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J Fam Pract. 1997 Feb;44(2):151-60.

A two-item screening test for alcohol and other drug problems.

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Department of Family Medicine, University of Wisconsin Medical School, Madison 53715, USA.



Although nonmedical use of illicit and prescription drugs is not uncommon among American adults, the currently recommended screening tests for substance use disorders (SUDs) focus only on alcohol. This study reports on the criterion validity of a two-item conjoint screening (TICS) test for alcohol and other drug abuse or dependence for a primary care sample.


A random sample of 434 primary care patients aged 18 to 59 years responded to nine screening items, which emanated from a focus group process. The DSM-III-R criteria for SUDs, as operationalized by the Composite International Diagnostic Interview-Substance Abuse Module, served as the criterion standard.


At least one positive response to the TICS ("In the last year, have you ever drank or used drugs more than you meant to?" and "Have you felt you wanted or needed to cut down on your drinking or drug use in the last year?") discriminated current SUDs with approximately 81% sensitivity and specificity. The TICS was particularly sensitive to polysubstance use disorders. Respondents with zero positive responses had a 7.4% chance of a current SUD; one positive response, 45.0%; and two positive responses, 75.0%.


More than 80% of young and middle-aged patients with current alcohol or other drug problems may be recognized by the TICS, which is easily integrated into a clinical interview.

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