Electronic tool assesses teen substance use risk

A simple electronic screening tool that asks adolescents how often they’ve used 8 commonly abused substances in the past year can separate teenagers into 4 clinically significant risk categories to help guide intervention, a new study reports.

Researchers asked 216 adolescents, aged 12 to 17 years, from outpatient clinics at a pediatric hospital a single question about frequency of use during the past year of 8 types of substances, including alcohol, marijuana, cocaine, and prescription drugs (Screening to Brief Intervention). They then asked patients who said they’d used alcohol or drugs further questions about the severity of use and had patients complete a structured diagnostic interview (Composite International Diagnostic Interview-Substance Abuse Module).

The researchers triaged the patients into 4 categories of nontobacco substance use: no alcohol or drug use; use without a substance use disorder (SUD); mild or moderate SUD; and severe SUD. Of the 216 patients, 123 (57.7%) reported no past substance use; 49 (23%) reported use but didn’t have an SUD; 22 (10.3%) qualified as having mild to moderate SUD; and 19 (8.9%) had severe SUD. Sensitivity and specificity were 100% and 84%, respectively for detecting nontobacco substance use; 90% and 94% for identifying SUDs; and 100% and 94% for severe SUDs. The study found no significant differences in sensitivity or specificity between the Screening to Brief Intervention (frequency-of-use only questions) and the full assessment.

The findings suggest that frequency screening questions are “a valid and efficient” way to assign clinically relevant risk levels to teenaged alcohol and drug use, the researchers conclude.

A related editorial calls the study “a major advance, yet only the beginning” of much-needed research into the screening and management of adolescent substance misuse by primary care pediatricians. It cites barriers to widespread routine screening in primary practice that include lack of knowledge of and training in how to screen for and manage teenaged substance use problems; the difficulty of treating such patients in busy practices; and lack of a database to provide pediatricians with clinical guidance.

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