Substance use, including alcohol and illicit drugs, has increased during the COVID-19 pandemic. Many people who already struggled with substance use have faced social isolation, financial distress, limited healthcare access, and anxiety symptoms. This can increase their use of drugs or alcohol as a way to cope.Addressing substance misuse in adolescentsUnfortunately, this trend has not only affected adults, but adolescents. Research published by Boston University found that, among adolescents who consumed drugs or alcohol, the use of alcohol and cannabis increased significantly after social distancing measures were implemented.When it comes to addressing substance use among adolescents, many clinicians have taken an approach known as “screening, brief intervention, and referral to treatment (SBIRT)”. The SBIRT approach includes:Screening the individual adolescent with validated surveysBrief, patient-centered intervention, mainly with motivational interviewingReferring the individual to behavioral treatment for more severe symptomsMotivational interviewing is a type of counseling that helps individuals make necessary, healthy changes to their behavior. This method does not try to force clients to change or tell them specifically what to do. Instead, the counselor converses with their client to guide them through their feelings and consider how they may need to change. This method was originally developed for individuals struggling with alcohol problems, but may help others who need to make changes in their lives and struggle to do so.What new research showsThe SBIRT approach has had a positive effect in the short term, but there’s been a lack of research on its longer-term effects. Now, a team of researchers report in Pediatrics that 185 adolescents who received SBIRT by a pediatrician or behavioral clinician showed better outcomes compared to 104 adolescents randomized to receive usual care.Adolescents in the “usual care” group were assigned to pediatricians who had access to EHR screening tools but did not have formal SBIRT training.The benefits included:Lower risk of depression after one year and three yearsLower risk of being diagnosed with substance use three years laterFewer emergency department visitsThese findings are important because adolescents with co-occurring substance use and mood symptoms are more likely to develop other comorbidities. They may use more health resources, such as emergency departments, and their substance use may escalate. Evidence-based interventions can help reduce health costs as well as improve quality of life.In a blog post about this study, the American Academy of Pediatrics noted that the study was limited because it was conducted in a health system that provides behavioral health, and the participants were insured. Most pediatric primary-care practices lack behavioral health providers. Many young people with substance use disorder may be uninsured or underinsured, which can make it more difficult for these clients to have access to SBIRT and its benefits. Because of these complicating factors, additional studies of the use of SBIRT in other settings are still needed.
