Screening, Brief Intervention, and Referral to Treatment in Adolescence Provides Lasting Benefit into Young Adulthood

Screening, brief intervention, and referral to treatment (SBIRT) has been shown to reduce substance use in adolescents, but the US Preventive Services Task Force has concluded that there is insufficient evidence to recommend it. This study randomized adolescent patients (ages 12–18; N=1871) to 1 of 3 SBIRT groups within a US pediatric practice: pediatrician-delivered SBIRT, embedded behavioral health counselor delivered-SBIRT, or treatment as usual (control). Researchers followed up after 7 years to assess outcomes related to substance use, mental health diagnoses, and healthcare utilization. They combined the two SBIRT groups and compared outcomes with the control group.

• Compared with the control group, participants who received SBIRT were less likely to have a substance use-related diagnosis at follow-up (24% versus 19%, respectively).
• Participants in the SBIRT groups had lower odds of inpatient hospitalization, compared with the control group (odds ratio, 0.59).
• Compared with patients in the control group, those who received SBIRT who had at least one visit had fewer visits to primary care (incidence rate ratio [iRR], 0.90) and psychiatry (iRR, 0.64), and more visits to addiction medicine services (iRR, 1.52).

Comments: It can be difficult to document reductions in substance use and associated harms in adolescents, whose use is often sporadic. This study adds important evidence to the burgeoning literature documenting the effectiveness of adolescent SBIRT in improving SUD and mental health outcomes. This is especially important in the US, because access to healthcare via insurance is more uniform in the adolescent years, whereas coverage is not guaranteed in adulthood.

Corey McBrayer, DO, MPH* & Sharon Levy, MD

* Rich Saitz Editorial Intern & Grant Medical Center Addiction Medicine Fellow, OhioHealth.

Reference: Sterling S, Parthasarathy S, Jones A, et al. Young adult substance use and healthcare use associated with screening, brief intervention and referral to treatment in pediatric primary care. J Adolesc Health. 2022;71(4S):S15–S23.