Medical Professionals: Screen Youth and Young Adults for Substance Use at Every Healthcare Exam

SAMHSA is working to raise awareness among primary care providers about the importance of screening all youth and young adults for substance use at every healthcare exam beginning at age 12, per the American Academy of Pediatrics (AAP) recommendations.

Screening is the first step in the Screening, Brief Intervention, and Referral to Treatment (SBIRT) evidence-based approach to identifying patients who may be using alcohol or drugs, and then taking steps as needed to address their substance use. Youth who screen positive should receive a brief intervention, which consists of a motivational interview and tailored advice. Primary care providers should refer youth with substance use disorders to treatment. Use SAMHSA’s FindTreatment.gov tool to learn about treatment resources for patients who need help with substance use disorders.

Substance use screening and early intervention for adolescents and young adults have proven benefits. Evidence shows short-term benefits and long-term positive outcomes among adolescent patients who were screened for substance use as part of SBIRT in pediatric primary care. Adolescent patients who were exposed to SBIRT had significantly fewer substance use disorders and less primary healthcare utilization (over a period of seven years after the initial screening) than adolescents who were not screened. Primary care providers should think of substance use as a pediatric onset condition and discuss the issue with patients and their parents.

Screening in primary care is beneficial because it is less stigmatizing than seeing an addiction specialist or psychiatrist. Most adolescents, whether they have public or private insurance, have access to primary care, which offers an opportune setting for preventing and intervening early in behavioral health problems.

Despite evidence of the efficacy of substance use screening, medical professionals do not widely use screening tools. Multiple barriers have been found to prevent providers from consistently implementing AAP screening recommendations for adolescent substance use, including the following:

• Limited time
• Competing medical and mental health problems
• Hesitance to screen when treatment resources are limited
• Lack of knowledge about or training in screening tools and their uses
• Concerns about confidentiality
• Doubt regarding youth patients’ honesty in reporting risky behaviors
• Lack of parental support for screening
• Billing and reimbursement issues

SAMHSA offers the following tips for primary care providers who care for youth, and young adults:

1. Screen all youth and young adult patients for substance use at every visit beginning at age 12.
2. Screening is typically not time-consuming. According to SAMHSA’s Advisory: Screening and Treatment of Substance Use Disorders among Adolescents, providers can screen adolescents for substance use in as little as two minutes.
3. Hold substance use screening and SBIRT training sessions during routine staff meetings or implement in-person training sessions to boost provider knowledge and confidence.
4. Reassure parents that talking about substance use is an important prevention tool.
5. Reassure patients under age 18 that their discussions with primary care practitioners are confidential unless they are in imminent danger.