Feature Article
Addressing Substance Use in Adolescents: Screening, Brief Intervention, and Referral to Treatment

https://doi.org/10.1016/j.nurpra.2019.10.004Get rights and content

Highlights

  • Adolescent substance use is a national public health crisis.

  • Most commonly used substances among adolescents are nicotine, alcohol, and marijuana.

  • Using nicotine, alcohol, marijuana, and other toxic substances can cause serious adverse effects on brain development during adolescence.

  • Adolescents who use nicotine, alcohol, and marijuana are at greater risk of impairment, including dependency, that can endure into adulthood.

Abstract

Adolescent substance use is a national public health crisis. The most commonly used substances among adolescents are nicotine, alcohol, and marijuana. Use of these substances during adolescence has serious adverse effects on brain development, with impairments that can endure into adulthood. Advanced practice nurses in primary care can address substance use in the adolescent population with the use of evidence-based interventions, such as Screening, Brief Intervention, and Referral to Treatment (SBIRT). This article describes trends in adolescent substance use and use of the SBIRT intervention for low, medium, and high-risk use in this population.

Introduction

Researchers, clinicians, and policymakers have identified adolescent substance use (SU) as a national public health crisis.1 The scope of the problem is illustrated in A Day in the Life of American Adolescents, which reports that on an average day, 881,684 adolescents smoke cigarettes, 646,702 use marijuana, and 457,672 drink alcohol.2 The purpose of this article is to report recent trends in adolescent SU and describe the Screening, Brief Intervention, and Referral to Treatment (SBIRT) intervention as a strategy to identify and intervene for at-risk SU in this population.

Section snippets

Overview

Since 1991, the Centers for Disease Control and Prevention (CDC) has conducted biennial surveys among high school students to assess high-risk health behaviors, including SU, using the Youth Risk Behavior Surveillance Survey (YRBSS). There has been a steady increase of SU among teens. According to the most recent YRBSS report completed in 2017, the most commonly used substances among students in grades 9 through 12 are alcohol, nicotine, and marijuana.3

Substance Use and the Developing Adolescent Brain

Adolescence is a time of rapid brain growth and development.13 Adolescents who use substances are vulnerable to the development of substance misuse and addiction, due to patterns of adolescent brain maturation.14 Adolescent brain development is “nonlinear”15; the prefrontal cortex is immature, resulting in limited executive functioning related to decision-making, impulse control, and judgment.16 However, the dopaminergic reward pathway, an anatomical structure responsible for the pleasurable

Risk and Protective Factors

Several risk and protective factors have been linked to SU among adolescents. Times of transition increase the risk of drug use for the adolescent. For example, at the move from elementary school to middle school, the early adolescent may be exposed to tobacco and alcohol for the first time. In high school, teens may have greater access to drugs by attending social activities where substances are present. Several factors put teens at higher risk for misusing alcohol and other substances, such

Screening, Brief Intervention, and Referral to Treatment

SBIRT is an evidence-based approach to identify and intervene for people who are at risk for problems related to substance use.1 The SBIRT process is endorsed by leading professional associations and government agencies such as the American Academy of Pediatrics (AAP)19 policy statements, the American Medical Association, the Substance Abuse and Mental Health Services Administration (SAMHSA), the Centers for Medicare and Medicaid Services, and the National Institute on Alcohol Abuse and

Conclusion

Trends in SU among adolescents, along with the serious neurocognitive impairments and health, social, and legal risks associated with use, underscore the urgency of addressing this public health problem.31 Prevention is the best strategy for addressing SU and reducing the development of SU disorders in adolescents. It is critical that providers implement strategies for early identification and intervention for problematic use among adolescents18 with the use of evidence-based practices such as

Dianna Inman, DNP, CPNP-PC, PMHS, PMHNP-BC, is an assistant professor at the University of Kentucky, Lexington, KY. She can be contacted at [email protected].

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  • Cited by (0)

    Dianna Inman, DNP, CPNP-PC, PMHS, PMHNP-BC, is an assistant professor at the University of Kentucky, Lexington, KY. She can be contacted at [email protected].

    Peggy El-Mallakh, PhD, PMHNP-BC, is an associate professor at the University of Kentucky, Lexington, KY.

    Lynne Jensen, PhD, ANP-BC, is an associate professor at the University of Kentucky, Lexington, KY.

    Julie Ossege, PhD, FNP-BC, FNAP, FAANP, is an associate professor at the University of Kentucky, Lexington, KY.

    Leslie Scott, PhD, PPCNP-BC, CDE, MLDE, is an associate professor at the University of Kentucky, Lexington, KY.

    This work was supported by a grant from the Substance Abuse and Mental Health Service Administration (1HT79T1025936-01).

    In compliance with national ethical guidelines, the authors report no relationships with business or industry that would pose a conflict of interest.

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