Preventing youth substance use through access to early intervention
Of high school students 35 percent indicate they are current drinkers, 20 percent are binge drinkers, and 24 percent use marijuana (CDC, 2013 offsite link). By the time they are seniors 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: binge drinking, substance misuse and addiction leads to negative health and social outcomes, can exacerbate mental health problems, and create challenges being successful in school and in the workplace. It is a key contributing factor to the leading causes of injury and death among teens.
The likelihood of developing a substance use disorder is greatest for those who begin use of alcohol or other drugs 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.
Advance innovative prevention and early intervention approaches to reduce youth substance use and promote health and wellbeing.
Approach: Screening and Early Intervention
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 to 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 featuring Screening, Brief Intervention, and Referral to Treatment (SBIRT).
- Similar to other health screenings, SBIRT starts with asking a few basic questions about alcohol and drug use in a safe and confidential setting, like a physician’s office, school-based health clinic, or student health care center.
- A trained practitioner then engages the young person in a conversation to encourage them to make healthy choices and changes regarding risky activity such as substance use. Motivational interviewing (MI) is one evidence-based approach that is helpful in engaging adolescents in a conversation about how they can make decisions to maintain their health and/or decrease risky behaviors. MI is designed to support the adolescent’s autonomy, facilitate development of important life skills, and promote healthy choices.
- SBIRT is designed to address various levels of alcohol and drug use and incorporates responses that range from affirming a young person’s decision not to use alcohol and other drugs, to engaging the young person in a brief conversation about their drug or alcohol use, to referring the young person 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.
Once launched and spread, the language of SBIRT will become a part of standard primary care throughout [our] System. Thanks to the SBIRT grant award, we have been able to translate a lack of knowledge and training, and perhaps even a fear about where to start addressing this sensitive issue, into effective action that will change the system.
The Foundation is partnering with national medical and professional associations, medical educators, advocacy organizations, technical assistance providers, and research institutions to achieve three goals:
Here are examples of our current work and grantee partnerships in each goal area.
To ensure health providers have the knowledge and skills to provide screening and early intervention services:
- 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 improve funding for, access to, and implementation of screening and early intervention services:
- 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 conduct research and advance learning to improve screening and early intervention practices:
- University of Minnesota’s Center for Adolescent Substance Abuse Research is partnering with Kaiser Permanente Division of Research to study an SBIRT model for primary care and school settings that is tailored to adolescents and involves parents.