Computer-Facilitated Substance Use Screening and Brief Advice for Teens in Primary Care: An International Trial

Abstract

WHAT'S KNOWN ON THIS SUBJECT: Primary care settings provide an important venue for early detection of substance use and intervention, but adolescent screening rates need improvement. Screening and brief interventions appear effective in reducing adult problem drinking but evidence for effectiveness among adolescents is needed. WHAT THIS STUDY ADDS:A computer-facilitated system for screening, feedback, and provider brief advice for primary care can increase adolescent receipt of substance use screening across a variety of practice settings, and shows promise for reducing adolescents' use of alcohol and cannabis. abstract OBJECTIVE: Primary care providers need effective strategies for substance use screening and brief counseling of adolescents. We examined the effects of a new computer-facilitated screening and provider brief advice (cSBA) system. METHODS:We used a quasi-experimental, asynchronous study design in which each site served as its own control. From 2005 to 2008, 12-to 18-year-olds arriving for routine care at 9 medical offices in New England (n = 2096, 58% females) and 10 in Prague, Czech Republic (n = 589, 47% females) were recruited. Patients completed measurements only during the initial treatment-as-usual study phase. We then conducted 1-hour provider training, and initiated the cSBA phase. Before seeing the provider, all cSBA participants completed a computerized screen, and then viewed screening results, scientific information, and true-life stories illustrating substance use harms. Providers received screening results and "talking points" designed to prompt 2 to 3 minutes of brief advice. We examined alcohol and cannabis use, initiation, and cessation rates over the past 90 days at 3-month follow-up, and over the past 12 months at 12-month follow-up. RESULTS:Compared with treatment as usual, cSBA patients reported less alcohol use at follow-up in New England (3-month rates 15.5% vs 22.9%, adjusted relative risk ratio [aRRR] = 0.54, 95% confidence interval 0.38-0.77; 12-month rates 29.3% vs 37.5%, aRRR = 0.73, 0.57-0.92), and less cannabis use in Prague (3-month rates 5.5% vs 9.8%, aRRR = 0.37, 0.17-0.77; 12-month rates 17.0% vs 28.7%, aRRR = 0.47, 0.32-0.71). CONCLUSIONS:Computer-facilitated screening and provider brief advice appears promising for reducing substance use among adolescent primary care patients.

Point Prevalence of Co-Occurring Behavioral Health Conditions and Associated Chronic Disease Burden Among Adolescents

“…There is a growing body of literature suggesting that screening, brief intervention, and referral to treatment (SBIRT) can be an effective approach to integrating the identification and brief treatment into pediatric primary care settings. [44][45][46] Similarly, a recent systematic meta-analysis found significantly better outcomes across studies for adolescents treated for mental health problems using an integrated medical-behavioral health approach. 47 Such approaches are also consistent with the patientcentered medical home model, which uses a team-based approach to care and frequently integrates behavioral health services into primary care.…”

Peer Network Counseling as Brief Treatment for Urban Adolescent Heavy Cannabis Users

“…Motivational interviewing fits well within pediatric health care settings (Erickson et al, 2005) and is considered an evidenced-based, frontline approach to reducing substance use through increased levels of patientcentered care, shared decision making, and improved clini-cian-patient relationships (Anstiss, 2009;Rollnick et al, 2008). Brief interventions targeting cannabis have shown favorable results, with single sessions reducing use among pediatric emergency department patients (Bernstein et al, 2009), and primary care patients using screening and brief advice (Harris et al, 2012). A study that compared computer-delivered brief interventions against therapistdelivered brief interventions found that computer-delivered brief interventions reduced cannabis-related consequences (e.g., interpersonal, financial problems), whereas therapistdelivered brief interventions reduced driving under the influence (Walton et al, 2013).…”

State-of-the-Art Office-Based Interventions to Eliminate Youth Tobacco Use: The Past Decade

“…102,103 Another promising area of research is the use of selfadministered computer-facilitated screening tools combined with brief clinician intervention. 104 Internetbased intervention, including smart phone applications and social media, may also have utility in clinical settings and warrant investigation. And lastly, given the significance of nicotine addiction, pharmacotherapy and combination pharmacotherapy deserve additional study in both adolescents and young adults.…”