The TAPS tool is a brief, two-part assessment of substance use and misuse in primary care patients that can be self-administered or administered through clinician interview.
The TAPS tool includes two parts: a screener and a brief assessment. The TAPS-1 is a screener adapted from the National Institute on Drug Use (NIDA) quick screen with 4 items assessing frequency of use of tobacco, alcohol (4+ or 5+ drinks for females and males, respectively), prescription medication, and illicit substances (e.g., marijuana, cocaine, methamphetamine, hallucinations). Any response other than “never” on the TAPS-1 indicates a positive screen, which leads to administration of the TAPS-2. The TAPS-2 is a brief assessment adapted from the Alcohol, Smoking, and Substance Involvement Screening Tool (ASSIST)-Lite including 3-4 yes/no questions for each class of substances assessing level of use, dependence, and concern from others. Cut-offs for problematic substance use and substance use disorder are based on scores on the TAPS-2. The TAPS tool can be administered by a clinician interviewer or completed by patients on a computer or tablet at a primary care clinic or through a patient portal at home.
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Young Adults (18-30)
Primary Care Practices
Performance of the Tobacco, Alcohol, Prescription Medication, and Other Substance Use (TAPS) Tool for substance use screening in primary care patients
McNeely J, Wu L-T, Subramaniam G, et al. Annals of Internal Medicine. 2016. 165: 690-699. doi: 10.7326/M16-0317
Summary: Researchers evaluated acceptability and performance of the TAPS tool compared to a reference standard (Composite International Diagnostic Interview; CIDI) for assessing adult problematic substance use and substance use disorders (SUDS) in primary care among 2,000 primary care patients in 7 clinics. Participants were approached in clinic waiting areas by a research assistant and were randomly assigned to first complete the interviewer-administered TAPS tool or the self-administered TAPS tool. Participants completed both TAPS modalities, the CIDI, and assessments of comfort with and preferences for the TAPS tool, and could agree to provide a cheek-swab. Researchers compared TAPS tool and CIDI responses to determine cutoffs for problematic use and SUD that maximized sensitivity (rate of correctly identifying positive cases) and specificity (rate of correctly identifying negative cases) across substances. Both TAPS tool modalities produced similar cut-off scores. The cut-off for problematic use was 1+, which produced high sensitivity for tobacco and marijuana (0.93 and 0.82, respectively), with lower, but acceptable, sensitivity for other substances. The cut-off for SUD was 2+, which produced sensitivity of 0.74, 0.71, and 0.70 for tobacco, marijuana, and alcohol, respectively. Sensitivity for detecting SUD for cocaine and methamphetamines (0.57), heroin (0.66), and sedatives (0.54) was lower and sensitivity for prescription opioids (0.48) was unacceptable. Specificity for detecting problematic use and SUD were .79. Participants were comfortable answering TAPS tool items (99%) and sharing results with physicians (95%). Participant preferences for the interviewer administered (31%) and self-administered (24%) TAPS tool varied, with 45% reporting no preference.
Take Away: The TAPS tool shows acceptable sensitivity for detecting problematic use and SUD for alcohol, tobacco, and marijuana, but further research is needed to improve sensitivity for detecting SUD for other illicit drugs and prescription medications.
Validation of the TAPS-1: A four item screening tool to identify unhealthy substance use in primary care
Grycznski J, McNeely J, Wu L-T, et al. Journal of General Internal Medicine. 2017. 32(9): 990-996. doi: 10.1007/s11606-017-4079-x
Summary: Researchers compared participant responses on the TAPS-1 to the reference standard to evaluate the validity of the TAPS-1 at detecting problematic substance use and SUDs. Researchers also compared TAPS-1 results to cheek-swab samples from participants who agreed to provide one during the study (n=1,802). Researchers selected cut-off scores that maximized combined sensitivity and specificity for each substance. A score above “never” was the optimal cut-off point for problematic use of any substance. The optimal cut-off for detecting SUD was “monthly” for tobacco and alcohol and “never” for illicit drugs and prescription medication. The self-administered TAPS-1 had up to 50% greater rates of disclosure compared to the interviewer administered TAPS-1, though this was primarily due to a significant administration order effect, where disclosure rates were greater for substances other than tobacco when participants completed the self-administered TAPS-1 first. Between 3% and 4% of participants who reported no illicit prescription medication or illicit drug use on the self-administered or interviewer-administered TAPS-1, had positive cheek-swabs. Though it appears that the TAPS-1 performed well without the TAPS-2, researchers recommend that clinicians still ask additional questions after a positive screen on the TAPS-1, such as those included in the TAPS-2, to guide care decisions.
Take away: The TAPS-1 shows adequate sensitivity and specificity to screen for problematic substance use and SUDS, but researchers still suggest pairing the TAPS-1 with a brief-assessment.
Identify substance misuse in primary care: TAPS Tool compared to the WHO ASSIST
Schwartz RP, McNeely J, Wu LT, et al. Journal of Substance Abuse Treatment. 2017. 76: 69-76. doi: 10.1016/j.jsat.2017.01.013
Summary: As a part of the larger study, researchers administered the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) as another reference measure for evaluating the TAPS tool. Researchers calculated TAPS tool sensitivity and specificity relative to scores on the ASSIST. Though all participants completed the TAPS 1 and 2, participants who indicated no substance use on the TAPS-1 received a score of 0 regardless of how they responded to the TAPS 2. The TAPS tool cut-off points for detecting moderate- (i.e. risky behavior that may otherwise go undetected in health care settings) and high-risk (i.e. risky behavior that warrants referral to substance use treatment) substance use were 1 and 2, respectively. Validity of the TAPS tool did not differ significantly between self-administered and interviewer-administered versions. Sensitivity and specificity for high-risk use of tobacco, alcohol, and illicit drugs were high. High-risk use of prescription opioids had a sensitivity of .41, but when items for prescription opioids and heroin were combined, as they are on the ASSIST, the sensitivity rose to .92. Sensitivity for high-risk use of prescription stimulants and sedatives were low, but could have been biased due to low sample sizes for those substance use classes. Sensitivity for detecting moderate risk use was acceptable for tobacco (.83), alcohol (.83), and marijuana (.71). Sensitivity for detecting moderate-risk illicit and prescription drug use were unacceptable. Specificity for detecting moderate risk substance use was .74 or greater. Researchers hypothesize that low sensitivity for detecting moderate-risk illicit substance use could be explained by participants who did not use, but experienced substance use-related problems receiving a moderate-risk score on the ASSIST, but scoring 0 on the TAPS tool.
Take Away: Compared to the ASSIST, the TAPS tool is a valid measure for detecting high-risk substance use in primary care patients, but further research should investigate sensitivity problems for detecting moderate-risk substance use.