Alcohol and drug use screening remains one of the most underused prevention tools in primary care today. Despite clear clinical guidance, most patients never get asked about their drinking or drug use during routine appointments. A major study published in JAMA Network Open in May 2026 reviewed the health records of over 2.1 million adults across 1,394 community health clinics in 25 US states. The conclusion was striking. Over an eight-year period, roughly 60% of patients had never once been screened for alcohol or drug use. That is not a minor oversight. It means millions of people had no opportunity for early identification before problems grew serious.

Why Alcohol and Drug Use Screening Saves Lives

Early identification changes outcomes. When a doctor asks the right questions at the right time, patients get the chance to reflect on their habits and receive brief counselling before a pattern of use becomes harder to address. Research consistently shows that routine substance use screening in primary care reduces alcohol consumption and improves both physical and mental health.

The US Preventive Services Task Force recognised this value, recommending routine alcohol use screening in primary care from 2018 and drug use screening from 2020. Yet this study, covering one of the largest community health clinic networks in the US, confirms that most patients still slip through without being asked a single question.

Alcohol alone causes approximately 178,000 deaths each year in the United States, according to the Centres for Disease Control and Prevention. Opioid-related deaths account for around 81,000 annually, a number pushed higher in recent years by the growing presence of synthetic opioids such as fentanyl. The COVID-19 pandemic worsened both trends. One study found that alcohol use disorder mortality rose by nearly 25% in 2020. These are not abstract statistics. They reflect real people who were never reached early enough.

Substance Use Screening Rates Differ Across Communities

The research examined four distinct groups: non-Hispanic White patients, non-Hispanic Black patients, Latino patients who preferred English, and Latino patients who preferred Spanish.

Spanish-preferring Latino patients showed the highest screening rates, around 59% higher odds of receiving alcohol screening compared with White patients. Black patients and English-preferring Latino patients recorded broadly similar screening rates to White patients. Community health centres in the US receive federal funding to serve diverse populations, and these results suggest many clinics actively tailor their outreach through culturally sensitive approaches and language-concordant services.

Still, the overall picture across all groups remains poor. Six in ten patients across the entire cohort had no documented screening over eight years. Every unscreened patient represents a missed opening to start a meaningful conversation about prevention.

Language, Culture and Substance Use Risk

Language preference tells us more than which language a patient speaks. It can signal broader patterns of cultural integration that researchers call acculturation. Spanish-preferring Latino patients not only had higher screening rates but also lower rates of diagnosed alcohol and opioid use disorder compared with other groups.

Prior research supports the view that substance use risk tends to rise as Latino individuals become more culturally integrated into US society over time. This points to a clear prevention opportunity. Engaging communities early, before acculturation-linked risk factors take hold, gives health providers the best chance of making a lasting difference.

Cultural barriers, language gaps, and limited awareness of available support all affect whether people engage openly with healthcare providers about alcohol and drug use. Removing those barriers is essential to making substance use screening genuinely accessible to everyone.

Closing the Alcohol and Drug Use Screening Gap

Progress has been made. The fact that screening recommendations now exist for both alcohol and drug use in primary care reflects how seriously the public health community takes early identification. But awareness does not automatically translate into action inside a consultation room.

Communities facing poverty, structural disadvantage, and limited access to services carry a higher burden of risk. For them, a missed screening appointment is not simply an administrative gap. It is a lost chance to address a problem before it becomes a crisis.

Alcohol and drug use screening is not a bureaucratic checkbox. It is one of the most direct ways to reach people before serious harm occurs. The data from this study makes one thing plain. There is considerably more work to do.

Source: jamanetwork