Substance Abuse  Anual Report 2014

Youth substance use prevention and early intervention

By the time they are seniors, almost 70 percent of high school students will have tried alcohol, half will have taken an illegal drug, nearly 40 percent will have smoked a cigarette, and more than 20 percent will have used a prescription drug for a nonmedical purpose (National Institute on Drug Abuse, 2014). Substance use disorders are costly to individuals, families, and communities: substance misuse and addiction leads to negative health, social, and behavioral outcomes including physical and mental health problems, challenges being successful in school and in the workplace, and is a key contributing factor to the leading causes of death among teens. 

The likelihood of developing a substance use disorder is greatest for those who begin use in their early teens. According to the National Institute on Drug Abuse, the majority of individuals who become addicted started using before age 18 and developed their disorder by age 20. 

“The teenage years are a critical window of vulnerability to substance use disorders. The adolescent brain is often likened to a car with a fully functioning gas pedal (the reward system) but weak brakes (the prefrontal cortex). Teenagers are highly motivated to pursue pleasurable rewards and avoid pain, but their judgment and decision-making skills are still limited. This affects their ability to weigh risks accurately and make sound decisions, including decisions about using drugs."

- National Institute on Drug Abuse (2014). Principles of Adolescent Substance Use Distorder Treatment: A Research-Based Guide.

The Majority of Young Adults in Treatment Started Using Alcohol and/or Drugs Before they were 18



Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (July 17, 2014). The TEDS Report: Age of Substance Use Initiation among Treatment Admissions Aged 18 to 30. Rockville, MD.


Advancing innovative prevention and early intervention approaches to reduce youth substance use and promote health and wellbeing.


Due to youth's vulnerability and the potential lifetime consequences of substance use disorders, the Foundation's strategic initiative is focused on prevention and early intervention for youth age 15-22.

To find better ways of addressing alcohol or other drug use among youth early on, before addiction has developed, the Foundation is investing in a public health approach called Screening, Brief Intervention, and Referral to Treatment (SBIRT). 

Focusing on Screening, Brief Intervention, and Referral to Treatment (SBIRT)


SBIRT is a public health approach developed primarily for adults that also shows promise for youth. Similar to other health screenings, SBIRT starts with asking youth people a few basic questions about their alcohol and drug use in a safe and confidential setting, like a physician's office, school-based health clinic, or student health center. A trained practitioner then engages the youth in a conversation about alochol and drug use and its impact on their health and life goals. This approach is designed to address various levels of alcohol and drug use and incorporates responses that range from affirming a youth's decision not to use alcohol or other drugs, providing brief advice or counseling about the range of health risks and social harms related to alcohol and drug use at an early age, to referral to addiction treatment services. 

There is strong evidence that SBIRT is effective in reducing problematic alcohol use in adults across a variety of settings. The evidence base for youth is promising. The American Academy of Pediatrics recommends SBIRT for substance use screening as part of routine adolescent care. The National Institute on Drug Abuse's Principles of Effective Adolescent Treatment emphasize the importance of identifying and intervening in drug use early and recommend that health care providers ask adolescents about substance use as part of routine annual medical visits. Despite these endorsements, SBIRT is rarely taught in medical or nursing schools, and its practice is largely limited to clinical settings that reach only a small percentage of the nation's youth. 

The Foundation is partnering with national medical and professional associations, medical educators, advocacy organizations, technical assistance providers, and research institutions to achieve the strategic initiative's goals: 


These goals are accomplished through partnering with our grantees.

To ensure health providers have the knowledge and skills to provide SBIRT:

  • The ABAM Foundation established the National Center for Physician Training in Addiction Medicine, to increase the number of physicians who are educated and trained in prevention, early intervention, and treatment of adolescent substance use disorders.
  • The American Academy of Pediatrics is increasing the use of SBIRT among pediatric providers.

To expand access to, increase funding for, and strengthen the implementation of SBIRT: 

  • The New Hampshire Charitable Foundation is working to expand SBIRT for adolescents in New Hampshire and advocate for state policy changes to sustain SBIRT financing. 
  • Community Catalyst is developing consumer-led advocacy campaigns in five states (Georgia, Massachusetts, New Jersey, Ohio, and Wisconsin) to enact state policy change to increase funding and training for SBIRT. 

To strengthen the evidence base and foster learning to improve prevention and early intervention:


Foundation Strategy Documents


Key Resources

National Institute on Drug Abuse: Principles of Adolescent Substance Use Disorder Treatment

American Academy of Pediatrics: Recommends Substance Use Screening as Part of Routine Adolescent Care

National Institute on Alcohol Abuse and Alcoholism: Alcohol Screening and Brief Intervention for Youth Guide

Substance Abuse and Mental Health Services Administration: Screning, Brief Intervention, and Referral to Treatment