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PA R T 3 : A New Way to View and Treat Adolescent Alcohol and Other Drug Use and Substance Use Disorders W H E R E T O S TA R T It is easy to become paralyzed in the face of discouraging information and the already large and growing size of the problem. We cannot afford inaction: too much is at stake and too much is changing. While the adolescent SAT system is problematic, it can be improved if we coordinate our efforts. Consequently, we have developed concrete action steps that, when used collaboratively by parents, treatment providers, researchers, insurers, and other funders, should begin to bring about needed change for youth at risk for a substance use disorder, using, abusing or dependent on alcohol or other drugs, and recovering from a substance use disorder. Attention needs to be paid to youth in all stages of the substance abuse continuum. By addressing the basic components of care considered for all other chronic illnesses (i.e., screening, wellness and prevention, early intervention, quality, and continuing care), there are systematic opportunities to transform the adolescent substance abuse treatment system.
SCREENING Screening for Risk Factors or Early Disease Presence Substance use problems are ubiquitous in all the settings where adolescents are found: schools, pediatric healthcare settings, juvenile justice facilities, etc. But it can be prevented and early use can be halted before it becomes addiction — but there have to be structures in place to provide early detection and appropriate, non-punitive intervention. Thus, screening for risk factors or early disease presence is one of the first lines of defense. In fact, substance use screening should be part of all wellness screens as this can have direct impact on healthy living. While adolescents should be screened within all treatment and social services systems that they come in contact with (e.g., mental health system, foster care system, juvenile justice system), there are two locations where large numbers of “general population” youth can be found: medical settings (e.g., pediatric offices and primary care facilities) and schools.
Screening in Medical Settings
ATTENTION NEEDS TO BE PAID TO YOUTH in all stages of the substance abuse continuum.
Screening, Brief Intervention and Referral to Treatment (SBIRT) is a scientifically validated, nationally recognized approach to screening for and addressing AOD problems within medical settings. It is endorsed by the National Institute of Alcohol Abuse and Alcoholism (NIAAA), the National Institute on Drug Abuse (NIDA), the Substance Abuse and Mental Health Services Administration (SAMHSA), and perhaps most importantly by the American Academy of Pediatrics [78, 79] and the American Medical Association (AMA). It is not endorsed, however, by the US Preventative Services Task Force for