Abstract
We review and synthesize results from a series of analyses estimating the benefit of screening for unhealthy alcohol use, depression, and tobacco to detect individuals at heightened risk for co-occurring anxiety, pain, depression, unhealthy alcohol use, and other substance use among people with HIV and HIV-uninfected individuals in the Veterans Aging Cohort Study. We also examine the potential impact of reducing unhealthy alcohol use and depressive symptoms on the incidence of co-occurring conditions. We found that screening for alcohol and depression may help identify co-occurring symptoms of anxiety, depression, and pain interference, treating unhealthy alcohol use may improve co-occurring pain interference and substance use, and improving depressive symptoms may improve co-occurring anxiety, pain interference, and smoking. We propose that an integrated approach to screening and treatment for unhealthy alcohol use, depression, anxiety, pain, and other substance use may facilitate diagnostic assessment and treatment of these conditions, improving morbidity and mortality.
Highlights
The health impact of unhealthy alcohol use is substantial and increasing
We evaluated common screening tools used in clinical practice: the Alcohol Use Disorders Identification Test (AUDIT) for alcohol screening [59], the Patient Health Questionnaire (PHQ-9) for depression screening [60], and a one-item smoking questionnaire for tobacco screening
In a series of published and unpublished analyses, we assessed the test performance of the AUDIT, the PHQ-9, and the one-item tobacco survey item as screening tools for identifying clustering condition symptoms. We evaluated these tools by calculating the sensitivity, specificity, and likelihood ratio of each measure to identify pain interference symptoms, depressive symptoms, anxiety symptoms, unhealthy alcohol use, and other substance use
Summary
The health impact of unhealthy alcohol use is substantial and increasing. Alcohol use disorder (AUD) is the most common substance use disorder globally, estimated to affect 100 million individuals, and has increased by 50% in the United States (US) over the past 10 years [1, 2]. Pain, and other substance use are not routinely assessed in clinical practice though new guidelines recommend routine screening for illicit drug use among those 18 years or older, when linkage to treatment and care can be offered [56]. We evaluated common screening tools used in clinical practice: the Alcohol Use Disorders Identification Test (AUDIT) for alcohol screening [59], the Patient Health Questionnaire (PHQ-9) for depression screening [60], and a one-item smoking questionnaire for tobacco screening Following these analyses, we examined the potential impact of reducing unhealthy alcohol use and depressive symptoms on the incidence of co-occurring conditions in two follow-up studies [31]. We briefly review the methodology used in this body of work, synthesize our main results, apply our results to key subgroups defined by HIV and HCV, and provide suggestions for steps forward
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
