Screening, Brief Intervention, and Referral to Treatment Benefits Adolescents

A screening, brief intervention, and referral to treatment (SBIRT) intervention delivered during adolescence may have persisting beneficial effects on substance use and health care utilization through young adulthood. These study findings were published in the Journal of Adolescent Health.

Researchers conducted a randomized trial at Kaiser Permanente Northern California (KPNC), which had carved-in mental health and addiction medicine services. Participating pediatricians were randomly assigned to receive training on SBIRT, work with an embedded behavioral clinician with whom they could refer patients, or administer treatment as usual. Adolescents who endorsed using any drugs or alcohol in the previous 12 months or had mood symptoms in the previous 2 weeks were eligible to receive the brief intervention. The intervention’s effect on 7-year outcomes of substance use, mental health status, medical diagnoses, and health care utilization was evaluated.

The patient population comprised 1871 adolescents (55.7% girls) with mean age of 15.8 years. The participants were 33.5% Black, 25.2% White, 23.8% Hispanic, 11.3% Asian, and 6.1% were of other ethnicities.

The SBIRT and usual care recipients had alcohol-related diagnoses (0.4% vs 1.8%; P <.01), marijuana-related diagnoses (1.2% vs 2.8%; P <.05), and anxiety (4.1% vs 6.5%; P <.05) in the year prior to index, respectively.

In general, girls and younger individuals had higher odds of having any behavioral health diagnosis, depression, and anxiety disorders and were more likely to use psychiatric care compared with boys and older individuals, respectively. Girls also had lower odds of having any substance use diagnosis and higher odds of being hospitalized compared with boys. Younger individuals were more likely to present at the emergency department than older individuals.

At 7 years, the SBIRT intervention was negatively related with diagnosis of tobacco disorder diagnosis (odds ratio [OR], 0.83; 95% CI, 0.69-1.00; P =.046), substance use disorder (OR, 0.80; 95% CI, 1.06-2.41; P =.027), Charlson comorbidity index (OR, 0.76; 95% CI, 0.59-0.98; P =.032), any drug disorder diagnosis (OR, 0.73; 95% CI, 0.54-0.98; P =.036), marijuana disorder diagnosis (OR, 0.70; 95% CI, 0.50-0.98; P =.037), and alcohol use disorder diagnosis (OR, 0.69; 95% CI, 0.51-0.94; P =.017) compared with usual care.

The SBIRT intervention was associated with lower inpatient hospitalizations (OR, 0.59; 95% CI, 0.41-0.85; P =.005) and decreased counts of psychiatry visits (incidence rate ratio [IRR], 0.64; 95% CI, 0.51-0.79; P <.001) and primary care visits (IRR, 0.90; 95% CI, 0.82-0.99; P =.025) and increased counts of addiction medicine visits (IRR, 1.52; 95% CI, 1.14-2.03; P =.004) compared with usual care.

Similar findings were observed in a sensitivity analysis among only patients with continued KPNC membership.

A limitation of this study is that the results may not be generalizable to the uninsured population.

Study authors conclude, “Our findings add to the growing evidence base on the beneficial effects of providing SBIRT for adolescents in pediatric primary care and extend the existing literature by demonstrating clinically significant effects on the development of substance use disorders and healthcare utilization into young adulthood. Like many other integrated behavioral health approaches, SBIRT may provide significant and lasting benefits to vulnerable adolescents as they mature into young adulthood.”