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Screening for Substance Use in Adolescents

Pediatrics; ePub 2016 Jun 20; Levy, Williams, et al

The American Academy of Pediatrics (AAP) Committee on Substance Use and Prevention has issued a revised policy statement of its 2011 statement on substance use screening for pediatricians that offers clinical guidance about available substance use screening tools and intervention procedures. The statement, Substance Use Screening, Brief Intervention, and Referral to Treatment, also includes an accompanying clinical report that contains clinical guidance for pediatricians and other clinicians who provide health care for adolescents.

The AAP recommends that clinicians:

• Increase their capacity in substance use detection, assessment, and intervention.

• Become familiar with adolescent Screening for substance use, Brief Intervention, and/or Referral to Treatment (SBIRT) practices and their potential to be incorporated into universal screening and comprehensive care of adolescents in the medical home.

The AAP advocates for:

• The strong support of continued research to determine the most effective brief intervention strategies applicable to adolescent health care.

• Health insurance providers to:

◊ Promote and pay for standard screening and brief intervention practices incorporated into medical home health maintenance appointments.

◊ Ensure a standard mechanism for payment for confidential follow-up care of adolescents to receive continuity of care for substance use disorders.

• Parity of access and services for adolescent mental health and substance use disorder treatment compared with general adolescent care and adult health care.

Citation: Levy SJL, Williams JF, American Academy of Pediatrics Committee on Substance Use Prevention, 2015-2016. [Published online ahead of print June 20, 2016]. Pediatrics. doi:10.1542/peds.2016-1210.

Commentary: Generally, drug use among teenagers has to do with experimentation, risk taking, and social acceptance and less to do with the issue of addiction, which is more typical of adults. Twelve percent of eighth-graders and more than half of 12th-graders have been drunk at least once in their life.1 In 2012, 45% of ninth- through 12th-graders reported ever using marijuana, and 24% reported marijuana use in the past 30 days.2 Eight percent of teenagers report daily marijuana use, an increase of 60% over the last decade. Prescription drug abuse has been reported in 15% of 12th-graders.3 The idea of “brief intervention” described as part of SBIRT is a practical concept that allows a response that ranges from positive reinforcement of decisions not to use substances, to a discussion about stopping use in those who use substances infrequently, to a discussion about further help in those with regular use. What we say to adolescents in our offices, though often not feeling like it during the office visit, helps them to make healthy choices outside of the office.4Neil Skolnik, MD

1. University of Michigan. Drug abuse now equals childhood obesity as top health concern for kids. Vol 13. Ann Arbor, MI: University of Michigan, C.S. Mott Children’s Hospital; 2011. http://mottnpch.org/sites/default/files/documents/081511toptenreport.pdf. Accessed July 23, 2015.

2. US Department of Health and Human Services. Healthy people 2020: substance abuse objectives. Washington, DC: US Government Printing Office; 2011. www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=40Accessed July 23, 2015.

3. Levy SJ, Williams JF, AAP committee on substance use and prevention. Substance use screening, brief intervention, and referral to treatment. Pediatrics. 2016;138(1):e20161211.

4. Hassan A, Harris SK, Sherritt L, et al. Primary care follow-up plans for adolescents with substance use problems. Pediatrics. 2009;124(1):144–150.