Screening for Substance Use with Computer Assisted Self Interview in Primary Care

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PROJECT SUMMARY I am a physician and early career translational investigator, with a research focus on identifying effective approaches for integrating substance abuse treatment into general healthcare settings. Because screening patients for substance abuse is time consuming on the part of clinicians, I propose research to address the validity of patient self-administered screening. The specific research and training aims of this study are integrated around two primary areas of focus: behavioral research methods (survey research, quantitative analysis, qualitative methods) and implementation research. Each of these areas is anchored by an experienced mentor with corresponding expertise, and further developed through didactic instruction combining coursework and directed readings as well as research experience. Under the sponsorship of my primary mentor Marc Gourevitch, MD, MPH, my research and training plans utilize the clinical and academic resources of New York University-Langone Medical Center and Bellevue Hospital, where substance abuse treatment and research has been a longstanding area of emphasis. My proposed study explores an innovative approach to improving rates of substance use screening in primary care, a major impediment to which has been the lack of a brief instrument that can accurately and efficiently identify patients with unhealthy substance use behaviors. The widely accepted and validated "Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) is too lengthy for the typical medical visit, and greatly under-utilized as a result. I will adapt the ASSIST, which was designed and validated to be administered as an in-person interview, to an audio guided computer-assisted self interview (ACASI) that patients can complete prior to their medical visit. I plan a mixed methods study in 3 phases to 1) adapt the ASSIST for ACASI administration in an urban safety- net primary care clinic population; 2) test its validity relative to the traditional interviewer-administered ASSIST; and 3) explore physician attitudes to using these screening results to address substance use in the primary care office.