70.1 SUBSTANCE SCREENING, BRIEF INTERVENTION, AND REFERRAL TO TREATMENT (SBIRT): IS IT WORKING FOR ADOLESCENTS?

Abstract

The objectives of this presentation are to: 1) review the principles of Screening, Brief Intervention, and Referral to Treatment (SBIRT); and 2) review adolescent outcomes of SBIRT implementation. A review of the literature was conducted in PubMed. We will review validated adolescent substance use screens and utilize case vignettes with examples of brief interventions, including referral to treatment, that illustrate the foundational principles of SBIRT. Substance use and other clinical outcomes, including specialty care follow-up, will be reviewed. An estimated 14.4% of youth ages 12 to 18 years old meet the DSM-5 criteria for a substance use disorder (SUD), of whom less than 10% receive treatment. Universal substance use screening, brief intervention (BI), and referral to treatment (RT) is recommended starting at age 12 years old. BI is an evidence-based, individualized intervention to respond to adolescent substance use screening results. Utilization of BI is associated with significant efforts to change substance use behaviors, including reduction in binge drinking episodes, drinking and driving, and alcohol-related injuries. While studies show that BI is associated with an overall decrease in cannabis and other illicit drug use, results for alcohol consumption are mixed. Adolescents who receive BI also have fewer acute care visits and lower use of outpatient services, including mental health. To date, the majority of “SBIRT” studies do not report on RT or adolescent follow-up with substance use treatment specialists post-BI. In adults, SBIRT is not associated with establishing specialty outpatient care. Two SBIRT trials in emergency department settings report that 5% to 25% of adolescents who received SBIRT interventions sought outpatient treatment. Delivery by a behavioral health clinician or the adolescent’s primary counselor significantly increases the odds of initiating outpatient treatment. SBIRT is an evidence-based intervention recommended for all adolescents to prevent or delay the onset of substance use and to provide individualized BI and RT for adolescents with problematic substance use and SUD. However, significant barriers remain to facilitating adolescent participation in outpatient specialty treatment.