For practical and clinical considerations, a stepped strategy for screening, combining an initial “substance use” screen and successive “substance-related problem” screeners to detect SUDs for intervention, is recommended (Whitlock et al., 2004). For example, national survey data estimate that 9% of American adults aged 18 years or older have an alcohol or drug use disorder within a 12-month period (SAMHSA, 2011). In busy health care settings, it would be burdensome to screen all individuals for SUDs; instead, a more efficient practice would be to target the detection of SUDs at individuals who screen positive for substance use. This approach would facilitate timely intervention or treatment referral, especially among individuals in emergency room or psychiatric treatment settings where SUDs are comparatively prevalent but individuals are under-diagnosed or under-treated because SUDs have not been systematically assessed (Rockett et al., 2003; Tiet et al., 2008; Vinson et al., 2007).
