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Original Research |

Performance of the Tobacco, Alcohol, Prescription Medication, and Other Substance Use (TAPS) Tool for Substance Use Screening in Primary Care PatientsPerformance of the TAPS Tool for Substance Use Screening ONLINE FIRST

Jennifer McNeely, MD, MS; Li-Tzy Wu, ScD, RN, MA; Geetha Subramaniam, MD; Gaurav Sharma, PhD; Lauretta A. Cathers, PhD; Dace Svikis, PhD; Luke Sleiter, MPH; Linnea Russell, BA; Courtney Nordeck, BA; Anjalee Sharma, MSW; Kevin E. O’Grady, PhD; Leah B. Bouk, CCRC; Carol Cushing, BBA, RN; Jacqueline King, MS; Aimee Wahle, MS; and Robert P. Schwartz, MD
[+] Article, Author, and Disclosure Information

This article was published at www.annals.org on 6 September 2016.


From New York University School of Medicine, New York, New York; Duke University Medical Center, Durham, North Carolina; National Institutes of Health, Bethesda, Maryland; The EMMES Corporation, Rockville, Maryland; Virginia Commonwealth University, Richmond, Virginia; Friends Research Institute, Baltimore, Maryland; University of Maryland, College Park, College Park, Maryland; and Duke Translational Research Institute, Kannapolis, North Carolina.

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Drug Abuse or the National Institutes of Health.

Acknowledgment: The authors acknowledge the contributions of Robert Ali and John Marsden, who developed the ASSIST-Lite instrument. They also appreciate the work done by members of the study team: Saima Mili, Phoebe Gauthier, Sarah Farkas, Patsy Novo, Laura McElherne, Kimberly Micki Roseman, Carla Kingsbury, Melissa Johnston, Eve Jelstrom, Patrice Yohannes, Jack Chally, Paul Van Veldhuisen, Anne Hoehn, Lauren Yesko, and Alex Borbely.

Grant Support: National Institute on Drug Abuse cooperative grant awards UG1DA013034, U10DA013727, UG1DA040317, and UG1DA013035.

Disclosures: Dr. McNeely reports grants from the National Institutes of Health (NIH)/NIDA Clinical Trials Network and a career development award (K23) grant from NIH/NIDA during the conduct of the study. Dr. Wu reports grants from NIH during the conduct of the study. Dr. Subramaniam is an employee of CCTN NIDA, which is the funding agency for the National Drug Abuse Treatment Clinical Trials Network; her participation in this publication arises from her role as a project scientist on a cooperative agreement for this study. Dr. Sharma, Ms. King, and Ms. Wahle are employed by The Emmes Corporation, which has a contract to provide data management and statistical analysis services in support of multisite clinical trials conducted within the NIDA Clinical Trials Network. Ms. Nordeck and Ms. Sharma are RAs on NIDA grants received by Friends Research Institute. Dr. Schwartz reports grants from NIDA during the conduct of the study; his employer received reimbursement for his time on a 1-time consultation from Reckitt Benckiser that was outside the submitted work. Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-0317.

Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.

Reproducible Research Statement:Study protocol: See the Supplement. Statistical code and data set: Available from Dr. Sharma (e-mail, gsharma@emmes.com).

Requests for Single Reprints: Jennifer McNeely, MD, MS, New York University School of Medicine, Department of Population Health, 550 First Avenue, VZ30 6th Floor, New York, NY 10016; e-mail, Jennifer.McNeely@nyumc.org.

Current Author Addresses: Dr. McNeely: New York University School of Medicine, Department of Population Health and Department of Medicine, Division of General Internal Medicine, 550 First Avenue, VZ30 6th Floor, New York, NY 10016.

Dr. Wu: Department of Psychiatry and Behavioral Sciences, Department of Medicine and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC 27710.

Dr. Subramaniam and Ms. Cushing: Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, 6001 Executive Boulevard, Bethesda, MD 20892.

Dr. Sharma, Ms. King, and Ms. Wahle: The EMMES Corporation, 401 North Washington Street, Rockville, MD 20850.

Dr. Cathers: Virginia Commonwealth University, 730 East Broad Street, Room 3076, Richmond, VA 23298.

Dr. Svikis: Virginia Commonwealth University, PO Box 98034, 1001 East Broad Street, Room 305, Richmond, VA 23298.

Mr. Sleiter and Ms. Russell: New York University School of Medicine, 227 East 30th Street, 7th Floor, New York, NY 10016.

Ms. Nordeck, Ms. Sharma, and Dr. Schwartz: Friends Research Institute, 1040 Park Avenue, Suite 103, Baltimore, MD 21201.

Dr. O’Grady: University of Maryland, College Park, College Park, MD 20742.

Ms. Bouk: Duke Translational Research Institute, Duke University School of Medicine, Kannapolis, NC.

Author Contributions: Conception and design: J. McNeely, L.T. Wu, G. Subramaniam, G. Sharma, R.P. Schwartz.

Analysis and interpretation of the data: J. McNeely, L.T. Wu, G. Subramaniam, G. Sharma, K.E. O’Grady, A. Wahle, J. King.

Drafting of the article: J. McNeely, L.T. Wu, G. Subramaniam, G. Sharma, L.A. Cathers, K.E. O’Grady, J. King, A. Wahle.

Critical revision for important intellectual content: J. McNeely, L.T. Wu, G. Subramaniam, G. Sharma, D. Svikis, R.P. Schwartz.

Final approval of the article: J. McNeely, L.T. Wu, G. Subramaniam, G. Sharma, L.A. Cathers, D. Svikis, L. Sleiter, L. Russell, C. Nordeck, A. Sharma, K.E. O’Grady, L.B. Bouk, C. Cushing, J. King, A. Wahle, R.P. Schwartz.

Provision of study materials or patients: J. McNeely, L.T. Wu, D. Svikis, R.P. Schwartz.

Statistical expertise: L.T. Wu, G. Sharma, K.E. O’Grady, L.B. Bouk, J. King, A. Wahle.

Obtaining of funding: L.T. Wu, G. Subramaniam, R.P. Schwartz.

Administrative, technical, or logistic support: J. McNeely, L.T. Wu, G. Subramaniam, L.A. Cathers, L. Sleiter, L. Russell, C. Cushing.

Collection and assembly of data: J. McNeely, L.T. Wu, L. Cathers, D. Svikis, L. Russell, C. Nordeck, A. Sharma, L.B. Bouk.


Ann Intern Med. Published online 6 September 2016 doi:10.7326/M16-0317
© 2016 American College of Physicians
Text Size: A A A

Background: Substance use, a leading cause of illness and death, is underidentified in medical practice.

Objective: The Tobacco, Alcohol, Prescription medication, and other Substance use (TAPS) tool was developed to address the need for a brief screening and assessment instrument that includes all commonly used substances and fits into clinical workflows. The goal of this study was to assess the performance of the TAPS tool in primary care patients.

Design: Multisite study, conducted within the National Drug Abuse Treatment Clinical Trials Network, comparing the TAPS tool with a reference standard measure. (ClinicalTrials.gov: NCT02110693)

Setting: 5 adult primary care clinics.

Participants: 2000 adult patients consecutively recruited from clinic waiting areas.

Measurements: Interviewer- and self-administered versions of the TAPS tool were compared with a reference standard, the modified World Mental Health Composite International Diagnostic Interview (CIDI), which measures problem use and substance use disorder (SUD).

Results: Interviewer- and self-administered versions of the TAPS tool had similar diagnostic characteristics. For identifying problem use (at a cutoff of 1+), the TAPS tool had a sensitivity of 0.93 (95% CI, 0.90 to 0.95) and specificity of 0.87 (CI, 0.85 to 0.89) for tobacco and a sensitivity of 0.74 (CI, 0.70 to 0.78) and specificity of 0.79 (CI, 0.76 to 0.81) for alcohol. For problem use of illicit and prescription drugs, sensitivity ranged from 0.82 (CI, 0.76 to 0.87) for marijuana to 0.63 (CI, 0.47 to 0.78) for sedatives; specificity was 0.93 or higher. For identifying any SUD (at a cutoff of 2+), sensitivity was lower.

Limitations: The low prevalence of some drug classes led to poor precision in some estimates. Research assistants were not blinded to participants' TAPS tool responses when they administered the CIDI.

Conclusion: In a diverse population of adult primary care patients, the TAPS tool detected clinically relevant problem substance use. Although it also may detect tobacco, alcohol, and marijuana use disorders, further refinement is needed before it can be recommended broadly for SUD screening.

Primary Funding Source: National Institute on Drug Abuse.

Figures

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Figure 1.

TAPS tool parts 1 and 2, showing items, skip pattern, and scoring system.

ADHD = attention deficit–hyperactivity disorder; GHB = γ-hydroxybutyrate; LSD = lysergic acid diethylamide; MDMA = 3,4-methylenedioxymethamphetamine; TAPS = Tobacco, Alcohol, Prescription medication, and other Substance use.

* Percocet is a trademark for a combination of acetominophen and oxycodone, manufactured by Endo Pharmaceuticals.

† Vicodin is a trademark for a combination of acetominophen and hydrocodone, manufactured by AbbVie.

‡ Xanax is a trademark for alprazolam, manufactured by Pfizer.

§ Ativan is a trademark for lorazepam, manufactured by Wyeth.

|| Klonopin is a trademark for clonazepam, manufactured by Genentech.

¶ Adderall is a trademark for mixed salts of a single-entity amphetamine product, manufactured by Shire.

** Ritalin is a trademark for methylphenidate hydrochloride, manufactured by Novartis.

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Figure 2.

Recruitment summary.

* Among the completer population, 5 participants did not complete the entire CIDI, 1 participant did not complete the entire interviewer-administered TAPS tool, and 1 participant did not complete the entire self-administered TAPS tool. Therefore, when the score for CIDI or TAPS was missing for a given substance, these cases were excluded from the analyses for that substance. CIDI = Composite International Diagnostic Interview; TAPS = Tobacco, Alcohol, Prescription medication, and other Substance use.

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