Effective Screening: It’s How You Ask

The key to successful substance abuse screening may be changing the way healthcare providers approach patients about it, the Boston Globe reported Nov. 15.

Although most of us have been asked about drug and alcohol use during a doctor or hospital visit, the question is often presented apologetically (“Sorry, I have to ask this?”), or in a general way that makes it easy for the patient to avoid answering truthfully.

The Massachusetts Screening, Brief Intervention, Referral, and Treatment program (MASBIRT), a federally funded, state-run program charged with improving screening for substance-use problems in an effort to reduce costs and health problems down the road, is training providers to approach the issue differently.

And they’re having considerable success. According to follow-up surveys among patients identified through MASBIRT-led screening as having recent risky substance use, one-third were abstaining from drugs and alcohol at six months — up from a 6-percent abstinence rate at the time of the screening.

The patient questionnaire used and recommended by MASBIRT, adapted from the National Institute on Alcohol Abuse and Alcoholism, has been clinically proven to reduce alcohol consumption and alcohol-related harms, including drunk driving.

A core component of the tool is its ability to identify people with problem use before they’ve hit the proverbial “rock bottom.” According to Bertha Madras, MD, professor of psychobiology at Harvard University School of Medicine, 94 percent of people who screen positive for a drug or alcohol abuse are completely unaware they have a problem.

“We don’t have blood tests or X-rays that can diagnose unhealthy substance use, so we are left with questions,” said Dan Alford, MD, medical director of MASBIRT and associate professor of medicine at Boston University School of Medicine. “If I ask you something like, ’Do you use drugs?’ you’re going to say no, even if you use drugs.”

“But,” he continued, “if I ask you how often you have used street drugs in the past month, you might be more willing to say, ’not very often.’”