Validity of Brief Screening Instrument for Adolescent Tobacco, Alcohol, and Drug Use

Abstract

BACKGROUND AND OBJECTIVE: The National Institute on Alcohol Abuse and Alcoholism developed an alcohol screening instrument for youth based on epidemiologic data. This study examines the concurrent validity of this instrument, expanded to include tobacco and drugs, among pediatric patients, as well as the acceptability of its self-administration on an iPad. METHODS: Five hundred and twenty-five patients (54.5% female; 92.8% African American) aged 12 to 17 completed the Brief Screener for Tobacco, Alcohol, and other Drugs (BSTAD) via interviewer-administration or self-administration using an iPad. Diagnostic and Statistical Manual, Fifth Edition substance use disorders (SUDs) were identified using a modified Composite International Diagnostic Interview-2 Substance Abuse Module. Receiver operating characteristic curves, sensitivities, and specificities were obtained to determine optimal cut points on the BSTAD in relation to SUDs. RESULTS: One hundred fifty-nine (30.3%) adolescents reported past-year use of ≥1 substances on the BSTAD: 113 (21.5%) used alcohol, 84 (16.0%) used marijuana, and 50 (9.5%) used tobacco. Optimal cut points for past-year frequency of use items on the BSTAD to identify SUDs were ≥6 days of tobacco use (sensitivity = 0.95; specificity = 0.97); ≥2 days of alcohol use (sensitivity = 0.96; specificity = 0.85); and ≥2 days of marijuana use (sensitivity = 0.80; specificity = 0.93). iPad self-administration was preferred over interviewer administration (z = 5.8; P < .001). CONCLUSIONS: The BSTAD is a promising screening tool for identifying problematic tobacco, alcohol, and marijuana use in pediatric settings. Even low frequency of substance use among adolescents may indicate need for intervention.

Perceived cannabis use norms and cannabis use among adolescents in the United States

“…We examined past-year CU and CUD to reflect recent or active use. For logistic regression analyses of past-year CU, we examined correlates of CU ≥2 days/year to focus on adolescents with a tendency of using cannabis repeatedly (Kelly et al, 2014). …”

Substance Use Screening, Brief Intervention, and Referral to Treatment

“…The AAPendorsed National Institute on Alcoholism and Alcohol Abuse's "Youth Guide" 36 provides clinicians with an age-based schema to ask patients about the frequency of their drinking and their friends' drinking in the past year and to correlate the respective responses with the current and future risk of having an alcohol use disorder. The BSTAD (Brief Screener for Tobacco, Alcohol and other Drugs) 37 uses highly sensitive and specific cutoffs to identify various SUDs among adolescents 12 to 17 years of age: ≥6 days of past-year use for tobacco and >1 day of past-year use for alcohol or marijuana. 37 The Screening to Brief Intervention (S2BI) tool 38 uses a stem question and forcedresponse options (none, once or twice, monthly, and weekly or more) in a sequence to reveal the frequency of past-year use of tobacco, alcohol, marijuana, and 5 other classes of substances most commonly used by adolescents (Table 3).…”

“…The BSTAD (Brief Screener for Tobacco, Alcohol and other Drugs) 37 uses highly sensitive and specific cutoffs to identify various SUDs among adolescents 12 to 17 years of age: ≥6 days of past-year use for tobacco and >1 day of past-year use for alcohol or marijuana. 37 The Screening to Brief Intervention (S2BI) tool 38 uses a stem question and forcedresponse options (none, once or twice, monthly, and weekly or more) in a sequence to reveal the frequency of past-year use of tobacco, alcohol, marijuana, and 5 other classes of substances most commonly used by adolescents (Table 3). The S2BI tool is highly sensitive and specific in discriminating among clinically relevant use-risk categories and therefore is remarkably efficient in its ability to detect severe SUDs aligned with criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition 39 (Table 4).…”

Pilot Studies Examining Feasibility of Substance Use Disorder Screening and Treatment Linkage at Urban Sexually Transmitted Disease Clinics

“…Consistent with revised criteria from DSM-IV to DSM-5 (Hasin et al, 2013), a scoring modification involved dropping the legal problems item and adding an item on craving. Our team has used this approach to assess DSM-5 SUDs in various clinical populations (Gryczynski et al, 2015; Kelly et al, 2014; McNeely et al, 2016). The modified WMH CIDI items query clinically significant problems in the past 12 months based on DSM-5 criteria separately for different substance classes, including alcohol, cannabis, heroin, prescription opioids, cocaine, amphetamines, and sedatives.…”