Comparison of the Substance Use Brief Screen (SUBS) to the AUDIT-C and ASSIST for detecting unhealthy alcohol and drug use in a population of hospitalized smokers

Hospitalized patients have high rates of unhealthy substance use, which has important impacts on health both during and after hospitalization, but is infrequently identified in the absence of screening. The Substance Use Brief Screen (SUBS) was developed as a brief, self-administered instrument to identify use of tobacco, alcohol, illicit drugs, and non-medical use of prescription drugs, and was previously validated in primary care patients. This study assessed the diagnostic accuracy of the SUBS in comparison to longer screening instruments to identify unhealthy and high-risk alcohol and drug use in hospitalized current smokers. Participants were 439 patients, aged 18 and older, who were admitted to either two urban safety-net hospitals in New York City and enrolled in a smoking cessation trial. We measured the performance of the SUBS for identifying illicit drug and non-medical use of prescription drugs in comparison to a modified Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) and its performance for identifying excessive alcohol use in comparison to the Alcohol Use Disorders Identification Test–Consumption (AUDIT-C). At the standard cutoff (response other than ‘never’ indicates a positive screen), the SUBS had a sensitivity of 98% (95% CI 95–100%) and specificity of 61% (95% CI 55–67%) for unhealthy alcohol use, a sensitivity of 85% (95% CI 80–90%) and specificity of 75% (95% CI 78–87%) for illicit drug use, and a sensitivity of 73% (95% CI 61–83%) and specificity of 83% (95% CI 78–87%) for prescription drug non-medical use. For identifying high-risk use, a higher cutoff (response of ‘3 or more days’ of use indicates a positive screen), the SUBS retained high sensitivity (77–90%), and specificity was 62–88%. The SUBS can be considered as an alternative to longer screening instruments, which may fit more easily into busy inpatient settings. Further study is needed to evaluate its validity using gold standard measures in hospitalized populations.