Early Recognition & Screening
Trainer Notes
& Activities
Overview
Key points
- GPs are well placed to screen for and assess AOD-related problems.
- Early recognition and screening effectively reduce AOD-related harm.
- Valid and reliable screening tools may facilitate early recognition and screening.
Suggested Objectives
To enable GPs to:
- conduct screening for alcohol and other psychoactive drug use among all general practice patients
- intervene early with AOD-related problems as a result of early recognition and screening.
Resource Kit for GP Trainers on Illicit Drug Issues
Part B3 Clinical Process: Early Recognition & Screening
Topic Contents
Slides
The slides with slide notes cover:
- major indicators of problematic AOD use
- the screening process in general practice
- tools to assist screening
- medical, behavioural and psychosocial indicators of AOD related harm
- the purpose, importance and context of screening and target groups
- main screening instruments suitable for the Australian context (e.g., AUDIT, DrugCheck, SDS, ASSIST)
- an overview of the role of urinalysis in AOD screening.
The slides are on the Resource Kit CDROM under this topic. Trainers are encouraged to select and/or adapt this slide set to meet the focus of the training and information needs of their participants.
Activities
The activities provide opportunities for GPs to:
- practise using screening tools
- rehearse skills
- become familiar with the screening process and relevant screening tools.
Handouts
- DrugCheck Screening Tool
Saunders, J.B. & Barnes, P. 2002, Training Package for Medical Practitioners in the Effective Identification and Treatment of Pharmaceutical and Illicit Drug Problems, Appendix 1c, (Alcohol and Drug Training and Research Unit), Queensland Divisions of General Practice and Department of Psychiatry, University of Queensland, Brisbane.
- Severity of Dependence Scale (SDS)
Saunders, J.B. & Barnes, P. 2002, Training Package for Medical Practitioners on the Effective Identification and Treatment of Pharmaceutical and Illicit Drug Problems, ADTRU (Alcohol and Drug Training and Research Unit), Queensland Divisions of General Practice and Department of Psychiatry, University of Queensland, Brisbane, pp. 99–102.
- Detectability in Urine
Saunders, J. & Barnes, P. 2002, Identification and Treatment of Pharmaceutical and Illicit Drug Problems: A General Practitioner’s Guide. ADTRU (Alcohol and Drug Training and Research Unit), Queensland Divisions of General Practice and Department of Psychiatry, University of Queensland, p. 8.
- Biochemical Measures of Drug Use
Handout based on: Dawe, et al. 2002, Review of Diagnostic Screening Instruments for Alcohol and Other Drug Use and Other Psychiatric Disorders, 2ndedn, Commonwealth Department of Health and Ageing, Canberra, pp. 99–102.
- Alcohol Use Disorders Identification Test (AUDIT) and Interpretation
Babor et al. 2001, ‘AUDIT – Self Report and Interview Tools’, in Babor, T., Higgins-Biddle, J.C., Saunders, J. & Monteiro, M.G. The Alcohol Use Disorders Identification Test (AUDIT): Guidelines for Use in Primary Care, 2ndedn, World Health Organization, Department of Mental Health and Substance Dependence, Geneva.
- Common Presentations of Drinking
Source: Population Health Education Curriculum (PHEC) Alcohol and Other Drugs Training Module (1998) Available within training curriculum from Rural and Remote Medical Education Online (RRMEO) at
NCETA 2004, Alcohol and Other Drugs: A Handbook for Health Professionals, Australian Government Department of Health and Ageing.
- Common Presentations of Drug Use
Source: Population Health Education Curriculum (PHEC) Alcohol and Other Drugs Training Module (1998) Available within training curriculum from Rural and Remote Medical Education Online (RRMEO) at
NCETA 2004, Alcohol and Other Drugs: A Handbook for Health Professionals, Australian Government Department of Health and Ageing.
- Taking a History – Assessment Forms
DeCrespigny, et al. 2003. Alcohol, Tobacco and Other Drugs Guidelines for Nurses and Midwives: Clinical Guidelines: Flinders University and Drug and Alcohol Services Council, Adelaide. p.183
Please refer to the Resource Kit CDROM for a copy of handouts (PDF and Word).
Resource Kit for GP Trainers on Illicit Drug Issues
Part B3 Clinical Process: Early Recognition & Screening
Sources of Additional Information
Patient Resources
Alcohol Screening Tools are available for the general public at:
(American measures)
These sites can help people find out whether their drinking patterns are low or high risk. People can assess their own drinking, learn about alcohol and health issues, and find resources for additional help.
‘Goldberg Depression Quiz and Goldberg Anxiety Quiz’,
Key Readings
Babor, T. & Higgins-Biddle, J.C. 2001, ‘Alcohol’, Brief Intervention for Hazardous and Harmful Drinking: A Manual for Use in Primary Care, WHO, Department of Mental Health and Substance Dependence, Connecticut, USA.
Brown, R.L. & Rounds, L.A. 1995, ‘Conjoint Screening Questionnaires for Alcohol and Other Drug Abuse: Criterion Validity in Primary Care Practice’, Wisconsin Medical Journal, vol. 94(3), pp. 135–140 (development of Drug Check screening instrument).
Dawe, S., Loxton, N., Hides, L., Kavanagh, D. & Mattick, R. 2002, Review of Diagnostic Screening Instruments for Alcohol and Other Drug Use and Other Psychiatric Disorders, 2nd edn, Commonwealth Department of Health and Ageing, Canberra.
Gill, T. 1996, GP Drug & Alcohol Supplement No. 3, Assessment & Treatment of Alcohol Problems in the General Practice Setting, Central Coast Area Health Service, NSW.
Gossop, M., Darke, S., Griffiths, P., Hando, J., Powis, B., Hall. W. & Strang, J. 1995 ‘The Severity of Dependence Scale (SDS): Psychometric properties of the SDS in English and Australian samples of heroin, cocaine, and amphetamine users’, Addiction vol. 90, pp. 607-614.
NCETA 2004, Handbook for General Practitioners and Other Health Professionals, National Centre for Education and Training on Addiction, Commonwealth Department of Health and Ageing, Canberra.
Shand, F., Gates, J., Fawcett, J. & Mattick, R. 2003, ‘Assessment of Alcohol Use
Disorders’, The Treatment of Alcohol Problems: a Review of the Evidence, ch. 3, Commonwealth Department of Health and Ageing, Canberra, pp. 11–21.
Shand, F., Gates, J., Fawcett, J. & Mattick, R. 2003, ‘Screening and Assessment’, Guidelines for the Treatment of Alcohol Problems, ch. 3, Commonwealth Department of Health and Ageing, Canberra, pp. 25–33.
WHO Assist Working Group 2002, ‘The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): development, reliability and feasibility’, Addiction, vol. 97, pp. 1183–1194.
Additional Readings
Allen, J., Litten, R., Fertig, J. & Babor, T. 1997, ‘A Review of Research on the Alcohol Use Disorders Identification Test (AUDIT)’, Alcoholism: Clinical and Experimental Research, vol. 21, issue. 4.
Babor, T. & Higgins-Biddle, J. 2000, ‘Alcohol Screening and Brief Intervention: Dissemination Strategies for Medical Practice and Public Health,’ Addiction, vol. 95(5), pp. 677–686.
Farmer, R. & Greenwood, N. 2001, ‘General Practitioners’ Management of Problem Drinkers – attitudes, knowledge and practice’, Drugs: Education, Prevention and Policy, vol. 8, issue 2.
Fleming, M. 1997, ‘Strategies to Increase Alcohol Screening in Health Care Settings’, Alcohol, Health & Research World, vol. 21, issue 4.
McCormick, R., Adams, P., Powell, A., Bunbury, D., Paton-Simpson, G. & McAvoy, B. 1999, ‘Encouraging general practitioners to take up screening and early intervention for problem use of alcohol: a marketing trial’, Drug and Alcohol Review, vol. 18, pp. 171–177.
Saitz, R., Sullivan, L. & Samet, J. 2000, ‘Training Community-Based Clinicians in Screening and Brief Intervention for Substance Abuse Problems: Translating Evidence into Practice’, Substance Abuse, vol. 21, issue 1.
White, C., Kouimtsidis, C., D’Souza, M., Freeman, H., Grau, M., Saunders, V., Toosey, T., Trompetas, A., Wake, M., Annan, J. & Ghodse, H. 2002, ‘Substance Misuse Services in Primary Health Care’, Drugs: Education, Prevention and Policy, vol. 9, issue 3.
Additional Resources
Signs and Symptoms of Drug Use
American Council for Drug Education
University of Newcastle & NCETA 1998, Raising the Issue and Assessment: How to Raise the Issue of Drug and Alcohol Use Sensitively and Effectively [videotape], Clinical Skills Series, University of Newcastle and NCETA (National Centre for Education and Training on Addiction), (See Part C2 Videos for description, source and cost).
Early Recognition & Screening
Activities
Activity 1: Raising Sensitive Topics
Purpose
To practise raising sensitive topics.
Process
1.1Nominate half of the participants to skill rehearse being supervisors, and the other half to skill rehearse being employees
1.2Take each group aside:
- ask the ‘supervisors’ to raise the issue of the ‘employee’s’ bad breath
- ask the ‘employees’ to discuss job prospects and general work difficulties with the ‘supervisor’
1.3Pair ‘supervisors’ and ‘employees’ together so they can skill rehearse the meeting
1.4Bring the larger group back together and ask each pair to discuss the experiences of the different roles
1.5Write a list of tactics that worked and those that didn’t work
1.6Ask one participant from each pair to imagine an illicit drug problem and a symptom associated with use of that drug
1.7Ask the pairs to skill rehearse a doctor and patient situation where the doctor raises the drug issue sensitively based on the symptoms described by the patient
1.8Return to the group and facilitate discussion about each pair’s experiences with the skill rehearsal.
Source: adapted from Turning Point Alcohol and Drug Centre Inc. 1997, Regional Training Program, Turning Point Alcohol and Drug Centre Inc, Fitzroy, Victoria.
Resource Kit for GP Trainers on Illicit Drug Issues
Part B3 Clinical Process: Early Recognition & Screening
Activity 2: Exploring the Issue
Purpose
To consider the most appropriate questions to use when screening for drug-related problems.
Process
2.1Present the Mr Gregory scenario to participants (see below)
2.2Facilitate discussion about Mr Gregory and possible approaches to the issue. Specifically, ask the participants:
- why the word “occasionally” may be misleading
- to name two questions that can be used to elicit a more specific account of his cocaine use
- to give examples of common presentations of cocaine use in general practice
- what questions they would ask Mr Gregory if he admitted to problematic cocaine use
2.3As a group, discuss:
- approaches to early recognition and screening
- the best style of questions to use.
Source: adapted from Wilson, L., Kahan, M. & Midmer, D. (eds). 1999, Project Create: Teaching Module Series for Undergraduate Medical Education and Faculty Development, vol. 1, University of Toronto, Toronto, pp.94–100.
Scenario: Mr Gregory
Mr. Gregory is a 33-year-old accountant who is single and lives alone. You have followed him for several months for ongoing cold-like symptoms, nausea and a sore throat. After several appointments, Mr Gregory reveals that he uses cocaine occasionally. You wonder if cocaine use may be contributing to his health problems.
Resource Kit for GP Trainers on Illicit Drug Issues
Part B3 Clinical Process: Early Recognition & Screening
Activity 3: Screening Instruments
Purpose
To practise using screening instruments and to discuss issues surrounding the use of screening instruments.
Process
3.1Divide participants into groups so that each group has a different screening tool (number of groups will depend on how many screening tools you have available)
3.2Ask each group to skill rehearse using the tool they have been given
3.3Allow each group to practise with all of the available screening tools
3.4As a whole group, discuss the screening tools, including issues such as:
- advantages and disadvantages of the tool
- what the tool screens for
- language and style of the tool
- groups for which it may be appropriate or inappropriate (e.g., women, youth, elderly, Indigenous)
3.5Ask participants to think of a patient for whom they could have used one of the screening tools
3.6Discuss one of the cases with the group.
Source: adapted from Turning Point Alcohol and Drug Centre Inc. 2002, Alcohol Training Resource Turning Point Alcohol and Drug Centre Inc., Fitzroy, Victoria.
Resource Kit for GP Trainers on Illicit Drug Issues
Part B3 Clinical Process: Early Recognition & Screening
Activity 4: Presenting Symptoms of Drug Use
Purpose
To recognise that any patient may use drugs and present with symptoms associated with their drug use.
Process
4.1Present each of the scenarios provided below
4.2Ask participants the following questions:
- would you screen the patient for alcohol or other drug use?
- if so, what screening tool/s would you use?
- why would you use that screening tool?
4.3Discuss each case, either in small groups or as a large group, in relation to:
- the factors associated with the chosen course of action
- what the symptoms may indicate.
Scenario 1
A well dressed Anglo-Saxon 40 year-old mother of 2 presents with a rash on her arms and slightly bloodshot eyes
Scenario 2
An older person presents seeking benzodiazepines to help them sleep, or ‘for their nerves’
Resource Kit for GP Trainers on Illicit Drug Issues
Part B3 Clinical Process: Early Recognition & Screening