Date of Graduation

Spring 5-17-2024

Document Type


Degree Name

Doctor of Nursing Practice (DNP)


School of Nursing and Health Professions




Psychiatric Mental Health Nurse Practitioner

First Advisor

Dr. Trinette Radasa

Second Advisor

Dr. Ricky Norwood



Background: Co-occurring disorders include substance use disorders and mental health conditions. These disorders affect 21.5 million individuals. Mental health screening tools, such as the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder Scale (GAD-7), are effective in screening individuals for depressive and anxiety mental health conditions within addiction settings.

Problem: Of those with an anxiety disorder, 20-40% will be diagnosed with an alcohol use disorder (AUD). Depressive disorders are the most common mental health conditions that can occur alongside an AUD. A literature review revealed that the PHQ-9 and GAD-7 are used in addiction treatment settings; however, not as frequently as needed. A retrospective chart analysis of thirty charts in an outpatient alcohol use disorder telehealth clinic found that only three percent of clinical staff were implementing the PHQ-9 and GAD-7.

Methods: A twelve-item pretest and eight-item posttest were distributed to clinical staff (physicians, psychiatric mental health nurse practitioners [PMHNPs], family nurse practitioners [FNPs], registered nurses [RNs], and medical assistants [MAs]) in an outpatient AUD telehealth clinic. The goal was to measure and further increase clinical staff knowledge, awareness, and confidence in screening for co-occurring depressive and anxiety disorders with the PHQ-9 and GAD-7. Knowledge and confidence of common depressive and anxiety disorders that can co-occur with AUD was also measured.

Interventions: An online workflow and toolkit were designed and distributed to clinical staff. The workflow and toolkit consisted of refreshers on the PHQ-9 and GAD-7, when to utilize them, and associated depressive and anxiety conditions that can manifest alongside an AUD.

Results: Sixteen clinical staff completed the pre and posttests. Overall, knowledge, awareness, and confidence increased by 14.72% from baseline.

Conclusions: The workflow and toolkit increased clinical staff knowledge and confidence in the value of using these mental health screening tools. However, there was a small sample size, which limited generalizability. Clinical staff feedback on the intervention was positive and related to their understanding of when to utilize the PHQ-9 and GAD-7 in applicable AUD patients. Due to the increased learning gained from RNs and MAs, future research could be focused on incorporating RNs and MAs. RNs and MAs could distribute mental health screening tools to patients before the provider interprets the scores with patients. Doing so would help save providers time.

Keywords: alcohol use disorder, anxiety screening tool, co-occurring disorder, depression screening tool, GAD-7, PHQ-9, substance use disorders

Included in

Nursing Commons