Defense Date


Document Type


Degree Name

Doctor of Philosophy


Clinical Psychology

First Advisor

Dace S. Svikis, PhD


Substance use is a leading cause of morbidity and mortality that is under-identified in primary care settings. Screening for substance use in primary care requires an efficient and accurate approach. Exploring methods to collect sensitive and accurate data about substance use and related problems is important to inform research practice and clinical care. Using RCT data comparing computerized and therapist delivered brief intervention for substance use problems, the present study had a unique opportunity to compare computerized anonymous and confidential surveys to a confidential, interviewer-administered assessment in a sample of N = 540 males and females at risk for heavy/problem alcohol and/or drug use and recruited through an urban primary care clinic. This study also compared self-reports of recent substance use to urine drug assay findings. Finally, the study identified correlates of any recent (past 30-day) use and days of alcohol and other drug use per week in the past 30 days. The sample was 39% male, 78% African American, and had a mean age of 45.1 years. More participants self-reported alcohol use on the computerized, anonymous screen, including any recent (past 30-day) alcohol use, binge drinking, and problems associated with alcohol use. Any recent (past 30-day) illicit drug use rates were highest on the confidential computerized survey, and quantity/frequency of alcohol use as well as frequency of illicit drug and prescription drug misuse were highest on the interviewer-administered assessment. Overall concordance rates between interviewer-administered assessment and urine drug screening (UDS) were 72% or higher for each substance, driven by large subgroups with no use. Among participants with discordant use, marijuana and heroin / opiate use were the only substance with lower detection on UDS than self-report. Exploratory analyses examined psychosocial correlates of self-reported substance use. Anonymously screening for recent substance use followed by an interviewer-administered assessment provides the most parsimonious method to identify sensitive data about substance use and related behaviors in primary care. This approach has the potential to facilitate implementation of substance screening into demanding clinical environments.


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