Substance Use Prevention

Adolescent Substance Use Disorders are a Growing Health Concern in the United States

According to the 2014 National Survey on Drug Use and Health, nine percent of youth aged 12-17 years old reported that they were currently using an illicit drug. Moreover, 20.6 million persons—eight percent of the population aged 12 or older—needed treatment for an illicit drug or alcohol use problem but did not receive treatment at a specialty facility in the past year.1

Substance use has significant and longstanding health and academic consequences for young people, including increased injuries, school failure, mental health problems, criminal involvement, and dependence in adulthood.2, 3, 4

Adolescence is the critical period to prevent substance use disorders. When the use of addictive substances is initiated in adolescence, the risk of addiction is magnified.5 The chances of developing an addiction are nearly seven times higher for teens who begin using before age 15 than for those who delay use until age 21 or older, and 96 percent of adults with substance disorders began use before age 20.6 The propensity of youth to engage in high-risk behaviors underscores the importance of delaying the onset of use, identifying risky behaviors, and intervening early to address misuse and deter addiction. Underage drinking and drug use contribute to a wide range of costly health and social problems, including motor vehicle crashes (the greatest single mortality risk for underage drinkers); suicide; interpersonal violence (e.g., homicides, assaults, rapes); unintentional injuries such as burns, falls, and drowning; brain impairment; alcohol dependence; risky sexual activity; academic problems; and alcohol and drug poisoning.7 On average, alcohol is a factor in the deaths of approximately 4,700 youths in the United States per year, shortening their lives by an average of 60 years.8 Although screening, brief intervention, and referral to treatment (SBIRT) has proven successful among adults, its efficacy in adolescents has been poorly understood. There is a growing sense of urgency about adapting this proven method for substance abuse prevention for adolescents–especially in normative settings like school health programs.

SBHCs Provide Comprehensive Activities in the Areas of Alcohol, Tobacco, and Drug Use Prevention

Sixty-nine percent of school-based health centers (SBHCs) provide substance abuse screening, and 10 percent have a trained alcohol and drug counselor on staff. SBHCs help increase the number of students exposed to programs and activities that discourage potentially harmful behaviors including alcohol, tobacco, and drug abuse, and violence and bullying. During the 2013-14 school year, SBHCs provided individual (77 percent), small student group (38 percent), and community activities (25 percent) to prevent alcohol, tobacco, and drug use.9

Primary care and behavioral health providers in SBHCs, in consultation with national adolescent substance use prevention experts, can implement the following components of SBIRT using specific evidence-based tools and interventions:

Screening: Providers use the CRAFFT tool, a six-question behavioral health screening method for use with children and adolescents under the age of 21 recommended by the American Academy of Pediatrics’ Committee on Substance Abuse. This screening tool is an evidence-based practice for effectively identifying young people struggling with substance use issues. Additional screening tools, such as the PHQ9 and GAD, used to assess depression and anxiety in adolescents can be used to identify underlying causes of substance use and the tools can be used by providers based on the needs of their patients.

Brief Intervention: Providers conduct brief interventions with students identified through the CRAFFT screening process as mid- to high-risk substance users. Providers use motivational interviewing—an effective brief intervention that is easy to use in a school setting—to help students make their own decision to abstain from substance use. Through several three to fifteen minute sessions with students, providers encourage students to learn more about consequences of substance use, understand why they use alcohol and/or drugs, and set goals for changing their behaviors. Research shows that motivational interviewing techniques, including counseling, assessment, multiple sessions, and brief interventions, are associated with greater participation in treatment and positive treatment outcomes.10

Referral to Treatment: Providers implement best practices for referral to treatment for adolescents demonstrating substance ause disorders requiring care beyond that of a brief intervention.

School-Based Health Alliance Resources

SBIRT in SBHCs: A Model for Adolescent Substance Use Prevention: The School-Based Health Alliance, with support from the Conrad N. Hilton Foundation, launched our SBIRT in SBHCs initiative to test the feasibility of SBIRT in a school-based setting. Our experience with this initiative leaves us confident that SBIRT is a successful approach for addressing adolescent substance use and misuse in an SBHC setting. Download this issue brief to learn more about our initiative and find recommendations for implementing the SBIRT approach in your SBHC.

(1) Substance Abuse and Mental Health Services Administration. Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-46, HHS Publication No. (SMA) 13-4795. Rockville, MD2013.
(2) Hingson RW, Heeren T, Jamanka A, Howland J. Age of drinking onset and unintentional injury involvement after drinking. JAMA : the Journal of the American Medical Association. Sep 27 2000;284(12):1527-1533.
(3) Volkow ND, Li TK. Drugs and alcohol: treating and preventing abuse, addiction and their medical consequences. Pharmacology and Therapeutics. Oct 2005;108(1):3-17.
(4) Clark DB, Martin CS, Cornelius JR. Adolescent-onset substance use disorders predict young adult mortality. The Journal of Adolescent Health. Jun 2008;42(6):637-639.
(5) Chambers R, Taylor J, Potenza M. Developmental Neurocircuitry of Motivation in Adolescence: A Critical Period of Addiction Vulnerability. American Journal of Psychiatry. 2003;160(6):1041-1052.
(6) Ibid.
(7) Centers for Disease Control and Prevention. Alcohol-Related Disease Impact (ARDI). 2009;
(8) Ibid.
(9) Schelar, E., Lofink Love, H., Taylor, K., Schlitt, J., & Even, M. (2016). Trends and Opportunities for Investment in Student Health and Success: Findings from the 2013-2014 Census of School-Based Health Centers (SBHCs). Washington, D.C.: School-Based Health Alliance.
(10) Center for Substance Abuse Treatment. Definitions and Terms Relating to Co-Occurring Disorders. COCE Overview Paper 1.DHHS Publication No. (SMA) 06-4163. Rockville, MD: Substance Abuse and Mental Health Services Administration, and Center for Mental Health Services;2006.