Substance Use and Abuse

Learning Objectives:

1. Relate the public health burden of substance use among teens including tobacco/nicotine, alcohol, prescription drugs, and non-prescription drugs
2. State the components of initial substance use screening, including CRAFFT questions
3. Describe when to use brief advice, motivational interviewing, and/or refer to treatment for substance use treatment
4. Recognize the comorbidity of mental health and substance use in adolescents
5. Describe the utility and appropriate use of a urine drug screen

Readings:

1. Levy SJ, Williams JF, AAP COMMITTEE ON SUBSTANCE USE AND PREVENTION. Clinical Report: Substance Use Screening, Brief Intervention, and Referral to Treatment (SBIRT). Pediatrics. 2016;138(1): e20161211
2. AAP COMMITTEE ON SUBSTANCE USE AND PREVENTION. Policy Statement: Substance Use Screening, Brief Intervention, and Referral to Treatment (SBIRT). Pediatrics. 2016;138(1):e20161210
3. NIH/NIDA “Drugs, Brains, and Behavior: The Science of Addiction” (revised 2014) 
4. Levy S, Siqueira LM, Committee on Substance Abuse, Ammerman SD, Gonzalez PK, Ryan SA, et al. Testing for drugs of abuse in children and adolescents. Pediatrics 2014;133(6):e1798-1807. 
5. Deas D, Brown ES. Adolescent substance abuse and psychiatric comorbidities. J Clin Psychiatry 2006;67(7):e02. 
6. U.S. Department of Health and Human Services (HHS), Office of the Surgeon General, Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC: HHS, November 2016. (great for general substance use info): executive summary and full report 

Videos:

1. National Institute on Drug Abuse (NIDA/NIH) YouTube videos, including on the Health risks of Vaping 

Websites and Online Resources

1. Adolescent SBIRT: Toolkit for Providers. Adolescent Screening, Brief Intervention, and Referral for Treatment for Alcohol and Other Drug Use. Developed in partnership with the Massachusetts Departments of Public Health, Mental Health, and the Massachusetts Child Psychiatry Access Project. 2015. Comprehensive toolkit including confidentiality, list of validated screening tools, treatment and support decision tree, and billing tips.
2. American Academy of Pediatrics (AAP) Substance Use Screening and Brief Intervention for Youth – has lots of information and links  
3. SAMHSA – “Incorporating substance abuse screening into adolescent office visits – CRAFFT”.
4. NIDA-Screening Tools for Adolescent Substance Abuse (May 2019): The BSTAD and S2BI are brief online tools to assess for substance use disorder risk among adolescents age 12-17 years old in primary care settings  
5. National Institute on Drug Abuse (NIDA-MED)/NIH-http://www.drugabuse.gov science-based resources for health professionals and those in training about screening, addressing, and treating addiction
   • Adolescent Screening and prevention tools
   • Resources specific to clinical disciplines
   • Health Professions education
6. State Medical Marijuana Laws 

1. AAP EQIPP: Substance Use – Screening, Brief Intervention, Referral to Treatment. 2018 (free with AAP membership) 
2. Ahadpour M, Forman R, E Kleinschmidt. Substance Use in Adults and Adolescents: Screening, Brief Intervention and Referral to Treatment (SBIRT).
   • Free through – www.medscape.org 

Online Resources:

1. SAHM Youth Providers 2.0 Topic Guide – Substance Use 
2. Office of Adolescent Health – Adolescent Health Topics – Substance Abuse
3. The Stanford Tobacco Prevention Toolkit – Theory-based and evidence-informed resources created by educators, parents, and researchers aimed at preventing middle and high school students’ use of tobacco and nicotine. Ideal for integrating into curriculum in school-based setting.
4. RX For Change: Clinician assisted Tobacco Cessation Comprehensive tobacco cessation training program that equips health professional students and practicing clinicians, of all disciplines, with evidence-based knowledge and skills for assisting patients with quitting.

Books: 

1. Ginsburg, K Ed. Reaching Teens: Strength-Based, Trauma-Sensitive, Resilience-Building Communication Strategies Rooted in Positive Youth Development, 2nd Edition. AAP, 2020
   • Chapter 48: Helping Adolescents Own their Solutions

MedEd Portal: 

1. Boykan R, Blair R, Baldelli P, Owens S. Using motivational interviewing to address tobacco cessation: two standardized patient cases for pediatric residents. MedEdPORTAL. 2019;15:10807.
2. Pitts S, Borus J, Harris S, Siegel J, Gooding H, Goncalves A, Levy S, Weitzman E, Burke P. Benefitting Brad: An Interprofessional Case of Adolescent Substance Use and ADHD. MedEdPORTAL Publications; 2015. 
3. Azari S, Ratanawongsa N, Hettema J, Cangelosi C, Tierney M, Coffa D, Shapiro B, Jain S, Hersh D, Manuel J, Ciccarone D, Lum P. A Skills-Based Curriculum for Teaching Motivational Interviewing-Enhanced Screening, Brief Intervention, and Referral to Treatment (SBIRT) to Medical Residents. MedEdPORTAL Publications; 2015.
4. Clifton M. Teen Substance Abuse Problem Based Learning (PBL). MedEdPORTAL Publication; 2009.

PediCases.2013
http://pedicases.org/archives/index.html

1. Adolescent Substance Abuse: The Craffty Pupil

• Inpatient settings
• Outpatient settings: school and college based, juvenile justice
• Emergency department
• School, County, or Community-based substance use support/treatment