If you or someone you care for is showing signs of substance use disorder, you likely have questions. You may wonder: How can you tell when drug or alcohol use is risky? And when has it crossed the line into causing harm? Fortunately, there are many screening tools that can help guide your next steps.
Who Should Get Screened?
You may seek a test because you’re worried something that once felt fun and social has now become a hard-to-break, unhealthy habit. Or your doctor may screen all their patients for overuse of alcohol and other substances as a way of kicking off the conversation. If you're worried, don’t hesitate to reach out to your health care provider.
Signs of a use disorder include:
- Having a hard time setting limits on the amounts you consume
- Feeling strong cravings or urges to keep on drinking or using drugs
- Having trouble at work, school, or home
- Continuing to use even though you know it’s causing problems in your life (such as hurting your relationships with others or making it hard to get to work on time)
- Needing more and more of the substance to feel the same effects
- Wanting to quit but not being able to stop
- Having withdrawal symptoms, such as shaking, if you do stop
What’s the Goal of Screening?
By diagnosing at-risk use at an early stage, you can learn about how it’s affecting your health before it causes serious conditions like liver disease or leads to accidental injuries like falls.
Screening can quickly identify whether you need further testing and treatment. What these tools don’t do is provide a diagnosis. Nor do they give detailed information on which treatments will work best.
Where Can You Find a Test?
Talk with your doctor if you’re concerned about your own or a loved one’s drinking or drug use. You can also reach out to a mental health specialist. If you’re worried that someone in your life is abusing a substance, seek out professional advice on how best to approach them about their use.
What Types of Tests Are There?
Generally speaking, screening tools for alcohol will assess how much you drink, how often, and whether that’s causing difficulties in your life. In fact, a key quality of alcohol use disorder is continued drinking despite the consequences. No single test is best for all people, so your doctor will tailor their approach. Screening may just be a casual face-to-face talk, or your doctor may use information from lab tests like liver damage, a sign of excessive alcohol use, to start the conversation. A more formal method is to use questionnaires, either in writing or verbally.
Tests include:
- The Alcohol Use Disorders Identification Test (AUDIT), a written questionnaire that takes just 2 minutes for you to do and 15 seconds for your doctor to score
- CAGE, a simple test with only four questions about alcohol use over your lifetime
- The Michigan Alcoholism Screening Test (MAST), with a yes/no format spanning 24 questions
- MAST - Geriatric Version (MAST-G), developed for older adults
- TWEAK, designed for pregnant women
- Problem Oriented Screening Instrument for Teenagers (POSIT), useful in adolescents
- AlcoholScreening.org, an online test you can take on your own
When it comes to illicit drug use, you may find it’s uncomfortable to speak with your primary care doctor about the topic, but it’s just as important as discussing other aspects of your health. Because some people may feel awkward talking about drugs, here your doctor may simply ask you questions, in a casual way, to get a better feel for your risk. But there also are a few screening tools:
- CAGE-AID, based on the original CAGE test but adapted to capture drug use
- The Drug Abuse Screening Test (DAST), similar to the MAST screening tool with 24 questions
- DAST-10, a faster, simpler version of the DAST with just 10 questions
- ASSIST, an online test that covers drug use as well as alcohol and tobacco use
Importantly, not all tests work equally well for all people. CAGE, for instance, is better at detecting alcohol dependence in Black people than in white people. AUDIT, on the other hand, works similarly in both races and has been validated in six countries across different cultures. Challenges to getting a clear result on screening tests include language barriers, inability to read or write, and learning disabilities.
Other clues to overuse that your health care provider might look for are:
- Weight loss
- Tiredness
- Red eyes
- Depression, anxiety, or sleep problems
- Lack of attention to cleanliness
What Happens Next?
If your test shows warning signs, your doctor will do a brief assessment to confirm how much, how often, and how long you’ve been using alcohol or drugs. They will also ask about any health, legal, or relationship issues related to this use. Your doctor will review your medical history as well as any treatments you’ve undergone for substance use and mental health. For mild-to-moderate problems or at-risk use, treatment can be as brief as a chat in your doctor’s office. If your doctor thinks you have a substance use disorder, you may get a formal diagnosis and receive specialized treatment. In all cases, your health care provider should follow-up with you to keep tabs on your condition and offer ways to prevent relapse.
If your substance use isn’t getting the attention it should from your regular doctor, see an addiction specialist who can explore your options and find you help.
