Screening tools effective in identifying substance use disorders in adolescents

Key takeaways:

• Three screening tools had area under the curve values indicating high agreement for nicotine, alcohol and cannabis use disorders.
• Unlike the others, the TAPs tool works for both adolescents and adults.

Three brief screening tools were effective in identifying substance use disorders in adolescents and can be recommended for use, according to researchers.

Sharon Levy, MD, MPH, chief of the division of addiction medicine at Boston Children’s Hospital, told Healio that she and her colleagues conducted the study “to update and refine screening tools that can help primary care providers identify adolescents who may have a substance use disorder, and those who may be engaging in very risky behavior, such as nonmedical use of ‘pills.’”

Levy and colleagues examined three screening tools, all chosen because they had been initially validated:

• the Screening to Brief Intervention (S2BI);
• the Brief Screener for Tobacco, Alcohol and Drugs (BSTAD); and
• the Tobacco, Alcohol, Prescription Medication and Other Substances (TAPS) tool.

All the screening tools used a question that measured the frequency of substance use in the past year, which created different risk levels for alcohol, nicotine and cannabis use disorders.

The researchers enrolled 798 adolescents aged 12 to 17 years, 52% of whom were girls and 65.7% were white. The participants were randomly assigned to either S2BI (n = 256), BSTAD (n = 267) or TAPS (n = 275).

Levy and colleagues reported that the area under the curve values for each tool were near or equal to 1 for nicotine, alcohol and cannabis use disorders, with point estimates of sensitivity and specificity “generally high.”

Additionally, no notable differences were found in the performance of the tools for any measure or substance, according to the researchers.

“The findings were similar to previous, smaller studies, which was reassuring,” Levy said. “If we step back for a moment, it is remarkable that we can pick out teens who are likely to have a substance use disorder with very simple questions (which, I point out, have to be asked the right way).”

Levy explained that the success of all three screening tools gives PCPs “a choice of easy-to-use tools that do what we need them to do.”

“I would recommend that PCPs who are not using a formal screening tool implement one of them. The S2BI and BSTAD are a bit shorter and quicker for patients under 18 than the TAPS, but these tools have not been tested with adults,” she said. “The TAPS works well across a broad age range, so PCPs who see both kids and adults can use one tool to screen everyone for substance use.”

Levy added that including a validated tool in electronic medical records “makes screening really easy.”

“Many of the practices we partner with have done this, and we routinely see screening rates of over 90%,” she said.

There are many ways that PCPs can help teenagers with substance use disorders, she added, “from giving brief counseling to prescribing medications to help with withdrawal or cravings to making a referral to a behavioral health counselor.”

“Identifying teens with substance use disorders is the first step and it is very gratifying to see the field move in this direction,” she said.