Substance Use Screening and Assessment

• Between 40-70% of people with bipolar disorder have a history of substance use disorder. (1)
• A current or past comorbid substance use disorder may lead to worse outcomes for bipolar disorders, including more symptoms, more suicide attempts, longer episodes and lower quality of life. (1)
• Substance abuse may obscure or exacerbate mood swings that have no other apparent external cause. (2)
• Substance abuse may also precipitate mood episodes or be used by patients to self-treat in an attempt to improve the symptoms or episodes. (2)

Audit-C: Alcohol Use Disorder Identification Test – Consumption:

• The AUDIT-C is a modified version of the AUDIT instrument that was developed by WHO to screen patients in primary health settings for hazardous or harmful drinking.
• The AUDIT-C is a 3 item instrument that screens for:
  • frequency of alcohol consumption
  • quantity of alcohol consumption
  • quantity of alcohol consumption on a single occurrence
• The AUDIT-C is a simple 3 question screen that can stand alone or be incorporated into general health history questionnaires.

CAGE-AID: Cut down; people Annoy you, feel Guilty; need Eye-opener – Altered to Include Drugs:

• The CAGE-AID is a conjoint questionnaire where the focus of each item of the CAGE alcohol use questionnaire was expanded to include alcohol and other drugs.
• The CAGE-AID is a simple 4 question self-report that is easily scored by the clinician.
• Advantage to using this screen is the ability to screen for alcohol and drug problems simultaneously rather than separately.

References:

1. Ostacher MJ, Sachs GS,. Update on Bipolar Disorder and Substance Abuse: Recent findings and treatment strategies, J Clin Psychology 2006; 67(9):e10.
2. American Psychiatric Association, Practice Guidelines for the Treatment of Patients with Bipolar Disorder, Am J Psychiatry 159: 4, April 2002 Supplement.