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

Abstract

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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Web-based training for primary care providers on screening, brief intervention, and referral to treatment (SBIRT) for alcohol, tobacco, and other drugs

“…Nonetheless, a consensus group convened by the National Institute on Drug Abuse recently came out in support of providing care for substance use disorders, including risky drug use, in primary care settings (McLellan et al, 2014). Moreover, the U.S. Preventive Services Task Force recommends that primary care providers (PCPs) routinely screen adult patients for alcohol use and provide brief behavioral counseling interventions to those engaged in risky or hazardous drinking (Moyer, 2013), echoing similar recommendations by the American Society of Addiction Medicine (American Society of Addiction Medicine, 1997), the National Institute on Alcohol Abuse and Alcoholism (National Institute on Alcohol Abuse and Alcoholism, 2007), the American College of Obstetricians and Gynecologists (American College of Obstetricians and Gynecologists, 2011), and the American Academy of Pediatrics (Levy & Kokotailo, 2011). In addition, the current clinical practice guideline from the U.S. Preventive Services Task Force, convened by the Agency for Healthcare Research and Quality as authorized by the U.S. Congress, recommends that clinicians and health-care delivery systems identify and document tobacco use status and use a brief intervention for every tobacco user seen in a healthcare setting (U.S.…”

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“…[6][7][8][9] The American Academy of Pediatrics (AAP) recommends screening all adolescent patients for tobacco, alcohol, and other drug use utilizing the SBIRT process and has strongly encouraged pediatricians to develop the skills and confidence necessary to adequately manage adolescent patients with substance use problems. 10 In addition, screening for substance use is an integral part of prevention efforts of US health care reform through the Affordable Care Act. 11 Despite this recommendation, fewer than 50% of general pediatricians reported screening all adolescent patients for drug and alcohol use in their practice.…”