Substance Use Screening Tool Library

Background

This library supports professionals in talking to clients about substance use in a respectful, non-judgmental, and validated manner. In doing so, it contributes to the main goal of the Strengthening Systems of Care for People with HIV and Opioid Use Disorder (OUD) project: to ensure that people with HIV and OUD have access to care, treatment, and recovery services that are client-centered and culturally responsive. 

Introduction

Between 2005 and 2010, the Substance Abuse and Mental Health Services Administration estimated that nearly one-third of individuals with HIV also used illicit drugs or engaged in binge drinking in the past 30 days.¹ While many people (with and without HIV) manage drug use without significant problems, some patterns of substance use can affect HIV viral suppression.²   

HIV service delivery settings offer an opportunity to have conversations with clients about substance use. Supportive and dignified conversations about substance use between service providers and people with HIV can lead to referrals and connection to needed services, increased retention in care, and increased viral suppression.  

By using validated substance use screening tools such as those included in this library, staff can identify substance use among clients, assess their risk of substance use related harms, and provide supportive linkages to harm reduction services and/or further assessment and treatment. The tools included have been studied to determine if they accurately measure what they were intended to measure. This is known as "validity." Each tool fact sheet contains information about its validity.  

Definitions

Screening vs. Assessment: This library includes various substance use screening tools. These tools are intended to provide a valid and reliable snapshot of a client’s substance use, which may point toward a need for further assessment and specialized support. When clients complete screening tools on their own or with the support of staff who are not trained in substance use or behavioral health treatment, the screening tools provide important preliminary information for trained clinicians to conduct follow-up assessments. 

Substance Use vs. Substance Use Disorder (SUD): The tools included in this library are validated mechanisms to identify substance use among clients. It is important to remember that substance use does not equate to an SUD. A SUD is a diagnosis provided by a trained clinician. Many individuals use substances (including illicit drugs) in ways that reduce potential harms and that they define as supportive to their lives. In fact, when using universal screening, only about 14% of the U.S. population can be classified as having an SUD.⁷ It is essential that providers do not place judgments and biases about drug and alcohol use on those who are willing to disclose and discuss their substance use. 

Sensitivity and Specificity: When selecting a screening tool, consider information on sensitivity and specificity. An ideal screening tool has both high sensitivity and high specificity. Sensitivity and specificity can change based on a number of factors including the substance in question and the population with whom the screening tool is administered. Each screening tool page provides this information. 

• Sensitivity is the ability of a test to correctly classify an individual as having the health outcome of interest, or screening “positive.” A sensitivity percentage describes the probability of someone who screens positive, actually having the outcome of interest.⁸ For example, a fourth-generation laboratory HIV test with 99.5% sensitivity provides a 99.5% chance that someone who tests positive actually has HIV.⁹ 
• Specificity is the ability of a test to correctly classify an individual as not having the health outcome of interest. A specificity percentage describes the probability of someone testing negative, when the outcome truly is not present.³ For example, a fourth-generation laboratory HIV test with 99.5% specificity, provides a 99.5% chance that someone who tests negative truly does not have HIV.⁸