Substance Use Screening in Dentistry: Gaps, Barriers, and Opportunities Identified

• Publications Highlights

A newly published study in The Journal of Studies on Alcohol and Drugs offers compelling evidence that dental professionals are uniquely positioned to play a greater role in addressing substance use disorders (SUDs)—and many are ready to do so.

Study Overview

Led by Dr. Jenna McCauley and colleagues from the National Dental Practice-Based Research Network (PBRN), this national survey of 790 U.S. dentists assessed current practices, attitudes, and barriers related to screening, counseling, and referring adult patients for substance use issues.

Key Findings

High Willingness, Limited Implementation

While most dentists reported a willingness to screen for SUDs, actual implementation remains inconsistent. Practitioners reported conducting screenings at least annually (or more often) for the following substances:

• Nicotine: 58%
• Alcohol: 42%
• Cannabis: 38%
• Illicit drugs: 39%

Counseling Gaps

Over 40% of dentists reported never counseling patients about alcohol, cannabis, or illicit drug use—even when problematic use was identified.

Referral Knowledge is Limited

Only one-third of dentists felt knowledgeable about referring patients for tobacco-related treatment. Familiarity with referral options for alcohol, cannabis, and illicit drug use was even lower.

Barriers Identified

Four key barriers emerged:

• Lack of training and resources
• Beliefs about relevance, responsibility, and effectiveness
• Concerns about patient discomfort or dishonesty
• Time constraints

Stigma is Low, Relevance is Recognized

Encouragingly, most dentists rejected stigmatizing beliefs about SUDs and agreed that substance use is relevant to oral health and within the scope of dental practice.

Practical Implications

This study highlights a significant opportunity for the dental profession:

Training and Tools

Dentists expressed strong interest in additional training, practical tools, and clear referral pathways to support SUD screening and intervention.

Reimbursement as a Lever

Third-party reimbursement was identified as a key facilitator for increasing engagement in SUD-related care.

Tobacco Cessation as a Model

The success of tobacco cessation efforts in dental settings offers a blueprint for expanding to other substances.

SBIRT in Dentistry

Integrating Screening, Brief Intervention, and Referral to Treatment (SBIRT) models—already used in primary care—could help close the gap between willingness and action in dental practices.

Why This Matters

Dentists often see patients more regularly than other healthcare providers and build long-term relationships that can support early identification and intervention. With substance use disorders contributing to significant morbidity, mortality, and healthcare costs, dental professionals have a critical role to play. This study provides a roadmap for how the profession can move forward—through additional research, targeted training, system-level supports, and policy changes that recognize and reimburse the important role dentists can play in addressing substance use. In addition to this survey, the Network is contributing to research by conducting a trial testing SBIRT combined with nicotine patch distribution by dentists. The results of this smoking cessation study, the FreSH study, led by Sandra Japuntich, are expected soon. Dentists and dental hygienists who wish to implement screenings for SUDS can use the NIDAMED’s chart to quickly identify the best tools for their practice needs and integrate substance use screening into patient care. The full chart is available on the NIDAMED website.

Resources

Read more about the SUDS study.

Read more about the FreSH study.

Screenings in the dental settings https://nida.nih.gov/nidamed-medical-health-professionals/science-to-medicine/screening-substance-use/in-dental-setting

Screening Tools: https://nida.nih.gov/nidamed-medical-health-professionals/science-to-medicine/screening-substance-use/in-dental-setting

References

McCauley JL, Crawford P, Leo MC, McBurnie MA, Barton D, Weidner HA, Rindal DB, National Dental PBRN Collaborative Group. Dental screening, counseling, and referral to treatment for substance use disorder: survey of the National Dental Practice-Based Research Network. Journal of Studies on Alcohol and Drugs 2025; in press.