Screening and brief interventions for adolescent substance use in the general office setting

Use of substances (alcohol and other drugs) by adolescents is ubiquitous and is associated with injuries, both intentional and unintentional, that are the leading causes of death in this age group (Eaton et al. 2008). Before finishing high school, more than 40% of teens have tried marijuana and 72% have drunk alcohol (Johnston et al. 2008). Although these percentages have declined slightly during the past decade, they remain quite high. Of particular concern, use of prescription narcotic medications has risen dramatically since 2001 (Johnston et al. 2008), and many adolescents believe that prescription medications are "safe" even when used without a doctor's prescription (Friedman 2006).
Annual well-care visits provide an opportunity for physicians to screen adolescent patients in a confidential setting and to provide individualized advice about the health risks associated with drug use. Research has demonstrated that even very brief medical advice from a physician can have a significant impact on the behavior of adults and results in significant cost savings (Babor et al. 2007). Preliminary research suggests that brief advice from a primary care provider can significantly decrease drinking by adolescents.
To be practical, screening must be easy to administer and must distinguish accurately between risk groups so that a physician can quickly determine the appropriate level of intervention. In this chapter, we describe a practical framework that can be used for screening and brief intervention for adolescent substance use and then demonstrate how appropriate tools may be used by presenting case vignettes.