Best Approaches for Alcohol and Drug Screening in Primary Care

Addiction Science Made Easy
June 2021
CTN Dissemination Library

Alcohol and drug use are among the top 10 causes of preventable death in the United States. For that reason, US Preventive Service Task Force recommends screening for both alcohol and drug use during primary care visits for adults.
 

However, a wide range of barriers have kept many systems from implementing screening in primary care, including time and workflow constraints, underlying issues of stigma, and lack of clinician knowledge.
 

This NIDA Clinical Trials Network study (CTN-0062-Ot) looked at ways clinics could add electronic health record (EHR)-integrated screening for substance use, comparing commonly used screening methods and looking at their impact on implementation outcomes.
 

Researchers worked with 6 primary care clinics to help them determine the best screening approach for them and their patients. Clinics added screening questions and a brief counseling script into their EHR systems, trained staff in the new procedures, and recruited supportive “clinical champions” (clinicians who motivate others to embrace a change).
 

Clinics varied in their screening approaches, including the type of visit targeted for screening (any visit vs. annual exams only), the mode of administration (administered by staff or self-administered by the patient), and the extent to which they used practice facilitation and EHR usability testing. Researchers looked at data from the EHRs collected over 12 months to see how often screening for alcohol and drug use was done, how often unhealthy alcohol or drug use was detected, and whether clinicians used the brief counseling script.
 

Of the 93,114 patients with primary care visits:

• 71.8% received screening for alcohol use and 70.5% received screening for drug use;
• screening at any visit resulted in higher screening rates (for both alcohol and drug use) compared to screening only at annual exams;
• use of a self-administered screening approach had a higher detection rate for moderate- to high-risk alcohol use compared to a staff-administered screening approach (detection of moderate- to high-risk drug use was low across all clinics);
• clinics that offered more staff training and EHR usability testing had somewhat greater adoption of the brief counseling script.

Conclusions: This study’s examination of common approaches to screening for substance use in primary care settings can help guide clinics and health care systems that are seeking to add this practice.  The high screening rate achieved in the study clinics supports the use of EHR-integrated screening for substance use as part of routine primary care. It also suggests best practices, like screening at any type of visit and using a self-administered screening tool.
 

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