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Screening for unhealthy use of alcohol and other drugs in primary care

Richard Saitz, MD, MPH, FACP, DFASAM
Section Editor
Andrew J Saxon, MD
Deputy Editor
Richard Hermann, MD


Unhealthy alcohol and other drug use are among the most common causes of preventable death [1]. “Unhealthy use” describes use of amounts that risk consequences or have resulted in consequences, as well as a DSM-5 substance use disorder.

Despite their frequent presentation in primary care, unhealthy alcohol and other drug use often go unrecognized. The combination of screening all adult primary care patients to identify individuals with unhealthy use and a brief counseling intervention has been proposed as a population-wide, preventive intervention in primary care [2]. Clinical trials support the use of screening and brief intervention in adults who have unhealthy alcohol use but not a moderate to severe alcohol use disorder. Screening is also the first step in identifying patients with a substance use disorder.

The DSM-IV-TR diagnoses, substance abuse and substance dependence, were replaced by one diagnosis, substance use disorder, in DSM-5 [3]. Although the crosswalk between DSM-IV and DSM-5 disorders is imprecise, substance dependence is approximately comparable to substance use disorder, moderate to severe subtype, while substance abuse is similar to the mild subtype. Substance use disorders are important to identify so that appropriate counseling and pharmacotherapy can be offered.

This topic reviews screening tests for unhealthy alcohol and other drug use in primary care. Treatment of patients screening positive with a brief intervention, and the efficacy of screening combined with a brief intervention, are described separately. The epidemiology, clinical manifestations, and diagnosis of substance use disorders are described separately, as are pharmacotherapy and psychosocial interventions for the disorders. (See "Brief intervention for unhealthy alcohol and other drug use" and "Risky drinking and alcohol use disorder: Epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis" and "Pharmacotherapy for alcohol use disorder" and "Psychosocial treatment of alcohol use disorder" and "Cocaine use disorder in adults: Epidemiology, pharmacology, clinical manifestations, medical consequences, and diagnosis" and "Opioid use disorder: Epidemiology, pharmacology, clinical manifestations, course, screening, assessment, and diagnosis" and "Pharmacotherapy for opioid use disorder" and "Treatment of cannabis use disorder".)


Risky use — Risky use of alcohol or other drugs are consumption amounts that increase the likelihood of health consequences (eg, injury, interpersonal problems, medical consequences). (See 'Medical consequences' below.)

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Literature review current through: Nov 2017. | This topic last updated: Oct 21, 2016.
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