Substance Abuse Screening Guidelines

The NIH and SAMHSA recommend that physicians screen all patients over the age of 12 for potential substance abuse problems. Patients should be screened at every visit since substance use may change over time.

How To Do Substance Abuse Screening

• Conduct a simple initial screening by asking about tobacco, alcohol, and drug use during the patient interview.Use a routine and non-judgemental approach when asking these questions.
• Start with open-ended questions, "Tell me about your alcohol use?" instead of "Do you drink alcohol?" -- assuming that all patients consume some alcohol may yield more forthright answers. Prove responses by asking about frequency (how many days per week on average) and quantity (how many drinks on a typical day).
• Alternatively, incorporate a short substance abuse screening instrument, like the 4-item CAGE or CAGE-AID (adapted version that also includes drug abuse), into a health status questionnaire that all patients complete before their appointment. When substance abuse is indicated, follow-up with additional interview questions to learn more.
• Patients may be less honest about drug use, but many signs and symptoms of drug use can be identified through the physical exam, laboratory, or toxicological testing.