Validation of the TAPS-1: A Four-Item Screening Tool to Identify Unhealthy Substance Use in Primary Care.
Abstract
BACKGROUND:The Tobacco, Alcohol, Prescription Medication, and Other Substance use
(TAPS) tool is a combined two-part screening and brief assessment developed for adult
primary care patients. The tool's first-stage screening component (TAPS-1) consists
of four items asking about past 12-month use for four substance categories, with response
options of never, less than monthly, monthly, weekly, and daily or almost daily. OBJECTIVE:To
validate the TAPS-1 in primary care patients. DESIGN:Participants completed the TAPS
tool in self- and interviewer-administered formats, in random order. In this secondary
analysis, the TAPS-1 was evaluated against DSM-5 substance use disorder (SUD) criteria
to determine optimal cut-points for identifying unhealthy substance use at three severity
levels (problem use, mild SUD, and moderate-to-severe SUD). PARTICIPANTS:Two thousand
adult patients at five primary care sites. MAIN MEASURES:DSM-5 SUD criteria were determined
via the modified Composite International Diagnostic Interview. Oral fluid was used
as a biomarker of recent drug use. KEY RESULTS:Optimal frequency-of-use cut-points
on the self-administered TAPS-1 for identifying SUDs were ≥ monthly use for tobacco
and alcohol (sensitivity = 0.92 and 0.71, specificity = 0.80 and 0.85, AUC = 0.86
and 0.78, respectively) and any reported use for illicit drugs and prescription medication
misuse (sensitivity = 0.93 and 0.89, specificity = 0.85 and 0.91, AUC = 0.89 and 0.90,
respectively). The performance of the interviewer-administered format was similar.
When administered first, the self-administered format yielded higher disclosure rates
for past 12-month alcohol use, illicit drug use, and prescription medication misuse.
Frequency of use alone did not provide sufficient information to discriminate between
gradations of substance use problem severity. Among those who denied drug use on the
TAPS-1, less than 4% had a drug-positive biomarker. CONCLUSIONS:The TAPS-1 can identify
unhealthy substance use in primary care patients with a high level of accuracy, and
may have utility in primary care for rapid triage.
Type
Journal articleSubject
HumansSubstance-Related Disorders
Mass Screening
Disclosure
Alcohol Drinking
Adult
Primary Health Care
Female
Drug Users
Tobacco Products
Surveys and Questionnaires
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https://hdl.handle.net/10161/19938Published Version (Please cite this version)
10.1007/s11606-017-4079-xPublication Info
Gryczynski, Jan; McNeely, Jennifer; Wu, Li-Tzy; Subramaniam, Geetha A; Svikis, Dace
S; Cathers, Lauretta A; ... Schwartz, Robert P (2017). Validation of the TAPS-1: A Four-Item Screening Tool to Identify Unhealthy Substance
Use in Primary Care. Journal of general internal medicine, 32(9). pp. 990-996. 10.1007/s11606-017-4079-x. Retrieved from https://hdl.handle.net/10161/19938.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Show full item recordScholars@Duke
Li-Tzy Wu
Professor in Psychiatry and Behavioral Sciences
Education/Training: Pre- and post-doctoral training in mental health service research,
psychiatric epidemiology (NIMH T32), and addiction epidemiology (NIDA T32) from Johns
Hopkins University School of Public Health (Maryland); Fellow of the NIH Summer Institute
on the Design and Conduct of Randomized Clinical Trials.Director: Duke Community Based
Substance Use Disorder Research Program.Research interests: COVID-19, Opioid misuse,
Opioid overdose, Opioid use disorder

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