Addressing Substance Use with the Adolescent in Primary Care

Abstract Objective: The objective of this chapter is to summarize evidence-based strategies for working with adolescent patients in primary care toward making healthy decisions around substance use. Background: Substance use that progresses to substance use disorder (SUD) most often begins in adolescence and early adulthood. Although alcohol use in adolescence continues to decline, cannabis use is on the rise, as is nicotine use via e-cigarettes as well as rates of opioid-related overdose. Primary care clinicians are uniquely positioned to engage adolescent patients in substance use prevention and early intervention. Main Ideas: When discussing substance use with adolescent patients, clinicians should speak with the adolescent without their parent or guardian present and delineate the confidentiality parameters of the conversation up front. All adolescent patients, ages 12–21, should be screened annually with evidence-based screening instruments for substance use. Brief, 5–15-min interventions based on motivational interviewing principles delivered by the primary care clinician or behaviorist are effective in helping adolescents using substances who have not yet developed a SUD to make healthier choices around their substance use, for example, to cut back or quit. Adolescents screening positive for SUD should be referred to evidence-based treatment when such SUD treatment is not available within the primary care practice. Family involvement in the adolescent's SUD treatment is nearly always essential to their long-term recovery. Conclusion: Screening, brief intervention, and referral to treatment, or SBIRT, is an evidence-based model to effectively address adolescent substance use in the primary care setting.