PS375 Unit 4 Substance Use Screening Paper Example

A Score of 27 and a Score of 11: A PS375 Unit 4 Screening Paper

[Student Name]

Purdue University Global

PS375: Psychology of Addiction

Unit 4 Screening Paper

[Instructor Name]

[Date]

The writer, the program, the clinic, the patients and every score are composite and illustrative; the articles cited are real.

Screening in a Primary Care Clinic

Our Tulsa outpatient substance use program runs a weekly screening day at a partner primary care clinic. Every adult patient who agrees completes a short alcohol and drug screen in the waiting room, and I meet with anyone who screens positive. The purpose is to find people whose use is risky or harmful before it becomes a crisis, and to connect those with likely disorders to treatment.

The AUDIT

Saunders et al. (1993) reported how the AUDIT was built within a multinational project run by the World Health Organization. The goal was a short test that primary care staff anywhere could use to spot risky drinking early, well before dependence set in. Its ten questions fall into three groups: drinking amount and frequency, dependence signs such as not being able to stop after starting, and harms such as injuries or worried relatives. Answers earn up to four points each, so totals run from zero to forty.

Scores are usually read in zones. Lower scores suggest low-risk drinking; scores in the middle ranges suggest hazardous or harmful drinking for which advice or brief counseling is appropriate; and scores of twenty or more suggest possible dependence and a need for further evaluation.

Two Patients

The first patient that Tuesday was Dale, whom I had met at our program in September. He was at the clinic for his annual checkup, and he agreed to complete the AUDIT again. He scored 27: daily drinking of six or more beers, morning drinking twice a month, guilt, a DUI and his doctor's concern. His score placed him well into the range suggesting dependence, consistent with his ongoing treatment.

The second was Linda, forty-four, a school bus driver at the clinic for blood pressure. She scored 11. Most evenings she finished several glasses of wine, more on weekends, and had once forgotten part of an evening. She did not drink before driving, had no dependence symptoms and had never thought of her drinking as a problem.

Linda's score did not say she had a disorder; it said her drinking was a risk worth talking about.

Screening, Brief Intervention and Referral

Babor et al. (2007) described screening, brief intervention and referral to treatment as a public health approach to substance use in health care settings. Screening is offered to everyone, not only to those who seem to have a problem. People with risky use receive a brief intervention, a short conversation that gives feedback on the score, discusses the risks and encourages change. People whose screens suggest a likely disorder are referred to specialty treatment. The authors noted that evidence for brief intervention is strongest for risky drinking in primary care, and weaker for drug use and for people with severe disorders, who generally need more than a brief conversation.

For Linda, I delivered a brief intervention of about ten minutes. I told her that her score suggested her drinking carried health risks, particularly for her blood pressure, and asked for her reaction. She told me she had not realized that her nightly wine added up to more than the recommended limits. We talked about what she might change, and she decided to keep wine to weekends for a month and to tell her doctor at her next visit. I gave her a short handout on drinking limits and the program's phone number.

For Dale, already in treatment, the score confirmed the need to continue, and I shared it with his counselor with his permission, noting that it had barely changed since September.

Following Up With Linda

A brief intervention is only a beginning, so the protocol includes a follow-up call. Four weeks later, I called Linda as we had agreed. She had kept wine to weekends for three of the four weeks and said she was sleeping better, though one stressful week had brought back nightly drinking. She had told her doctor, who planned to recheck her blood pressure in two months. She declined a referral and did not need one; her drinking was risky, not a disorder, and she was changing it. I offered to repeat the AUDIT at her next visit to see whether her score had dropped, and she agreed. For many people like Linda, a single honest conversation about a number is the whole intervention, and it can matter more than its length suggests.

Screening Teenagers

Adult screens do not fit teenagers well. Knight et al. (2002) evaluated the CRAFFT, a six-item screen developed for adolescents, among patients at an adolescent clinic. The questions, whose first letters spell its name, cover car rides with an impaired driver, relaxing with substances, solitary use, memory lapses, people urging cutting back and trouble while high. They found that the CRAFFT identified adolescents with problem use and substance use disorders with good accuracy, using a cutoff of two or more yes answers.

When Marcus came to our program in November, his CRAFFT score of four indicated a need for full assessment, which led to the counselor's diagnostic interview.

What Screening Cannot Do

A screening score is not a diagnosis. Linda's score of 11 did not mean she had an alcohol use disorder, and no score alone would have told us that Dale's disorder was severe. Screens depend on honest answers, which are less likely when people fear consequences, such as a bus driver worrying about her license. And they measure only what they ask about; the AUDIT says nothing about other drugs.

Practical Lessons

Three practices made screening work at the clinic. Screens are offered to everyone, which reduces the feeling of being singled out. Results are discussed privately and without judgment, in a small office rather than at the front desk. And every positive screen leads to something concrete: advice, a brief intervention, a referral or a follow-up call.

Conclusion

Two AUDIT scores from the same Tuesday led to different paths: continued treatment for Dale at 27 and a brief intervention for Linda at 11. Saunders and colleagues' development of the AUDIT, Knight and colleagues' validation of the CRAFFT for adolescents and Babor and colleagues' model of screening, brief intervention and referral explain how a short questionnaire can lead to the right next step, as long as a score is not mistaken for a diagnosis.

References

Babor, T. F., McRee, B. G., Kassebaum, P. A., Grimaldi, P. L., Ahmed, K., & Bray, J. (2007). Screening, brief intervention, and referral to treatment (SBIRT): Toward a public health approach to the management of substance abuse. Substance Abuse, 28(3), 7-30. https://doi.org/10.1300/J465v28n03_03

Knight, J. R., Sherritt, L., Shrier, L. A., Harris, S. K., & Chang, G. (2002). Validity of the CRAFFT substance abuse screening test among adolescent clinic patients. Archives of Pediatrics & Adolescent Medicine, 156(6), 607-614. https://doi.org/10.1001/archpedi.156.6.607

Saunders, J. B., Aasland, O. G., Babor, T. F., de la Fuente, J. R., & Grant, M. (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction, 88(6), 791-804. https://doi.org/10.1111/j.1360-0443.1993.tb02093.x