Our relationship with substances dates back centuries. Many substances—opium, cannabis, cocaine, and alcohol—began as medicinal and religious tools before evolving into recreational use, overconsumption, and dependence. Today, about 18 million Americans have reported symptoms of marijuana use disorder. Excessive alcohol use is a leading cause of death in the U.S., contributing to more than 200 diseases, automobile accident fatalities, and deaths from violence and suicide. According to the 2023 National Survey on Drug Use and Health, 28.9 million people in the U.S. aged 12 and older had alcohol use disorder in the prior year.
Although overdose deaths have been declining since reaching an all-time high during the early years of the COVID-19 pandemic, the crisis created by substance use has not passed. Overdose continues to be the leading cause of death for Americans between the ages of 18 and 44.
Comprehensive Screening is a Critical Need
To effectively battle the overdose crisis, it is essential that we prioritize prevention, intervening before substance use disorders (SUD) develop. Early screening to determine an individual’s risk is critical, yet implementation is often inadequate.
Despite a decades-long push to legitimize medical education about SUD, comprehensive addiction training is still rare in the American system. The National Center on Addiction and Substance Abuse has even labeled SUD a “failure of the medical profession at every level.”
Progress in this area has been slow: Only 15 of 180 American medical programs teach addiction medicine, and the content is not regulated. Boston University stands out as it weaves addiction training through all four years of medical education, teaching “motivational interviewing” techniques that include patients in their health goals.
Across healthcare, screening to identify “pre-addiction” is largely absent, which is unfortunate because it is much easier to address the risk and prevent serious substance use at this early stage. Screening often doesn’t occur because clinicians may lack the training to ask the right questions or may not routinely ask patients about substance use. In addition, our fragmented healthcare system compartmentalizes care. A patient’s mental health, behavioral health, and physical health are not well integrated, which can allow substance use issues to fall through the cracks.
In particular, mental health and substance use are often correlated, which makes SUD screening by mental health providers especially important.
Stigma: A Profound Barrier to Identification of SUD
Once a SUD concern is identified, stigma presents a hurdle to treatment. Substance use and addiction are often seen as a personal choice, not only by the general public but also by professionals who are charged with helping people with SUD. Despite extensive research proving addiction is a complex brain disorder, many still consider it a personal weakness or character flaw. Using “person-first” language focuses on the individual rather than the disorder, which is essential in helping reduce stigma.
Digital Solutions Assist in Overcoming Screening Barriers
Addressing the SUD screening gap requires innovative approaches to remove barriers. CHESS Health’s digital ePrevention solution offers advancement in the space, making automated SUD screening available and accessible to individuals and healthcare providers. ePrevention elevates prevention initiatives, including the clinical practice of SBIRT (Screening, Brief Intervention, and Referral to Treatment), and addresses gaps in traditional approaches, including
- Scalability: Digital tools enable systematic screening across entire populations or healthcare systems, not just individual encounters.
- Early Detection: Digital screening can identify at-risk individuals before problems escalate, enabling preventive interventions rather than crisis response.
- Convenience: People can complete screenings at their own pace, in familiar environments, without scheduling appointments. Plus self-assessment tools give individuals agency in their health journey and can increase motivation for treatment.
- Accessibility: Digital screening can reach people who otherwise might not engage with healthcare providers or do not have qualified providers in their area.
- Consistency: The screening is standardized to ensure everyone receives the same quality assessment.
- Privacy: People concerned about their own substance use may be more likely to answer questions honestly when they can complete a confidential self-assessment.
- Workflow Efficiency: With an already overtasked healthcare workforce, providing a tool that streamlines the process and guides staff through evidence-based questions and interventions removes barriers to conducting thorough and regular screenings.
- Immediate Support: Individuals receive real-time feedback and referral to resources when risk is identified.
- Data-driven insights: Digital tools allow for effective tracking of assessments and outcomes, providing data that can be used to inform public health strategies.
Moving Forward with SUD Screening
To reduce the devastating impact of SUD, prevention and early intervention must be an integral part of care. Implementing screening as part of routine medical care is an effective method for catching substance use before it becomes a life-altering problem. Beyond the care setting and further upstream, there is a need for easily digestible education accessible in community settings like schools, libraries, senior centers, or digitally to include in city and neighborhood newsletters.
Digital solutions like ePrevention can make this critical tool accessible to more people, removing geographic barriers to care and the impact of stigma. In addition, improved medical education and coordination between healthcare providers on SUD and efforts to help the public understand that SUD is a disease, not a moral failing, will go a long way toward closing the screening gap and supporting healthier communities.
