Tobacco, Alcohol, Prescription medications, and other Substance use Tool (TAPS)
The TAPS Tool (Tobacco, Alcohol, Prescription medication, and other Substance use Tool) is a two-part screening and brief assessment tool that identifies unhealthy substance use in adults in primary care. A 4-item first stage (TAPS-1) asks about past-12-month use of tobacco, alcohol, non-medical prescription medication and other drugs, and a second stage (TAPS-2) gives a 0–3 risk score for each substance used in the past 3 months.
For professional reference, research, and education only. Not for diagnosis or medical advice.
The TAPS Tool (Tobacco, Alcohol, Prescription medication, and other Substance use Tool) is a two-part screening and brief assessment tool for unhealthy substance use in adult primary care, developed in the NIDA Clinical Trials Network 1.
About the TAPS Tool
The TAPS Tool integrates a brief screener (TAPS-1) with a more detailed assessment (TAPS-2) if initial risk is identified 2.
It assesses past-year and past-3-month use across a range of substances, including tobacco, alcohol, cannabis, cocaine, prescription stimulants, sedatives, and opioids. The tool supports SBIRT (Screening, Brief Intervention, and Referral to Treatment) workflows in busy clinical environments, where a positive screen can lead into a brief intervention such as motivational interviewing.
It is appropriate for use with adults aged 18 and older.
What does the TAPS Tool measure?
TAPS-1 includes 4 items about past 12-month use, each answered as never, less than monthly, monthly, weekly, or daily or almost daily 2, covering:
- Tobacco
- Alcohol
- Prescription medications (used non-medically)
- Other drugs
If any use is reported, TAPS-2 follows with frequency-based questions for the past 3 months, asking how often each substance was used and whether use affected responsibilities or safety.
How do you give the TAPS Tool?
The TAPS Tool is for adults aged 18 and older. It has been validated in both interviewer-administered and electronic self-administered (myTAPS, tablet) formats, with similar diagnostic performance 1.
In the validation study 3:
- Time. myTAPS took a median of 4.0 minutes.
- Ease of use. 98.3% of participants found it easy to use 3.
- Help needed. 25% asked for help, more often those aged over 65 or with lower education, so clinics should be ready to offer an interviewer-administered option 3.
It runs in two stages:
- Stage 1 (TAPS-1): a rapid screen of the four substance categories.
- Stage 2 (TAPS-2): given for substances endorsed in TAPS-1, with brief follow-up questions on use and its impact.
How do you score and interpret the TAPS Tool?
Each substance category produces a risk score from 0 to 3; scores are read per substance rather than as one total.
- Score 1 or more identified problem use, and 2 or more was used to identify a substance use disorder in the validation study 1.
- On the TAPS-1 alone, the optimal cut-points for identifying a substance use disorder were monthly or more often for tobacco and alcohol, and any reported use for illicit drugs and prescription medication misuse 2.
For a single drug-use screen with severity levels, the DAST-10 is an alternative; for alcohol alone, the AUDIT.
Psychometric properties
In 2,000 adults at five primary care clinics in the NIDA Clinical Trials Network, the interviewer- and self-administered versions had similar diagnostic characteristics against the modified Composite International Diagnostic Interview 1. For problem use (cutoff 1+):
- Tobacco: sensitivity 0.93, specificity 0.87 1.
- Alcohol: sensitivity 0.74, specificity 0.79 1.
- Illicit and prescription drugs: sensitivity from 0.82 (marijuana) to 0.63 (sedatives), with specificity of 0.93 or higher 1.
- Any substance use disorder (cutoff 2+): sensitivity was lower 1.
For the TAPS-1 alone, the self-administered format identified substance use disorders with 2:
- Tobacco: sensitivity 0.92, specificity 0.80 2.
- Alcohol: sensitivity 0.71, specificity 0.85 2.
- Illicit drugs: sensitivity 0.93, specificity 0.85 2.
- Prescription medication misuse: sensitivity 0.89, specificity 0.91 2.
- Biomarker check: among those who denied drug use, fewer than 4% had a drug-positive oral fluid test 2.
Limitations
- Screening, not diagnosis. A positive screen indicates a need for clinical evaluation; it does not diagnose a substance use disorder.
- Better for problem use than disorder. The developers concluded that further refinement is needed before the TAPS Tool can be recommended broadly for substance use disorder screening.
- Imprecise for less common drugs. Low prevalence of some drug classes gave imprecise estimates, and sensitivity was lowest for sedatives.
- Frequency alone is limited. TAPS-1 frequency responses did not discriminate well between levels of problem severity.
- Self-report. Results depend on disclosure; some people need help completing the electronic version.
For individuals: This page is a clinical reference, not a diagnostic tool. If you have concerns about your own symptoms, bring this information to a qualified mental health professional.
Track TAPS Tool scores with clients
Send TAPS Tool check-ins by email or QR code before a session. Each response is scored on submission and charted over time, so you and your team can see how a client is changing.
Related
Billing
In the US, the Tobacco, Alcohol, Prescription medications, and other Substance use Tool (TAPS) is usually billed under these CPT codes. Payer rules vary.
Assessments
- Alcohol, Smoking and Substance Involvement Screening Test (ASSIST v3.1)
- Assessment of Recovery Capital (ARC)
- AUDIT Scoring & AUDIT-C · Alcohol Use Disorders Identification Test
- MDQ: Mood Disorder Questionnaire
- Young Mania Rating Scale (YMRS): Scoring and Cutoffs
- ACE Score: Scoring & Interpretation of the ACE Questionnaire
Dot size shows how strongly each scale's condition is linked to this one in HiBoop's co-occurrence map.
Common paths
- Cognitive Behavioural Therapy
CBT reduced alcohol and drug use more than minimal or non-specific treatment in a meta-analysis of 30 RCTs, and matched other specific therapies.
Magill M, et al. J Consult Clin Psychol. 2019;87(12):1093–105. - Motivational Interviewing
MI reduced substance use versus no intervention at short-term follow-up but differed little from usual care in a Cochrane review of 93 studies.
Schwenker R, et al. Cochrane Database Syst Rev. 2023;12(12):CD008063.
FAQ
Is the TAPS Tool self-report or clinician-administered?
The TAPS Tool has been validated in both self-administered (tablet/electronic) and interviewer-administered formats. The self-administered format, known as myTAPS, showed high acceptability in primary care, though older adults and those with lower education may benefit from interviewer support. Both formats demonstrated comparable psychometric performance in the original NIDA Clinical Trials Network validation study.
What substances does the TAPS Tool screen for?
TAPS covers four substance categories: tobacco, alcohol, prescription medications used non-medically, and other drugs (including cannabis, cocaine, stimulants, sedatives, and opioids). The TAPS-1 first-stage screener asks about past 12-month use across these categories, and the TAPS-2 follow-up component gathers frequency and impact data for any endorsed substance.
Can the TAPS Tool diagnose a substance use disorder?
No. The TAPS Tool is a screening and brief assessment tool; it is not designed to provide a diagnosis. A positive screen indicates a need for further clinical evaluation. Diagnosis of a substance use disorder requires a comprehensive clinical assessment by a qualified healthcare professional using recognized diagnostic criteria.
How is the TAPS Tool scored?
TAPS-1 captures frequency of use (never, less than monthly, monthly, weekly, daily or almost daily) for each of the four substance categories. TAPS-2 then generates a risk score of 0–3 per substance category based on frequency of use and reported impact on responsibilities or safety. Scores are interpreted per substance rather than as a single composite total, which supports identifying which substance(s) warrant clinical attention.
References
- 1.McNeely J, Wu LT, Subramaniam G, et al. Performance of the Tobacco, Alcohol, Prescription Medication, and Other Substance Use (TAPS) Tool for Substance Use Screening in Primary Care Patients. Ann Intern Med. 2016;165(10):690-699.
- 2.Gryczynski J, McNeely J, Wu LT, et al. Validation of the TAPS-1: A Four-Item Screening Tool to Identify Unhealthy Substance Use in Primary Care. J Gen Intern Med. 2017;32(9):990-996.
- 3.Adam A, Schwartz RP, Wu LT, et al. Electronic self-administered screening for substance use in adult primary care patients: feasibility and acceptability of the tobacco, alcohol, prescription medication, and other substance use (myTAPS) screening tool. Addict Sci Clin Pract. 2019;14(1):39.
Developed by Dr. Jennifer McNeely and colleagues (NYU School of Medicine) in the NIDA Clinical Trials Network, with support from the National Institute on Drug Abuse (NIDA). Public domain.