Recognition and Referral for Individuals with Substance Abuse Disorders

In addition to reducing misuse and abuse of medications they prescribe, dental healthcare providers have the opportunity to screen for substance abuse disorder in their patients. For a screening tool to be used in a dental setting, it must be easy to interpret and not time-consuming or onerous to administer. A commonly used screening tool is the drug abuse screening test 10 (DAST-10). This tool may be used with screening, brief intervention, and referral to treatment (SBIRT) as part of an evidence-based practice to identify, monitor, reduce and prevent problematic use and abuse of alcohol, illicit, and prescription medications (Figures 3-4).87 The scoring rubric for this screening test also provides recommendations that allow the treating dentist to provide interventions tailored to risk of substance use/abuse. These interventions may range from a brief (3-15 minute), patient-centered discussion employing Motivational Interviewing concepts designed to raise awareness of his/her substance abuse to facilitation of referral to drug treatment experts for in-depth assessment and, if necessary, treatment. Additionally, there are other tools for clinician screening for substance use and training modules available through the National Institute on Drug Abuse (NIDA) that allow for screening and interventions tailored to specific populations.88

Figure 3. DAST-10 assessment screening questions.87
Chart showing drug screening questionnaire (DAST)
Figure 4. DAST-10 score risk categories.87
Chart showing score risk categories

Prior to instituting a SBIRT program, the dental healthcare providers must identify and/or create a structure for the screening, intervention and referrals. Utilization of skilled dental team members as an integral part of the screening, counseling, and referral process for drug misuse and abuse allows dentists to reach more of their patients with critical screening tools and education. Consider these questions when implementing a program in your practice:87

  1. What screening and assessment tools will be used?
  2. Will the same person provide screening, brief intervention, and referrals?
  3. How will staff be trained, updated, and informed about the SBIRT protocols?
  4. Should all patients be screened?
  5. How often should patients be screened?
  6. Will educational materials be distributed to patients? If so, which ones?
  7. Where/how will patients needing further assistance be referred? What referral resources, if any, are currently used?
  8. How will SBIRT results be documented?
  9. Who will ensure compliance with SBIRT implementation including screening, intervention, and referral?
  10. Will we bill for SBIRT screening and/or other services?