User:Nicolekha/Substance abuse

Traumatic experiences and Substance Use
Research has shown that people with alcohol or drug use problems may be more likely to experience traumatic events than those without these problems. Some studies have shown a link between alcohol use and engagement in risky behaviors in which adolescents may get hurt, such as hitchhiking, walking in unsafe neighborhoods, and driving after using alcohol or drugs. In contrast, many people who have experienced child abuse, criminal attack, disasters, war, or other traumatic events turn to alcohol or drugs in attempts to self-medicate or to dampen mood symptoms associated with a dysregulated biological stress response.

Some researchers have posited that a third confounding variable may impacting the onset and development of both traumatic symptomatology and drug abuse. Genetic factors common to PTSD, alcohol consumption or disorder, and other drug disorders have been reported. A suspected shared environmental risk factor in the PTSD–substance use disorders comorbidity is the exposure to trauma.

Screening and Assessment
The screening and assessment process for substance use behavior is important for the diagnosis and treatment of substance use disorders. Screeners are used in the process of identifying individuals who have or may be at risk for a substance use disorder and are usually brief to administer. Assessments are used to clarify the nature of the substance use behavior to help determine appropriate treatment. Assessments usually require specialized skills, and are longer to administer than screeners.

Screeners
Effective screening for substance use disorders (SUDs) has been considered a national priority in the US. There are several screening tools that have been developed and that vary in types of substances measured, population demographics (e.g. age, sex, specific populations), and method of administration (e.g. self- or clinician-administered). The time it takes to administer these screening tools ranges from 5-15 minutes and most of the tools are both self-administered.

Adults
The Tobacco, Alcohol, Prescription medication, and other Substance use (TAPS) tool was developed to address the need for a brief screening and assessment instrument. The TAPS consists of two components: TAPS-1 which contains 4 items about tobacco, alcohol, illicit drugs, and non-medical use of prescription drugs and TAPS-2 which consists of substance-specific assessment questions to arrive at a risk level for that substance. The World Health Organization (WHO) Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) screens risky substance use in adults and consists of eight questions covering tobacco, alcohol, cannabis, cocaine, amphetamine-type stimulants (including ecstasy). The WHO ASSIST has been widely used and adapted around the world for use with different populations and in different contexts.

Given that the harmful use of alcohol is one of the leading risk factors for population health worldwide, a large number of screening tool assess for alcohol use. The Alcohol Use Disorders Identification Test (AUDIT) was developed by the WHO to identify persons harmful or hazardous alcohol use. Other versions of the AUDIT have been validated for use in in different contexts. The AUDIT-C, which consists of the first 3 questions of the full 10-item AUDIT, was validated and is typically used in research settings and the AUDIT-3 consists of only the third question from the full AUDIT (the. binge drinking question). The CAGE is another brief screening test that consists of 4 questions used to assess for lifetime alcohol abuse and/or dependence (Have you ever felt you should Cut down on your drinking?, Have people Annoyed you by criticizing your drinking?, Have you ever felt bad or Guilty about your drinking?, Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (Eye-opener)?). While both the AUDIT and the CAGE demonstrate good validity and reliability, one of the main differences between the two tools is that the AUDIT was shown to be better at detecting less severe forms of alcohol use. The Michigan Alcohol Screening Test (MAST), a 25-item questionnaire, identifies past and current symptoms of problematic drinking and alcoholism by asking individuals yes/no questions (e.g. 'Do you feel you are a normal drinker?,' 'Do friends or relatives think you are a normal drinker?'). Shorter versions of the MAST have also been developed and validated.

Adolescents
Two brief screening tools were developed by the National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and validated for use with adolescents aged 12-17 years. The Screening to Brief Intervention (S2BI) and Brief Screener for Tobacco, Alcohol, and other Drugs (BSTAD) ask adolescents about the frequency of their alcohol and/or other substance use. The S2BI screens for past-year frequency by using a gradient scale (Never, Once of Twice, Monthly, Weekly or More), while the BSTAD screens for past-year frequency by using number of days (out of 365). Responses are then categorized into different risk levels for each substance (no reported use, lower risk, higher risk). Both screeners provide information on implications and suggested recommendations for follow-up. The S2BI and BSTAD instruments demonstrate high sensitivity and specificity for identifying substance use and SUDs among adolescents. According to the developers of the S2BI, it is best used in conjunction with “The Adolescent SBIRT Toolkit for Providers.”

The CRAFFT is another screening tool that was validated for use with adolescents aged 12-21 years. The CRAFFT is designed to identify substance use (alcohol, marijuana, and/or other illegal drugs, prescription or over-the-counter medications), substance-related riding/driving risk based on question categories (Car, Relax, Alone, Friends/Family, Forget, Trouble items), and SUDs. The tool includes a guide for percent risk of an adolescent having a DSM-5 SUD based on their CRAFFT score.