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TAPS tool effectively detects problem substance use

The Tobacco, Alcohol, Prescription medication, and other Substance use tool successfully identifies clinically relevant problem substance use in adult primary care patients, according to data published in Annals of Internal Medicine.

“Substance use, a leading cause of illness and death, is underidentified in medical practice,” Jennifer McNeely, MD, MS, of the department of public health at New York University School of Medicine, and colleagues wrote. “Primary care settings require a screening and assessment approach that is efficient and accurate, and informs clinical care. Although very brief screening tools have been developed to efficiently identify alcohol and drug use, they do not provide enough information about the specific substances used, or the patient's risk level, to guide clinical actions.”

McNeely and colleagues developed the Tobacco, Alcohol, Prescription medication, and other Substance use (TAPS) tool to better screen and assess problem substance use in primary care settings. To evaluate the efficacy and performance of the TAPS tool, they conducted a multisite study within the National Drug Abuse Treatment Clinical Trials Network.

For the study, 2,000 adult patients from five primary care clinics were given an interviewer-administered or a self- administered version of the TAPS tool. Both versions performed similarly.

Results of the TAPS tool were compared to the modified Composite International Diagnostic Interview (CIDI) as a reference standard measure.

The optimal cutoff score for problem use was set at 1+. For identifying problem use of tobacco, the TAPS tool had a sensitivity of 0.93 (95% CI, 0.9-0.95) and a specificity of 0.87 (95% CI, 0.85-0.89). For identifying problem alcohol use, the TAPS tool had a sensitivity of 0.74 (95% CI, 0.7-0.78) and a specificity of 0.79 (95% CI, 0.76-0.81).

Specificity for problem use of illicit and prescription drugs was 0.93 or greater, while sensitivity ranged from 0.82 (CI, 0.76-0.87) to 0.63 (CI, 0.47-0.78) for marijuana and sedatives, respectively.

Overall, at a cutoff of 2+, sensitivity was lower for identification of substance use disorder.

“Having information about a patient's substance use is essential for ensuring the quality and safety of medical care,” McNeely and colleagues concluded. “This study supports the use of the TAPS tool (at a cutoff of 1+) in screening primary care patients for problem substance use. The tool also may detect alcohol, tobacco, and marijuana use disorders, although further refinement is needed before it can be broadly recommended as a screener for [substance use disorder].” – Alaina Tedesco

Disclosures: The researchers report primary funding from the National Institute on Drug Abuse. Please see study for full list of disclosures.