Substance Use Screening, Brief Intervention, and Referral to Treatment Among Youth-Serving Clinicians

Abstract

Importance: Despite decreasing substance use by adolescents in recent years, overdose rates continue to rise. Morbidity and mortality from substance use is preventable if detected; however, screening practices among youth-serving clinicians are unknown.

Objective: To describe youth-serving clinicians' screening, brief intervention, and referral to treatment practices for substance use disorders (SUDs) among adolescents.

Design, setting, and participants: This cross-sectional study used DocStyles data from September 5 to October 12, 2023, on clinical practice settings in the US. Responding clinicians included family physicians, internal medicine physicians, pediatricians, nurse practitioners, and physician assistants.

Exposure: Delivery of services to youths aged 17 years or younger.

Main outcomes and measures: Screening, brief intervention, and referral to treatment practices, including screening frequency and type of screening tool used, and screening at every well visit using a screening tool were assessed using descriptive statistics and multivariable logistic regression.

Results: Of 1047 youth-serving clinicians (mean [SD] age, 45.3 [11.4] years; 555 male [53.0%]), 467 (44.6%) were family physicians, 250 (23.9%) were pediatricians, 132 (12.6%) were internal medicine physicians, 107 (10.2%) were nurse practitioners, and 91 (8.7%) were physician assistants (survey response rate, 57%). Median years in practice was 13 (IQR, 7-23 years). Most clinicians (634 [60.6%]) reported that skills in SUD diagnosis were relevant to their practice, and 800 (76.4%) reported seeing at least 1 adolescent with an SUD monthly. A majority of clinicians (596 [56.9%]) reported screening for SUDs at every well visit, with a high proportion of pediatricians reporting screening at every well visit (173 of 250 [69.2%]). Clinicians who screened at every well visit were more likely to use a screening tool (odds ratio, 1.87 [95% CI, 1.44-2.44]). Only 411 clinicians (39.3%) reported screening at every well visit using a screening tool; 321 clinicians (30.7%) offered all components of screening, brief intervention, and referral to treatment practice. Clinicians who reported seeing 5 or more adolescents with an SUD per month had a higher odds of screening with a standardized tool at every annual well visit (adjusted odds ratio, 2.19 [95% CI, 1.30-3.71]).

Conclusions and relevance: These findings suggest that while most clinicians report screening youths for SUDs at least sometimes, a substantial proportion screened only intermittently. Efforts to improve screening rates through education and systems-based practice changes may facilitate offering anticipatory guidance and SUD treatment in all youth-serving clinical settings.

Figure 1.. Screening for Substance Use and Substance Use Disorders in Adolescents by Specialty

Data were calculated based on DocStyles clinician data from September 5 to October 12, 2023. eTable 1 in Supplement 1 provides detailed data on proportions by specialty.

Figure 2.. Screening Tool Use for Substance Use Disorders in Adolescents by Specialty

Data were calculated based on DocStyles clinician data from September 5 to October 12, 2023. eTable 1 in Supplement 1 provides detailed data on proportions by specialty. BSTAD indicates Brief Screener for Tobacco, Alcohol, and Other Drugs; CRAFFT, Car, Relax, Alone, Forget, Friends, Trouble; S2BI, Screening to Brief Intervention; TAPS, Tobacco, Alcohol, Prescription Medication, and Other Substance Use.

Figure 3.. Concordance With Recommended Screening Practices by Specialty

Data were calculated based on DocStyles clinician data from September 5 to October 12, 2023. eTable 1 in Supplement 1 provides detailed data on proportions by specialty.

Figure 4.. Associations of Youth-Serving Clinicians’ Characteristics With Reporting Concordance With Recommended Screening Practices (N = 1047)

The adjusted odds ratios (AORs) were calculated using a multivariable logistic regression model adjusted for the demographic and clinical characteristics shown. The unadjusted absolute difference is the difference between the percentage of each category reporting concordance with recommended screening practices and the percentage of the reference category. OUD indicates opioid use disorder; SUD, substance use disorder.