Family substance use screening: less to hide, more to gain.

Abstract

A relentless rise in undertreated or untreated substance use disorders highlights the magnitude of the challenge the society is facing and a critical need to identify evidence-based, practical approaches in order to effectively screen people at high risk for unhealthy alcohol use, tobacco and drug use, increase early detection of substance use disorders, and offer the proper care they need. The Family CAGE (an acronym of four questions on alcohol use) is a brief questionnaire adapted from the original CAGE questionnaire devised by Frank et al1 and studied by Basu et al2, in this issue under a format encompassing drug use (AID=Adapted to Include Drugs). The study examines the validity and associated characteristics of the questionnaire for the diagnosis of alcohol and other substance use disorders as well as the inter-rater reliability between one family member and the substance user. The results were drawn from a cross-sectional analysis of two samples: treatment seeking substance-using patients, and individuals receiving outpatient psychiatric treatment while not pursuing treatment for substance use disorders. In both groups, the scores of the Family CAGE-AID and the traditional CAGE-AID questionnaires were significantly correlated. In the psychiatric sample, a correlation between the scores of the questionnaire and ICD-10 symptom score was observed, along with a moderate but significant agreement between the scores of substance users and family members. Family CAGE-AID was found to be sensitive and specific for the diagnosis of substance dependence formulated using ICD-10 criteria2. There are a few points to consider. Because of the design of the study, family members’acceptance of the questions about other members’ alcohol and drug use problems is unknown, which needs further study. The authors acknowledged that a limited range of substance use diagnoses and disease severity in the study sample limited the generalizability of study findings, and that psychiatric evaluation was not performed to control for the quality of responses among participating relatives. However, the findings demonstrate the practicality and potential utility of a family screen instrument for alcohol and drug use problems. Among future applications, the involvement of multiple family members in the interview, and confirmation studies in large samples at the primary care level and within different age ranges should be considered. Following evaluation, data gathered on interventions outcome and follow up assessment will be of interest.