TAPS Screening Tool

Part	Substance class	Score	Risk level
1	Tobacco, alcohol, illicit drugs, nonmedical prescriptions	Never	Negative TAPS-1 screen, not a published risk category
2	Tobacco	0	No use in past 3 months
2	Tobacco	1	Problem use
2	Tobacco	2+	Higher risk
2	Alcohol	0	No use in past 3 months
2	Alcohol	1	Problem use
2	Alcohol	2+	Higher risk
2	Cannabis	0	No use in past 3 months
2	Cannabis	1	Problem use
2	Cannabis	2+	Higher risk
2	Illicit opioids	0	No use in past 3 months
2	Illicit opioids	1	Problem use
2	Illicit opioids	2+	Higher risk
2	Prescription opioids	0	No use in past 3 months
2	Prescription opioids	1	Problem use
2	Prescription opioids	2+	Higher risk
2	Sedatives	0	No use in past 3 months
2	Sedatives	1	Problem use
2	Sedatives	2+	Higher risk
2	Prescription stimulants	0	No use in past 3 months
2	Prescription stimulants	1	Problem use
2	Prescription stimulants	2+	Higher risk
2	Illicit stimulants	0	No use in past 3 months
2	Illicit stimulants	1	Problem use
2	Illicit stimulants	2+	Higher risk
2	Other drugs	0	No use in past 3 months
2	Other drugs	1	Problem use
2	Other drugs	2+	Higher risk

Open NIDA’s TAPS Tool for the questions. Chart the result. Part 2 uses NIDA’s three categories: no use in the past 3 months, problem use, and higher risk. A never on every Part 1 item does not open Part 2. Chart that result as a negative TAPS-1 screen, not as a published risk category. Do not paste the items into the note.

The next step is not the same phrase for every class. NIDA’s cutoff note is the split: further assessment starts at 1 for classes other than tobacco, alcohol, and marijuana, and a score of 2 or higher is a high priority. The actions in the table are what you do with that split.

Part	Substance class	Score	Next step
1	All four screen domains	Never	Reinforce abstinence
2	Any class	0	Reinforce recent abstinence; ask about the past year
2	Tobacco, alcohol, cannabis	1	Brief intervention this hour
2	Opioids, sedatives, stimulants, other drugs	1	Further assessment this week
2	Tobacco, alcohol, cannabis	2+	Priority assessment and referral
2	Opioids, sedatives, stimulants, other drugs	2+	Priority assessment and referral

Score it before the hour starts

It’s 6:10. A.R. is in the chair. The official result is still in another tab. If you start the hour without a line per class, the clinician who opens the chart on Monday has to rebuild the score from memory.

The TAPS screening tool is two parts. NIDA describes Part 1 (TAPS-1) as a 4-item screen for tobacco, alcohol, illicit drugs, and nonmedical prescription use in the past 12 months. Any answer other than never opens Part 2 (TAPS-2) for that substance. Part 2 is a brief assessment of past-3-month problem use, and it returns a risk level for that class. You can hand A.R. the online tool or ask the questions yourself. Either way, the items stay on NIDA’s site.

A single drug-problem index is a different job. NIDA Data Share describes the DAST as a quantitative index of the severity of problems related to drug abuse other than alcohol. Use the DAST screening tool when you need that index. Use TAPS screening when the next step depends on which class was endorsed, including tobacco and alcohol.

McNeely and colleagues compared the tool with a reference standard in adult primary care. NIDA’s screening tools page says it is validated for adults, can be self-administered or clinician-interviewed, and generates a risk level for each substance class. That primary-care validation is not a promise about your specialty caseload. Use the published cutoffs, and do not treat a sensitivity figure from primary care as if it were measured in your room.

Next step for each risk level

NIDA’s published cutoff table is short. Score 0 is no use in the past 3 months. Score 1 is problem use. Score 2 or higher is higher risk. Chart that category, then take the step below.

No use in the past 3 months

• Part: 2
• Substance class: The class TAPS-1 opened
• Score: 0
• Risk level: No use in the past 3 months
• Next step: Reinforce the recent abstinence. Ask how the past year looked, because a positive Part 1 with a 0 on Part 2 is not a never-used history
• Chart note: TAPS-1 positive for alcohol, TAPS-2 score 0, no use in the past 3 months. Abstinence reinforced. Past-year pattern asked. Relapse risk named if prior use was heavy

Part 1 already covered the past 12 months. A 0 on Part 2 means no use in the past 3 months, not a never-used history. Give the reinforcement. Then ask how the past year looked. Do not file a 0 as “no substance history.”

A fully negative Part 1 is a different line. Every domain answered never, so Part 2 never opened. Chart a negative TAPS-1 screen. That result is not one of NIDA’s published risk categories. Give positive feedback and support the choice to abstain. That is what NIDA asks for a negative screen.

Problem use

• Part: 2
• Substance class: The class on the result
• Score: 1
• Risk level: Problem use
• Next step: Brief intervention this hour for tobacco, alcohol, and cannabis. Further assessment this week for every other class
• Chart note: TAPS-2 illicit opioids score 1, problem use. Concern named. Further assessment booked this week. Follow-up dated

What do you do with a 1 on heroin that you would not do with a 1 on alcohol?

NIDA’s cutoff note says that at the recommended cutoff of 2 or higher, sensitivity above 70% for a DSM-5 substance use disorder held for tobacco, alcohol, and marijuana only. For other substances, further assessment starts at a score of 1. A score of 2 or higher is a high priority for most classes because the positive predictive value is high. Cannabis is the class NIDA’s sentence calls marijuana. If the official result says marijuana, chart marijuana so the next reader can match your line to the tool.

For a score of 1, name the concern, recommend reducing or stopping nonmedical use, and use a brief intervention. The hour for that conversation is in substance use counseling techniques. You still need a clinical interview before you call it a disorder. NIDA is explicit that the risk category does not replace that interview.

Higher risk

• Part: 2
• Substance class: The class on the result
• Score: 2+
• Risk level: Higher risk
• Next step: Priority further assessment, a clear recommendation to stop, and a referral offered before the client leaves
• Chart note: TAPS-2 alcohol score 2 or higher, higher risk. Concern named. Stopping recommended. Referral offered and response recorded. Follow-up dated

Do not wait for a later session to write the handoff. If you do not prescribe, the medication question belongs with a prescriber. Your line names the handoff, the client’s response, and the date you will check whether it happened.

For illicit or prescription opioids, ask about overdose risk and whether the client already has naloxone. The prescription itself sits with a clinician who can provide it. For tobacco, offer a cessation referral and leave nicotine-replacement or other medication decisions with the prescriber. For a prescribed sedative or stimulant, do not direct an abrupt stop in the therapy hour. Coordinate any change with the prescriber, and chart that you did.

What changes by substance class

The score bands are shared. The handoff is not. These steps are practice handoffs for the hour. They are not extra categories on NIDA’s cutoff table.

Tobacco needs a cessation plan you can name, not a vague “cut down.” Alcohol at higher risk needs the referral offered in the room, plus a question about withdrawal if the client stops suddenly. You do not manage withdrawal in a talk-therapy hour. You notice the risk and hand it to medical care.

Illicit opioids and prescription opioids stay on separate lines. Heroin or fentanyl is not the same chart line as a prescription opioid taken other than as prescribed. Illicit stimulants (cocaine, crack, methamphetamine) stay separate from prescription stimulants. Sedatives on this tool mean nonmedical use, such as taking a benzodiazepine for the feeling or without a prescription. Adherent use of a medication you did not assess is not a positive screen. If you are unsure which question the client answered, reopen the official tool rather than guessing the class.

Other drugs are the substances the named classes do not cover. Chart the name the client used, then the score. A street name in the note without the class leaves Monday’s clinician translating.

If the job is a repeated depression, anxiety, or functioning measure rather than a substance class, leave this table. The scales for mental health matrix is the selection step for that measure.

Chart the line before you close the hour

Write one TAPS screening tool line per endorsed class. A negative Part 1 is one line for the whole screen, not nine zeros.

Keep the items out of the chart. A later reader needs the class, the score, the risk level, and what you did. They do not need a copy of NIDA’s questions, and you do not have a reason to store item wording you were not asked to store.

If your program is a substance use disorder treatment program covered by 42 CFR Part 2, read that rule before you send the note outside the treating relationship. A therapy chart in a general outpatient practice is not automatically a Part 2 record. When you are not sure, ask the privacy officer before you release it.

The signed note is where the line lives. AI clinical notes can hold the sentence you already wrote. They do not choose the screen, interpret the score, or replace the referral.

When you stop scoring and hand off

Stop this table when the client in front of you is not the adult the TAPS screening tool cutoff was built for.

A client age 12 to 17 needs an adolescent screener. NIDA points you to its adolescent substance use screens, not to this adult tool.

Stop and follow your practice risk pathway when the hour is a crisis, including active withdrawal, overdose risk tonight, or a suicide concern. A higher-risk substance score does not replace that pathway. Finish the safety step, then come back to the class line if the hour still has room.

Do not score a client who has not agreed to the screen. A waiting-room link is not that agreement. Say what the result will be used for, who will see the note, and that the client can decline. If they decline, chart the decline. Do not backfill a score.

NIDA also says the tool is meant for use under a medical provider’s supervision. It is not a self-assessment, and it does not replace your clinical judgment. If A.R. completed it at home and arrived frightened by the risk category, reopen the result with them. Do not let that category stand as the treatment plan.

Download the selection matrix

When the next question is which brief mood, anxiety, or functioning measure to repeat, use the selection matrix rather than another substance screen. It is a six-row matrix, a fit-and-stop card, and one worked outpatient example. It does not include TAPS items.

References

• McNeely, J., Wu, L.-T., Subramaniam, G., Sharma, G., Cathers, L. A., Svikis, D., Sleiter, L., Russell, L., Nordeck, C., Sharma, A., O’Grady, K. E., Bouk, L. B., Cushing, C., King, J., Wahle, A., & Schwartz, R. P. (2016). Performance of the Tobacco, Alcohol, Prescription Medication, and Other Substance Use (TAPS) Tool for substance use screening in primary care patients. Annals of Internal Medicine, 165(10), 690-699.
• National Institute on Drug Abuse. (n.d.). Tobacco, Alcohol, Prescription medication, and other Substance use (TAPS) Tool.
• National Institute on Drug Abuse. (2016, February 25). Drug Abuse Screening Test. NIDA Data Share.
• National Institute on Drug Abuse. (2025, September 24). Screening tools and prevention.
• National Institute on Drug Abuse. (n.d.). Screening tools for adolescent substance use.
• Legal Information Institute. (n.d.). 42 CFR Part 2, Confidentiality of substance use disorder patient records.