Substance abuse screening

Substance abuse prevention and early intervention

Substance abuse is costly to individuals and society: it is a cause of violent and risky behaviors, a barrier to successful academic performance and career advancement, and a key contributing factor to the leading causes of death among teens. The Conrad N. Hilton Foundation has funded substance abuse prevention since 1982. The majority of the Foundation's $68 million investment funded the development and dissemination of Project ALERT, a substance abuse prevention curriculum for middle school students.

Experts' understanding of substance abuse has evolved with time and experience. In the 1980s, substance abuse was widely viewed as a moral failure. By the 1990s, it was regarded as a social behavior rooted in complex cultural norms. Experts today address substance abuse as a health issue—a preventable and treatable chronic condition. This public health perspective informs the Foundation's new strategic direction.

Youth is the critical period to prevent substance abuse disorders. The human brain—including the areas that support decision making and impulse control—is not fully developed until age 25. Addiction develops more easily in the adolescent brain than in the adult brain because it is still growing. The chances of developing an addiction are nearly seven times higher for people who begin using addictive substances before age 15 than for those who delay use until age 21 or older.


Youth substance use and abuse are detected and addressed early, which provides a path towards healthy living.


Due to youth's vulnerability and the potential lifetime consequences of substance abuse, the Foundation has focused its strategy on improving substance abuse outcomes for youth age 15-22 by means of early intervention.

Prevention-Treatment Continuum

Prevention Treatment Continuum

Early intervention primarily focuses on high-risk users but research shows that it has some primary prevention benefits as well, by reinforcing the positive behavior of the non-users and low-risk users who are screened. Early intervention models bridge prevention and treatment and seek to interrupt abusive behavior before addiction develops.

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

Screening, Brief Intervention, and Referral to Treatment

Screening, Brief Intervention, and Referral to Treatment (SBIRT) is the most widely tested and used early intervention model.  To illustrate the SBIRT model, the figure above shows a youth encountering SBIRT in a health care setting such as his primary care physician's office, at his school, or as an online questionnaire. First, this youth would be asked a series of screening questions to determine his level of risk. If he is abstaining from using substances, he would receive positive reinforcement and education on the risks of substance use. If he displays a mid- to high-risk profile, he would be given a brief intervention, ranging from a motivational conversation to a multi-day workshop. If he displays a severe abuse problem, he would be referred to an addiction treatment provider.

There is strong evidence for the effectiveness of SBIRT with adults' alcohol and drug use across a variety of settings. The evidence base for youth is limited but promising. Despite its promise, 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 Hilton Foundation will partner with national medical and professional associations, medical educators, advocacy organizations, technical assistance providers, and research institutions to:

  1. Increase skills and knowledge of SBIRT within the medical community serving youth.
  2. Improve the implementation of SBIRT services for youth
  3. Strengthen the evidence base and promote learning

Foundation Strategy Documents

Substance abuse prevention and early intervention