Screening for Substance Misuse

In the military, the Department of Defense (DoD) Drug Demand Reduction Program aims to prevent substance misuse through education, outreach, and awareness programs, and detect and deter DoD civilian and military personnel from using illicit drugs and misusing prescription drugs. It includes compulsory random drug testing, finding a 2% or less urine drug positive rate for military personnel and a 1% urine drug positive rate for DoD civilians in Testing Designated Positions.

The National Institute on Drug Abuse (NIDA) maintains a Chart of Evidence-Based Screening Tools for Adults and Adolescents that can be used to help in the identification of risky substance use or patients at risk for substance use disorders. This chart contains links to specific evidence-based screening instruments, to include general substance misuse screenings such as the NIDA Drug Use Screening Tool: Quick and Full Screen, as well as more specific screenings such as the Opioid Risk Tool. It is important to note however; that according to the USPSTF, there is “insufficient evidence to assess the balance of benefits and harms of screening for illicit drug use. of benefits and harms of screening for illicit drug use.[ Reference 1 ]

Consideration to Co-occurring Disorders with Substance Misuse

Some individuals with alcohol and substance misuse have co-occurring psychosocial problems that affect their likelihood of establishing and maintaining good clinical outcomes and improved functional status.[ Reference 2 ]

  • Several mental health conditions, such as bipolar disorders, schizophrenia and antisocial personality disorder, are associated with increased rate of alcohol use disorder.
  • Anxiety and depressive disorders may also relate to alcohol use disorder[ Reference 3 ]

Individuals with other substance use disorders are similarly at increased risk for the development of mild to moderate depressive disorders due to effects of the substance or as an exacerbation of a preexisting depressive disorder.

Insomnia, antisocial personality disorder and posttraumatic stress disorder are conditions more common to those with substance use disorders than those without them.[ Reference 4 ]

Individuals with alcohol and substance use disorders may have more than one substance use disorder.

  • Opioid use disorder is often associated with other substance use disorders, especially those involving tobacco, alcohol, cannabis, stimulants and benzodiazepines.
  • Substances may be taken to reduce symptoms of opioid withdrawal or craving for opioids, or to enhance the effects of administered opioids.[ Reference 5 ]

Those individuals with alcohol and substance use disorders may also have co-occurring physical conditions.

  • Drinking alcohol at levels above weekly or daily limits can damage the heart, interfere with brain communication pathways, lead to liver inflammation and other liver problems, weaken the immune system, and increase the risk of developing mouth, throat, esophagus, liver and breast cancer, according to the National Institute on Alcohol Abuse and Alcoholism.
  • Substance misuse can directly or indirectly lead to significant co-occurring health conditions to include cardiovascular disease, stroke, cancer, HIV/AIDS, hepatitis and lung disease.

References

  1. The Management of Substance Use Disorders Work Group. (2015). VA/DoD clinical practice guideline for the management of substance use disorders. Washington, DC: Department of Veterans Affairs, Department of Defense. Retrieved from http://www.healthquality.va.gov/guidelines/MH/sud/VADoDSUDCPGFinal1.pdf.

  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, (5th ed.). Washington, DC: Author.

  3. Compton, W.M., Conway, K.P., Stinson, F.S., Colliver, J.D., and Grant, B.F. (2005). Prevalence, correlates, and comorbidity of DSM-IV antisocial personality syndromes and alcohol and specific substance use disorders in the United States: Results from the national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry 66(6), 677–685.

  4. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, (5th ed.). Washington, DC: Author.

  5. National Institute on Drug Abuse. (2012). Medical consequences of drug abuse. Retrieved from http://www.drugabuse.gov/related-topics/medical-consequences-drug-abuse.