessly into the TAPS-2 component. TAPS-2 then contains a 2-3 additional questions to identify problem substance use within each of the four domains. At its longest, the entire survey is less than 15 questions.
A validated, brief screening tool
Researchers validated the TAPS tool across five adult primary care clinics in a population of 2000 outpatients. Impressively, 99% of patients reported that they felt comfortable answering the questions contained on the screening instrument and 95% stated they would be comfortable sharing the results with their doctor. During the validation study, some patients self-administered the tool while the remaining patients answered the same screening questions posed by interviewer. The results were remarkably similar between the two administrations modes. Screening tool results were confirmed by the use of oral fluid testing that screened for various illicit substances, but not tobacco or alcohol.
Self-administration is an important feature for any drug screening tool
One of the major barriers to detecting substance abuse is patient reticence to disclosing substance use to healthcare providers. A so-called social desirability bias or desire to be viewed as “good” leads to underreporting. On the other hand, healthcare providers sometimes fail to ask about substance use directly. The online TAPS tool has the potential to overcome both of these barriers. Since it is self-administered, healthcare providers need only to request that patients complete the screening instrument. Previous research has shown that patients generally report drug use more accurately in questionnaire form rather than through direct interview.
While the tool is available online and patients may access it outside of the healthcare setting, NIDA insists that the tool should only be used under the supervision of a qualified healthcare provider. Unfortunately, people who screen positive are presented with “suggested actions” that are better suited to a healthcare provider. For example, the patient with a positive TAPS screen sees: Assess for SUD; Questions from the DSM-5 SUD criteria can be used as a guide. This criticism aside, making this tool available to prospective patients may have the unintended benefit of allowing patients who would otherwise not seek out health care (young, otherwise healthy individuals) to self-identify problem substance use. Ideally, this would prompt them to seek professional advice.
“Non-medical use” may be confusing
One potential weakness of the tool is that several patients were confused about what “nonmedical use of a drug” meant. Self-administered surveys performed well in tobacco, alcohol, and illicit drug use, but underperformed slightly in the nonmedical use of a drug category. Consequently, healthcare providers who use the TAPS tool to screen patients should still be cognizant of the fact that patients who are misusing prescription medications may slip through the screen. Healthcare providers caring for a patient who takes a medication with abuse potential, e.g., opioids, benzodiazepines, etc., who test negative in the TAPS tool should confirm the result during patient interview.
The TAPS tool is the newest in NIDA’s expanding collection of free, valid, clinically relevant tools to combat substance abuse. Usability studies show that the validated TAPS tool is easy for patients to use and that they are comfortable using it. It remains to be seen whether the tool will be just another drug use screen or will emerge as the premier instrument for this purpose. Nevertheless, it is nice for healthcare professionals to know that a convenient, valid, reliable substance use screen is freely available.