The Tobacco, Alcohol, Prescription medications, and other Substances (TAPS) tool is a validated, two-step screening that helps identify substance use patterns, assess risk, and guide collaborative care. TAPS is an effective tool that creates an opportunity for an honest dialogue about substance use, reduces stigma, and supports collaborative, patient-led change.
Why Use TAPS?
- Validated & standardized: Ensures consistent, evidence-based screening.
- Supports early intervention: Detects risky use before it escalates.
- Facilitates collaborative care: Results guide shared decision-making.
This measure is a brief screening tool for substance use. It does not provide a full diagnosis, but can guide care conversations and flag when further assessment is needed.
Step 1: Introduce the Tool
Goal: Create safety and explain the purpose before asking any questions. Use inclusive, nonjudgmental language, and support the patient's choice.
“I ask everyone these questions because substance use of any kind can impact mental health. This isn’t about judgment; it’s about getting the full picture so we can decide together what support makes sense.”
Step 2: Administer TAPS-1
The goal of TAPS-1 is to screen for the presence of substance use in the past year.
Ask:
“In the last 12 months…”:
| Question | Category | Tip |
| “...how often have you used tobacco or any other nicotine delivery product (i.e., e-cigarette, vaping or chewing tobacco)?” | Tobacco | Include cigarettes, cigars, vaping, smokeless tobacco. |
| “...how often have you had 5 or more drinks (men)/4 or more drinks (women) containing alcohol in one day?” | Alcohol | Clarify “one occasion” = single day/evening. |
| “...How often have you used prescription meds just for the feeling, more than prescribed, or not prescribed to you?” | Prescription Meds (Non-Medical Use) | Clarify medical vs. non-medical use. |
| “...how often have you used any drugs including marijuana, cocaine or crack, heroin, methamphetamine (crystal meth), hallucinogens, ecstasy/MDMA?” | Other Drugs | Keep tone curious; acknowledge cannabis legality differences. |
TAPS Part 1 → Part 2 Routing
Part 1 uses a Likert scale (Never → Daily or almost daily) across 4 questions.
- If all 4 answers = “Never” → screening stops (no Part 2).
- If any answer = “Less than monthly” or more frequent on any of the 4 questions → continue to Part 2 (TAPS-2).
This ensures any patient reporting any substance use moves onto TAPS-2 for further assessment.
Step 3: TAPS-2 Administration
After TAPS-1 identifies the presence of substance use, the TAPS-2 is used to assess the nature of recent substance use. It focuses on the past 3 months and generates a subscale score for each substance category (e.g., alcohol, tobacco, cannabis, opioids).
Questions Content
TAPS-2 items are grouped by substance category (e.g., tobacco, alcohol, cannabis, opioids, stimulants). For each category, the questions ask about four main areas:
- Use in the past 3 months
- Simple yes/no to confirm any use.
- Frequency and intensity
- How often the substance is used (e.g., daily, weekly).
- For alcohol and tobacco: whether use meets heavy use thresholds.
- Control and dependence
- Failed attempts to cut down.
- Cravings or strong urges to use.
- Social and safety concerns
- Has anyone else expressed concern?
Scoring
Each “yes” response to substance-related questions = 1 point; “no” = 0.
- Interpretation:
- 0 = No use in the past 3 months.
- 1 = Problem use → may indicate risky patterns; further assessment is warranted.
- 2+ = Higher risk → strong predictive value for possible SUD per DSM-5 criteria.
- Risk considerations:
For alcohol, tobacco, and cannabis, a score of 2+ indicates high risk.
For other substances, any score ≥1 should prompt further evaluation.
The TAPS-2 is not diagnostic; instead, it flags patients who may need additional support. Its design supports efficient clinical decision-making while opening the door for safety-focused conversations.
Step 4: Assessing Risk Level and Supporting Safety
Use the Risk Level column for triage, the Clinical Focus & Actions column for next steps, and the Safety Prompts column for structured risk conversations in session.
TAPS-2 Clinical Decision-Making Guide
| Substance Category | Score | Interpretation | Risk Level | Clinical Focus & Actions | Safety Prompts |
| Tobacco, Alcohol, Cannabis | 0 | No use in past 3 months | Low | Maintain health; reinforce healthy habits; provide education; re-screen as needed. | — |
| 1 | Suggested problem use | Moderate | Set treatment goals; integrate safety planning; relapse prevention, peer support,Use motivational interviewing; discuss harm reduction; monitor over time. | • “Any withdrawal symptoms when cutting down?” • “Any blackouts?” • “Has anyone expressed concern for your safety?” • “Any self-harm or aggression when intoxicated?”
| |
| 2+ | Higher risk; potential SUD (DSM-5) | High | Full SUD assessment + evidence-based SUD therapy; HLOC evaluation, and/or Medications for Substance Use Disorders. | • All moderate prompts, plus:
• “What’s your plan if you feel at risk of unsafe use?” | |
Other Drugs (Cocaine, Stimulants, Sedatives, Opioids, Heroin, Hallucinogens, Inhalants, Other) | 0 | No use in past 3 months | Low | Maintain health; provide education; re-screen as needed. | — |
| 1 | Clinically significant → further eval recommended | Moderate | Set treatment goals; integrate safety planning; relapse prevention, peer support, Use motivational interviewing; discuss harm reduction; monitor over time. | • “Any withdrawal symptoms when cutting down?”
• “Has anyone expressed concern for your safety?” • “Any self-harm or aggression when intoxicated?” | |
| 2+ | High risk; strong predictive value for SUD | High | Same as above plus: Full SUD assessment + evidence-based SUD therapy; HLOC evaluation, and/or Medications for Substance Use Disorders. | • All moderate prompts, plus: • “Do you have naloxone/fentanyl test strips?” • “What’s your plan if you feel at risk of unsafe use?” |
This approach allows for a clearer picture of use patterns across different substances. If risks are identified, safety planning (also known as relapse prevention planning) may include:
- Identifying warning signs and coping strategies.
- Creating a list of supportive contacts.
- Providing information on crisis or detox services.
- Discussing overdose prevention (e.g., naloxone, fentanyl test strips).
- Sharing community resources (e.g. 12-step groups, crisis hotlines, etc).
Therapists can treat substance use disorders within their scope, often in parallel with mental health treatment.
Step 5: Documentation
- Record both scores and context (triggers, functional impact, coping strategies).
- Note the patient's goals, strengths, and agreed upon follow-up steps.
- Document any risk assessment findings and safety planning actions.
TAPS is most effective when it’s part of a collaborative conversation, not just a checklist. When administered with empathy, you can use the results to shape care. By doing so, you can play a key role in treating substance use disorders, tracking progress, and celebrating meaningful change.
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