What is the best screening tool for a 24-year-old woman with a history of drug misuse to assess for a substance use disorder?

Screening Tool Recommendation for a 24-Year-Old Woman with Positive Drug Misuse History

The Drug Abuse Screening Test 10-items (DAST-10) is the most appropriate screening tool to recommend for this 24-year-old woman with a positive response to drug misuse history. 1

Rationale for DAST-10 Selection

The DAST-10 is specifically designed for substance use disorder screening and offers several advantages in this clinical scenario:

• High diagnostic accuracy with sensitivity of 90-100% and specificity of 77% for identifying substance use disorders 1
• Self-report format that can be easily administered in a primary care pharmacy setting
• Validated scoring system that stratifies risk: 0 points = low risk; 1-3 points = moderate risk (monitor and reassess); >3 points = substance abuse or dependence 1
• Specifically designed to identify substance abuse and dependence, which is the primary concern given the patient's positive drug misuse history

Comparison with Alternative Screening Tools

CRAFFT

While the CRAFFT is mentioned as a preferred tool in some guidelines 1, it was originally designed for adolescents and has limited validation in adult populations. It would be more appropriate for younger patients (under 21 years).

Screening to Brief Intervention (S2BI)

The S2BI lacks robust validation data for adult populations and is not specifically recommended in the guidelines for this age group.

TAPS Tool

Although the TAPS tool addresses multiple substances, it has less extensive validation data compared to the DAST-10 for identifying substance use disorders in primary care settings.

Implementation of DAST-10 Screening

The DAST-10 includes 10 questions that assess various aspects of drug use:

1. Use of drugs other than those required for medical reasons
2. Use of more than one drug at a time
3. Ability to stop using drugs when desired
4. Blackouts or flashbacks from drug use
5. Feelings of guilt about drug use
6. Complaints from spouse/parents about drug involvement
7. Neglect of family due to drug use
8. Engagement in illegal activities to obtain drugs
9. Withdrawal symptoms when stopping drug use
10. Medical problems resulting from drug use 1

Scoring and Interpretation

• Give one point for each "yes" answer, except question 3, which scores one point for "no"
• 0 points = low risk
• 1-3 points = moderate risk (monitor and reassess)

• 3 points = substance abuse or dependence 1

Follow-up Based on Screening Results

After administering the DAST-10, follow these evidence-based steps:

1. For low risk (score of 0): Reinforce healthy behaviors and provide preventive education
2. For moderate risk (score 1-3): Implement brief counseling using motivational interviewing approach, which has been shown to decrease quantity and frequency of drug use 1
3. For high risk (score >3): Provide brief counseling, negotiate a treatment plan, and consider referral for specialized treatment 1

Important Clinical Considerations

• Maintain a non-judgmental approach during screening to encourage honest disclosure
• Be aware that underreporting is common due to fears of legal sanctions, child custody issues, and stigma 1
• Avoid stigmatizing language such as "addict" that may discourage the patient from seeking care 1
• Consider that the DAST-10 is a screening tool, not a diagnostic instrument, and positive results should be followed by more comprehensive assessment

The DAST-10 provides the most reliable and validated approach for identifying substance use disorders in this adult patient with a known history of drug misuse, making it the optimal choice for your primary care pharmacy service.