Screening and Brief Intervention for Underage Drinkers

Clark, Duncan B.; Gordon, Adam J.; Ettaro, Lorraine; Owens, Jill M.; Moss, Howard B.

doi:10.4065/mcp.2008.0638

Cited by 33 publications

(32 citation statements)

References 56 publications

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“…With CAGE showing poor psychometric properties in teens, attempts have been made to devise other problem-based screens. 11 CRAFFT 12 (Car, Relax, Alone, Forget, Friends, Trouble) has been the most extensively studied, and is comprised of three substance use questions and six substance problem questions. Although found to have acceptable psychometric properties in some studies, 12 the specificity of the CRAFFT has been unacceptably low in some clinical settings 13 and inferior to screening based on substance use frequency.…”

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confidence: 99%

Screening for Underage Drinking and Diagnostic and Statistical Manual of Mental Disorders, 5th Edition Alcohol Use Disorder in Rural Primary Care Practice

Clark

Martin

Chung

et al. 2016

The Journal of Pediatrics

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Objective To examine the NIAAA Youth Guide alcohol frequency screening thresholds when applied to DSM-5 diagnostic criteria, and to describe alcohol use patterns and AUD characteristics in rural youth from primary care settings. Study design Adolescents (n=1193; ages 12 through 20) visiting their PCP for outpatient visits in six rural primary care clinics were assessed prior to their practitioner visit. A tablet computer collected youth self-report of past-year frequency and quantity of alcohol use and DSM-5 AUD symptoms. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were determined Results ; For early adolescents (ages 12 through 14), 1.9% met DSM-5 criteria for past-year AUD and ≥3 days with alcohol use in the past year yielded a screen for DSM-5 with optimal psychometric properties (sensitivity: 89%; specificity: 95%; PPV: 37%; NPV: 100%). For middle adolescents (ages 15 through 17), 9.5% met DSM-5 AUD criteria, and ≥3 past year drinking days showed optimal screening results (sensitivity: 91%; specificity: 89%; PPV: 50%; NPV: 99%). For late adolescents (ages 18 through 20), 10.0% met DSM-5 AUD criteria, and ≥12 past year drinking days showed optimal screening results (sensitivity: 92%; specificity: 75%; PPV: 31%; NPV: 99%). The age stratified NIAAA frequency thresholds also produced effective results. Conclusion In rural primary care clinics, 10% of youth over age 14 had a past-year DSM-5 AUD. These at-risk adolescents can be identified with a single question on alcohol use frequency.

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confidence: 99%

Screening for Underage Drinking and Diagnostic and Statistical Manual of Mental Disorders, 5th Edition Alcohol Use Disorder in Rural Primary Care Practice

Clark

Martin

Chung

et al. 2016

The Journal of Pediatrics

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“…Pediatric SBIRT is not widely implemented, however, and despite calls for more research, 1 to our knowledge, few studies 19,20 have examined its implementation. Evidence suggests that adolescent SBIRT is effective, but we know little about contextual factors, such as settings, screening tools, staffing approaches, and use of electronic health records (EHRs).…”

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Implementation of Screening, Brief Intervention, and Referral to Treatment for Adolescents in Pediatric Primary Care

et al. 2015

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IMPORTANCE Early intervention for substance use is critical to improving adolescent outcomes. Studies have found promising results for Screening, Brief Intervention, and Referral to Treatment (SBIRT), but little research has examined implementation.OBJECTIVE To compare SBIRT implementation in pediatric primary care among trained pediatricians, pediatricians working in coordination with embedded behavioral health care practitioners (BHCPs), and usual care (UC). DESIGN, SETTING, AND PARTICIPANTSThe study is a 2-year (November 1, 2011, through October 31, 2013), nonblinded, cluster randomized, hybrid implementation and effectiveness trial examining SBIRT implementation outcomes across 2 modalities of implementation and UC. Fifty-two pediatricians from a large general pediatrics clinic in an integrated health care system were randomized to 1 of 3 SBIRT implementation arms; patients aged 12 to 18 years were eligible.INTERVENTIONS Two modes of SBIRT implementation, (1) pediatrician only (pediatricians trained to provide SBIRT) and (2) embedded BHCP (BHCP trained to provide SBIRT), and(3) UC.MAIN OUTCOMES AND MEASURES Implementation of SBIRT (primary outcome), which included assessments, brief interventions, and referrals to specialty substance use and mental health treatment. RESULTSThe final sample included 1871 eligible patients among 47 pediatricians; health care professional characteristics did not differ across study arms. Patients in the pediatrician-only (adjusted odds ratio [AOR], 10.37; 95% CI, 5.45-19.74; P < .001) and the embedded BHCP (AOR, 18.09; 95% CI, 9.69-33.77; P < .001) arms had higher odds of receiving brief interventions compared with patients in the UC arm. Patients in the embedded BHCP arm were more likely to receive brief interventions compared with those in the pediatrician-only arm (AOR, 1.74; 95% CI, 1.31-2.31; P < .001). The embedded BHCP arm had lower odds of receiving a referral compared with the pediatrician-only (AOR, 0.58; 95% CI, 0.43-0.78; P < .001) and UC (AOR, 0.65; 95% CI, 0.48-0.89; P = .006) arms; odds of referrals did not differ between the pediatrician-only and UC arms. CONCLUSIONS AND RELEVANCEThe intervention arms had better screening, assessment, and brief intervention rates than the UC arm. Patients in the pediatrician-only and UC arms had higher odds of being referred to specialty treatment than those in the embedded BHCP arm, suggesting lingering barriers to having pediatricians fully address substance use in primary care. Findings also highlight age and ethnic groups less likely to receive these important services.

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“…10,11 More recently, developmentally appropriate tools and strategies have been designed specifically for use with adolescents. [12][13][14][15] Experience with substances can be considered a spectrum that varies from primary abstinence to addiction. The goal of applying universal SBIRT with adolescents is to identify an individual's experience along this spectrum and institute the appropriate intervention for each adolescent at every health care visit.…”

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confidence: 99%

Substance Use Screening, Brief Intervention, and Referral to Treatment for Pediatricians

Levy¹,

Kokotailo²

2011

Pediatrics

167

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As a component of comprehensive pediatric care, adolescents should receive appropriate guidance regarding substance use during routine clinical care. This statement addresses practitioner challenges posed by the spectrum of pediatric substance use and presents an algorithmbased approach to augment the pediatrician's confidence and abilities related to substance use screening, brief intervention, and referral to treatment in the primary care setting. Adolescents with addictions should be managed collaboratively (or comanaged) with child and adolescent mental health or addiction specialists. This statement reviews recommended referral guidelines that are based on established patient-treatment-matching criteria and the risk level for substance abuse. Pediatrics 2011;128:e1330-e1340 INTRODUCTIONAlthough it is common for adolescents and young adults to try moodaltering chemicals, including nicotine, it is important that this experimentation not be condoned, facilitated, or trivialized by adults including parents, teachers, and health care providers. Use of alcohol and other drugs remains a leading cause of morbidity and mortality for young people in the United States. 1,2 Even the first use of alcohol or another drug can result in tragic consequences such as unintentional injury or death. All substance use involves health risks that can occur long before there is drug addiction, and teenagers seem to be particularly susceptible to health risk-taking behaviors and injuries related to alcohol, tobacco, and other drug use. 3,4 In addition, research has established that adolescence is a period of neurodevelopmental vulnerability for developing addictions; age at first use is inversely correlated with lifetime incidence of developing a substance use disorder. [4][5][6] The pediatrician has a well-recognized and important professional and societal role in the prevention, detection, and management of all pediatric health risks and disorders, including tobacco, alcohol, and other drug use among children and adolescents. Consistent with Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents,7 primary care practitioners are ideally suited for preventing problem behaviors and consistently screening for them, including the development of mental health disorders and psychosocial problems, among which are substance use and addiction. The nonuse message should be reinforced by pediatricians through clear and consistent information presented to patients, parents, and other family members COMMITTEE ON SUBSTANCE ABUSE KEY WORDS alcohol, screening, SBIRT, substance abuse ABBREVIATIONS SBIRT-screening, brief intervention, and referral to treatment AAP

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Screening and Brief Intervention for Underage Drinkers

Cited by 33 publications

References 56 publications

Screening for Underage Drinking and Diagnostic and Statistical Manual of Mental Disorders, 5th Edition Alcohol Use Disorder in Rural Primary Care Practice

Screening for Underage Drinking and Diagnostic and Statistical Manual of Mental Disorders, 5th Edition Alcohol Use Disorder in Rural Primary Care Practice

Implementation of Screening, Brief Intervention, and Referral to Treatment for Adolescents in Pediatric Primary Care

Substance Use Screening, Brief Intervention, and Referral to Treatment for Pediatricians

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