Substance Abuse Screening in Patients With Anxiety Disorders

Substance use disorders (SUDs) occur significantly more often in patients with anxiety disorders than in the general population. How can clinicians reliably identify comorbid drug and alcohol use disorders? Here are concepts and screening tools for better detection and the ultimate safety of your patient. For more on this topic, see Substance Use Disorders in Patients With Anxiety Disorders, on which this Tipsheet is based.

TIPSHEET: SUBSTANCE ABUSE SCREENING IN PATIENTS WITH ANXIETY DISORDERS

RISK FACTORS FOR FUTURE SUD IN PATIENTS WITH ANXIETY DISORDERS

■ Anxiety disorder itself is a risk factor for SUD

■ Any use of drugs or alcohol to cope with anxiety

■ More lifetime anxiety and depressive disorders

■ Other indicators of risk include

    • Positive family history
    • Any binge drinking
    • Younger age
    • Male

KEY CONCEPTS AND SCREENING TOOLS

■ All patients with anxiety disorders should be screened for drug- and alcohol-related problems at the initial assessment

■ Patients with anxiety disorders seen on an ongoing basis should also have follow-up screening on a routine basis

■ The most widely used screening tools for alcohol problems include

    • 4-item CAGE questionnaire (Cut down, Annoyed, Guilty, Eye-opener)
    • 10-item AUDIT (Alcohol Use Disorders Identification Test)
    • A truncated 3-item version of the AUDIT is also recommended by the NIAAA

SCREENING QUESTIONS (CAGE)

■Have you ever felt you should cut down on your drinking?

■ Have people annoyed you by criticizing your drinking?

■ Have you ever felt bad or guilty about your drinking?

■ Have you ever had a drink first thing in the morning (as an "eye opener") to steady your nerves or get rid of a hangover?

SCREENING QUESTIONS (AUDIT-C)

■ How often do you have a drink containing alcohol?

■ How many drinks containing alcohol do you have on a typical day when you are drinking?

■ How often do you have 5 or more drinks on 1 occasion