Abstract: Importance: Current screening tools for Alcohol Use Disorder (AUD) or Substance Use Disorder (SUD) discover this disease at a late stage. Objective: The goal of this study was to develop a simple prevention screening tool for patients who may be prone to develop AUD and/or SUD prior to the development of addiction. Design: The study involved a self-administered survey type study using a cross-sectional design and was carried out in the spring of 2020 over a one-month period. Setting: This study was completed at an urgent care facility which supports a separate Medication Assisted Treatment (MAT) clinic. Those patients who presented to the MAT clinic (SUD group) were seen in a separate area that the patients presenting for urgent care (Control group). Participants: Participants (N = 259) were voluntarily recruited from MAT and Urgent care patients: Patients receiving acute care were assigned to the Control group (N = 126, 50.8% female, 5.7% non-white, 27.2 age < 34)) and those receiving treatment for SUD were assigned to the MAT group (N =133, 40.8% female, 4.8% non-white, 36.8% <34)). Main Outcome and Measure: The survey questioned demographics (4 items), risk factors for AUD/SUD (6 items), information about first alcohol/opioid experiences (16 items), and factors for seeking AUD/SUD treatment and recovery (2 items). Feelings were categorized as positive (e.g., euphoria, happiness, self-confident), neutral (e.g., nothing, normal), or negative (e.g., depressed, sad, sick). Results: The MAT group felt more positive feelings with first usage of alcohol and opioids compared to the control group (p<.001). With first usage of opioids specifically, MAT (0.13 + 0.04) and Control (0.29 + 0.07, p <.001) groups differed. Over half (55.3%), of the MAT participants reported feeling self-confident with first use of alcohol while only 29.7% of the Control reported this (p<.001). Over three-fifths (63.7%)of the MAT group reported feeling of euphoria with the first usage of opioids compared to one-tenth (9.8%) in the Control group (p<.001). Conclusions: This retrospective cross-sectional report shows the first affective responses to substances may predict risk for future SUD and could be used as a prevention screening tool. Reporting positive feelings with first usage of alcohol and opioids could be used as a screening tool for patients who may be more prone to developing AUD and SUD.

The authors have declared no competing interest.

This study was funded by The Behavioral Health Institute at Geisinger Commonwealth School of Medicine

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

Members of Institutional Review Board (IRB) of Geisinger Health Systems reviewed and approved your research protocol under [45 CFR 46.110(b)(1) expedited review Category 7: Research on individual or group characteristics or behavior (including, but not limited to, research on perception, cognition, motivation, identity, language, communication, cultural beliefs or practices, and social behavior) or research employing survey, interview, oral history, focus group, program evaluation, human factors evaluation, or quality assurance methodologies on 04/19/2021 Please note the following information about your IRB approval: Approval Date: 04/19/2021 Risk Assigned: Minimal Risk Approved Subject Screening: 500 Approved Subject Enrollment: 240 Approved PHI Elements: No Identifiers collected Consent/Authorization Process: Waiver approved under 45 CFR 46.117 (c) 1 or 2/ 21 CFR 56.109 (c)1 HIPAA Authorization for research approved under 45 CFR 164.508 (a) (1) Sponsor: Clinic Research Fund - Research Assistance & Support, GCSOM Behavioral Health Initiative

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.

Yes

All data produced in the present study are available upon reasonable request to the authors