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[Dr. Geetha Subramaniam speaking] So, I think screening adolescents for substance
use disorder is very important and also pediatric primary care providers have a great opportunity
to do this because parents bring their adolescence or preteens into the clinic because they need
the physicals before they have sports activities coming up, or sometimes even before they send
them off to college.
So, that's a great opportunity to do what we call universal screening.
So, you don't target any particular individual - everybody who comes in there.
The other reason that you may want a screen is that there are certain reasons why why
substance abuse occurs at a higher incidence In targeted populations, you would only administer
to people that you would considered high-risk.
So, these would be those with prior diagnosis of ADHD,
depression, maybe those that may have been to a dentist and gotten
prescription opioids, accidents, sexually transfer disease or even pregnancy.
These individuals would be a more vulnerable and therefore you may get a higher screen
positive rate if you were to administer screens to those individuals.
So, there are two tools that arevalidated that are available on the NIDAMED website.
The first tool is the BSTAD, which stands for brief screening for tobacco alcohol and
drugs.That tool asks for the past year use of tobacco, alcohol, prescription medications
and other drugs.
The second tool is the S2BI, which stands for screening to brief intervention.
This tool as well, similarly asks for past your use of tobacco,
alcohol, prescription medications and other substances.
So you might ask what's different?
So, really the way that they differ is in their responses.
BSTAD asks for number of days of use in the past year, so one would respond from anywhere
from 0 to 365.
Whereas the S2BI has a gradient response, where you respond either - never, once or
twice, monthly, weekly, daily etc.
How does one decide on which tool to select?
My first response would be to say, it would be very important to select an empirically
validated tool.
So, we have now these two tools that have been empirically validated in pediatric primary
care settings and therefor this would be recommendation and selection would be based on the
providers preference - you know some people may like to have a numeric value in terms
of responses and others may like to have a much more tangible response
saying, "I use it monthly," "I use it weekly," where it actually lends itself
to a communication and a conversation thereafter.
So, one of the advantages of these two screening tools the S2BI and the BSTAD is that they've
been validated for both self administration by the individual, the youth in this
particular case.
So, it can be done in the form of a tablet, or a
computer in the waiting room.
Or, the clinician if they prefer to do it adminitered this way - have a nurse practitioner
or an LPN do it while they're checking vitals and ask these questions.
Confidentiality issues are paramount.
First of all, I would say providers need to check with their local and state rules about
confidentiality as it varies from region to region.
Generally speaking, adolescents are going to be somewhat
insecure not knowing what's going to be revealed to their caregivers, parents, family members,
etc.
So, when screening it's also important to give them the opportunity to respond to the
questions in a private manner so that their parents are not looking over their shoulder.
But more importantly when the provider sits with the individual to review the screening
results, or the assement results, I think there need to be some conversations about
in what situations would the adolescent reponses be shared with their parents and
when will not be shared.
There are some state rules where the confidentiality rules don't apply and that is usually when
they are a danger to themselves or others
There are several resources available on the NIDAMED website We have a chart that offers
a list of validated screening tools for adolescents.
Over beyond that, there's also opportunities for providers to
direct the teens to the NIDA teen website.There's also materials available
for parents who have lots of questions regarding this.
Another resource I would probably also recommend is the
Monitoring the Future and this is particularly important to providers because one of the
processes of engaging an individual into changing their use behaviors
is to help them understand how infrequent substance abuse is in that
probably age group because most individuals, er, teenagers who are using substances are
of the opinion that everybody in their class is using drugs and that is really not the
case.
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