Barriers in Substance Use Disorder Screening and Intervention for Youth Include Physician Training, Reimbursement

Young woman with drug addiction , The concept of crime and drug addiction. 26 June, International Day Against Drug Abuse and Illicit Trafficking
Physicians reported that a lack of training in brief intervention and reimbursement make providing screening and intervention more difficult when caring for youth with possible substance use disorders.

Increased reimbursement and better training for primary care providers (PCPs) in the evidence-based screening, brief intervention, and referral to treatment (SBIRT) modality could improve substance use disorder screening of adolescents and young adults, according to survey data published in Psychiatric Services.  

Investigators used a sequential exploratory mixed-methods design to examine trends in substance abuse disorder screening for adolescents and young adults (ages 12-21 years) in the United States. Investigators first conducted informant interviews with 12 experts on substance use disorders, among whom 8 were SBIRT researchers and 4 were affiliated with a government entity or health plan. Interviewees were asked about PCP familiarity with SBIRT guidelines and tools and barriers to screening among adolescents, and were asked for their suggestions to overcome barriers. The data abstracted from these interviews were then used to construct a 25-item survey, which was administered to 75 PCPs. Survey participants provided information regarding how often they discussed substance use with patients and what barriers to screening they perceived in their practice. 

The majority (84%) of PCPs indicated that they had spoken with young patients about risky behavior associated with substance use disorders. However, 27% of respondents indicated that they had not used a standardized tool to conduct screenings, and 28% reported only using a screening instrument with patients they deemed to be at risk. Of PCPs who used a screening tool (n=55), 38 (69%) used a validated tool and 17 (31%) created their own tool or “amended a broader…risk assessment tool.”

Related Articles

PCPs who indicated that they did not screen every patient with a validated tool were subsequently asked about barriers to providing a screening service. The following survey options were most commonly indicated as barriers: “parents who [would] not allow confidential consultation with adolescents” (51%); time constraints (41%); “sensitivity around whether and how to involve parents” (22%); lack of a dedicated staff member or technology for screening (17%); and that screening procedures were not reimbursable (12%).

Of the respondents, 69% said that they provided brief intervention or consultation. However, only 36% indicated that they perceive brief intervention to be effective. Only 53% of respondents reported receiving training on providing brief interventions, and half of key informants agreed that PCPs needed more guidance on brief intervention screening. More than a third (37%) of survey respondents indicated that more training would improve their ability to increase SBIRT uptake, as would greater reimbursement (51%) and dedicated technology (47%) or staff (44%) to conduct screening.

These data suggest that while PCPs often do discuss substance use disorder issues with young patients, increased training, the presence of dedicated staff, and greater reimbursement would improve uptake of SBIRT procedures. Consistent SBIRT application for adolescent patients is important to identify and treat substance use disorder among this vulnerable patient demographic.


Palmer A, Karakus M, Mark T. Barriers faced by physicians in screening for substance use disorders among adolescents [published online February 20, 2019]. Psychiatr Serv. doi: 10.1176/