TOPLINE:

Most adult patients supported substance-use screening and discussions in primary care, but their comfort levels varied by demographic, with over half preferring their doctor over a nurse or medical assistant to ask about alcohol and drug use. Middle-aged, Black, and Hispanic patients showed less comfort with questions on alcohol or drug use.

METHODOLOGY:

• Researchers surveyed 977 adult patients (mean age, 51.1 years; 61% women; 72% White) across nine primary care clinics in two urban academic healthcare systems in New York City and Boston and one rural Federally Qualified Health Center in Maine.
• Participants were asked about their views on screening for alcohol and drug use in clinics that had recently implemented universal screening (2018-2020).
• Screening approaches varied, including the use of patient- and staff-administered methods.
• The survey gathered self-reported demographic information and included 19 items about attitudes toward discussing alcohol and drug use in primary care. It covered comfort levels, concerns about documentation in medical records, and willingness to receive relevant advice from their primary care provider.
• Responses were grouped into three categories: disagree/strongly disagree, neither agree nor disagree, and agree/strongly agree.

TAKEAWAY:

• Most participants across all demographic groups reported supportive attitudes toward substance-use screening in primary care; 90% agreed that doctors should ask about use, and 71% supported testing if health was affected.
• In all, 92% of participants indicated they would provide honest answers about substance use, and 80% trusted that this information would be used to help them. More than half (58%) preferred their doctor over a nurse or medical assistant to ask about use, and 52% preferred face-to-face screening over paper screening.
• Participants aged 18-29 years were more comfortable discussing alcohol use than drug use. Participants aged 18-29 years and those older than 65 years were more likely than middle-aged participants to trust that their substance-use information would be used to help them and to agree that doctors should test for excessive use.
• Black and Hispanic participants showed more discomfort with discussing substance use, feeling it was personal and confidential. White participants showed a lower preference for face-to-face screening over paper screening and were slightly less likely to want their doctor to order tests for unhealthy substance or drug use.

IN PRACTICE:

“While high acceptability among patients may support successful implementation, patients' potential concerns should be addressed to promote patient-centered care. Strategies are needed to increase comfort and alleviate concerns about how information will be used — particularly among middle-aged, Black, and Hispanic patients,” the authors of the study wrote.

SOURCE:

This study was led by Madeline C. Frost, Health Systems Research Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs Puget Sound Health Care System, Seattle. It was published online on August 18, 2025, in Journal of Primary Care & Community Health.

LIMITATIONS:

The analysis was exploratory in nature and did not test specific hypotheses. The study did not track prior screening experiences or specific drugs considered by participants. The findings may not apply to settings outside of academic and Federally Qualified Health Center settings.

DISCLOSURES:

This study was funded by grants from the National Institute on Drug Abuse. The content for the study was based on work done as a part of VA Advanced Fellowship Program in Health Systems Research, supported by the US Department of Veterans Affairs. One author reported receiving royalties and serving as a consultant for various organizations.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.