New research shows that SBIRT — screening, brief intervention, and referral to treatment for drug misuse — is effective at preventing substance use in adolescents in a variety of clinical settings.
In a collection of 12 articles published as a supplement to the Journal of Adolescent Health, investigators offered new perspectives on the role of the approach in adolescent health, research that may ultimately provide the foundation for developing evidence-based policies and effective support for young people at risk for substance-use disorders, experts said.
"As a pediatrician and addiction specialist, I know how important it is for primary care doctors to understand adolescent substance use," said Scott E. Hadland, MD, MPH, MS, chief of the Division of Adolescent and Young Adult Medicine at Massachusetts General Hospital for Children and Harvard Medical School, Boston, Massachusetts. "And yet, I think many primary care physicians feel ill-equipped to ask the questions, and then when they do learn that a young person is using substances, they don't know what to do with that information. That's why SBIRT is so important, because it gives the full toolkit needed to examine this."
Substance-use disorders typically emerge during adolescence, making this period a critical time for intervention. Overdose deaths have risen dramatically during the COVID-19 pandemic, with mortality increasing among youth by 94% between 2019 and 2020 and 20% from 2020 to 2021.
Substance-use disorders are associated with a host of adverse physical health outcomes, including the transmission of various diseases, mental health problems, and the risk for addiction.
Given the potential benefits of early intervention in substance-use disorder, the American Academy of Pediatrics currently recommends use of SBIRT, an integrated public-health approach to the delivery of early intervention and treatment services for people at risk of developing substance-use disorders.
As part of that process, adolescents complete a validated instrument to identify substance use (Screening), receive counseling on minimizing substance use (Brief Intervention), and, if necessary, get connected to formal substance-use disorder treatment (Referral to Treatment).
In the supplement, researchers examined the implementation of SBIRT across a range of settings: healthcare facilities, schools, communities, and juvenile justice programs. Highlights of this research include:
Adolescents in SBIRT programs delivered by pediatricians were less likely to be diagnosed with substance use and to be hospitalized than were those who underwent usual care at the hands of pediatricians. According to a randomized controlled trial of more than 1800 adolescents (ages 12-18 years), the benefits of SBIRT on substance use and healthcare needs persisted well into young adulthood.
Middle-school students were satisfied with a school-based SBIRT model in King County, Washington. The study included 3253 students, 116 of whom completed a postintervention survey. Nearly all students rated their experience as "good" or better, according to the researchers. Meanwhile, participation in the program resulted in stronger connections between students and the school, they added.
School-based health centers are a viable setting for screening and detecting adolescents at risk for substance use disorders. As part of a study of 1077 high-school students in Albuquerque, New Mexico, adolescents who presented to these health centers completed a questionnaire that included a formal screening for substance use. Youth who reported using substances were most likely to engage in a follow-up assessment if they had contact with a behavioral healthcare provider within 2 weeks of the positive screen.
Pediatric rheumatologists and endocrinologists do not routinely screen their adolescent patients for substance use, despite many having concerns about the effects of alcohol and marijuana on their patients. A national survey of 225 clinicians identified several barriers to screening, even as roughly 75% of respondents agreed that screening youth for substance use fell within their clinical purview.
"The articles in the supplement make a strong case for performing SBIRT in multiple settings," said Kaitlin Sheedy, MPH, a senior associate at Abt Associates, a health research group, who acted as project director for the program. "Many families and young people can't afford doctor visits or don't live near a clinic. These articles show that the SBIRT framework works not only in healthcare settings, but also in other places like school, juvenile justice programs, and other community-based programs. This may also help tackle some of the racial disparities evident in access to services and treatment."
For Hadland, the supplement serves another much-needed role: It helps build the evidence base for the utility of SBIRT in adolescents, which he says has been "lacking" to date.
"To be clear, we don't yet have enough evidence to be certain that this is the right practice," he told Medscape Medical News. "We need evidence to not only demonstrate the potential clinical effectiveness of SBIRT, but also evidence to show the approach is cost-effective as well. But the bottom line is, this is probably an important practice for us to be engaging in. Clinician[s] should be having these conversations."
J Adolesc Health. Published online October 2022. Supplement
Sheedy is an employee of Abt Associates. Hadland reports no relevant financial relationships. The research was funded by the Conrad N. Hilton Foundation.
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Image 1: Scott E. Hadland, MD, MPH, MS
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Cite this: SBIRT Helps Address Substance-Use Disorders in Adolescents - Medscape - Sep 27, 2022.