An Electronic Screen for Triaging Adolescent Substance Use by Risk Levels | Adolescent Medicine | JAMA Pediatrics | JAMA Network
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Hingson  RW, Zha  W, Weitzman  ER.  Magnitude of and trends in alcohol-related mortality and morbidity among US college students ages 18-24, 1998-2005 .  J Stud Alcohol Drugs Suppl.2009;(16):12-20.PubMedGoogle Scholar
Hingson  RW, Heeren  T, Winter  MR.  Age at drinking onset and alcohol dependence: age at onset, duration, and severity.  Arch Pediatr Adolesc Med. 2006;160(7):739-746.PubMedGoogle ScholarCrossref
Grant  BF, Dawson  DA.  Age at onset of alcohol use and its association with DSM-IV alcohol abuse and dependence: results from the National Longitudinal Alcohol Epidemiologic Survey.  J Subst Abuse. 1997;9(0):103-110.PubMedGoogle ScholarCrossref
Massachusetts Department of Public Health Bureau of Substance Abuse Services.  Provider Guide: Adolescent Screening, Brief Intervention, and Referral to Treatment Using the CRAFFT Screening Tool. Boston: Massachusetts Dept of Public Health; 2009.
Harris  SK, Herr-Zaya  K, Weinstein  Z,  et al.  Results of a statewide survey of adolescent substance use screening rates and practices in primary care.  Subst Abus. 2012;33(4):321-326.PubMedGoogle ScholarCrossref
Monti  PM, Barnett  NP, Colby  SM,  et al.  Motivational interviewing versus feedback only in emergency care for young adult problem drinking.  Addiction. 2007;102(8):1234-1243.PubMedGoogle ScholarCrossref
Spirito  A, Monti  PM, Barnett  NP,  et al.  A randomized clinical trial of a brief motivational intervention for alcohol-positive adolescents treated in an emergency department.  J Pediatr. 2004;145(3):396-402.PubMedGoogle ScholarCrossref
Tait  RJ, Hulse  GK, Robertson  SI, Sprivulis  PC.  Emergency department–based intervention with adolescent substance users: 12-month outcomes.  Drug Alcohol Depend. 2005;79(3):359-363.PubMedGoogle ScholarCrossref
Okuyemi  KS, Nollen  NL, Ahluwalia  JS.  Interventions to facilitate smoking cessation.  Am Fam Physician. 2006;74(2):262-271.PubMedGoogle Scholar
Anczak  JD, Nogler  RA  II.  Tobacco cessation in primary care: maximizing intervention strategies.  Clin Med Res. 2003;1(3):201-216.PubMedGoogle ScholarCrossref
Cryan  JF, Gasparini  F, van Heeke  G, Markou  A.  Non-nicotinic neuropharmacological strategies for nicotine dependence: beyond bupropion.  Drug Discov Today. 2003;8(22):1025-1034.PubMedGoogle ScholarCrossref
Prokhorov  AV, Winickoff  JP, Ahluwalia  JS,  et al; Tobacco Consortium, American Academy of Pediatrics Center for Child Health Research.  Youth tobacco use: a global perspective for child health care clinicians.  Pediatrics. 2006;118(3):e890-e903.PubMedGoogle ScholarCrossref
Levy  SJ, Kokotailo  PK; Committee on Substance Abuse.  Substance use screening, brief intervention, and referral to treatment for pediatricians.  Pediatrics. 2011;128(5):e1330-e1340.PubMedGoogle ScholarCrossref
Knight  JR, Shrier  LA, Bravender  TD, Farrell  M, Vander Bilt  J, Shaffer  HJ.  A new brief screen for adolescent substance abuse.  Arch Pediatr Adolesc Med. 1999;153(6):591-596.PubMedGoogle Scholar
Knight  JR, Sherritt  L, Shrier  LA, Harris  SK, Chang  G.  Validity of the CRAFFT substance abuse screening test among adolescent clinic patients.  Arch Pediatr Adolesc Med. 2002;156(6):607-614.PubMedGoogle ScholarCrossref
Johnston  LD, O'Malley  PM, Bachman  JG, Schulenberg  JE.  Monitoring the Future: National Results on Drug Abuse. 2012 Overview: Key Findings on Adolescent Drug Use. Ann Arbor: Institute for Social Research, University of Michigan; 2013.
Rojas  NL, Sherrit  L, Harris  S, Knight  JR.  The role of parental consent in adolescent substance use research.  J Adolesc Health. 2008;42(2):192-197.PubMedGoogle ScholarCrossref
National Institute on Drug Abuse.  Screening for Drug Use in General Medical Settings Resource Guide. Bethesda, MD: National Institutes on Drug Abuse; 2012.
Donovan  JE.  Estimated blood alcohol concentrations for child and adolescent drinking and their implications for screening instruments.  Pediatrics. 2009;123(6):e975-e981.PubMedGoogle ScholarCrossref
Babor  T, de la Fuente  J, Saunders  J, Grant  M.  AUDIT: The Alcohol Use Disorders Identification Test: Guidelines for Use in Primary Health Care. Geneva, Switzerland: World Health Organization; 1992.
Cottler  LB.  Composite International Diagnostic Interview–Substance Abuse Module (SAM). St Louis, MO: Dept of Psychiatry, Washington University School of Medicine; 2000.
American Psychiatric Association.  Diagnostic and Statistical Manual of Mental Disorders.5th ed. Arlington, VA: American Psychiatric Association; 2013.
American Psychiatric Association.  Diagnostic and Statistical Manual of Mental Disorders.ed 4. Washington, DC: American Psychiatric Association; 1994.
Levy  S, Sherritt  L, Harris  SK,  et al.  Test-retest reliability of adolescents’ self-report of substance use.  Alcohol Clin Exp Res. 2004;28(8):1236-1241.PubMedGoogle ScholarCrossref
Smith  PC, Schmidt  SM, Allensworth-Davies  D, Saitz  R.  Primary care validation of a single-question alcohol screening test.  J Gen Intern Med. 2009;24(7):783-788.PubMedGoogle ScholarCrossref
National Institute on Alcohol Abuse and Alcoholism.  Alcohol Screening and Brief Intervention for Youth: A Practitioner's Guide. Bethesda, MD: National Institute on Alcohol Abuse and Alcoholism; 2011. NIH publication 11-7805.
Millstein  SG, Marcell  AV.  Screening and counseling for adolescent alcohol use among primary care physicians in the United States.  Pediatrics. 2003;111(1):114-122.PubMedGoogle ScholarCrossref
Van Hook  S, Harris  SK, Brooks  T,  et al; New England Partnership for Substance Abuse Research.  The “Six T’s”: barriers to screening teens for substance abuse in primary care.  J Adolesc Health. 2007;40(5):456-461.PubMedGoogle ScholarCrossref
Barry  KL, Blow  FC, Willenbring  ML, McCormick  R, Brockmann  LM, Visnic  S.  Use of alcohol screening and brief interventions in primary care settings: implementation and barriers.  Subst Abus. 2004;25(1):27-36.PubMedGoogle ScholarCrossref
Danielsson  PE, Rivara  FP, Gentilello  LM, Maier  RV.  Reasons why trauma surgeons fail to screen for alcohol problems.  Arch Surg. 1999;134(5):564-568.PubMedGoogle ScholarCrossref
Wilson  CR, Sherritt  L, Gates  E, Knight  JR.  Are clinical impressions of adolescent substance use accurate?  Pediatrics. 2004;114(5):e536-e540.PubMedGoogle ScholarCrossref
Office of Applied Studies, Substance Abuse and Mental Health Services Administration (SAMHSA). Substance abuse treatment admissions referred by the criminal justice system: 2002. The DASIS Report2004. Accessed November 27, 2013.
National Institute on Drug Abuse. The NIDA Quick Screen. Screening for Drug Use in General Medical Settings: Resource Guide. Accessed November 27, 2013.
American Academy of Pediatrics, Committee on Substance Abuse. Make time to screen for substance use during office visits. AAP News. 2002;21:14, 34.
Knight  JR, Harris  SK, Sherritt  L,  et al.  Prevalence of positive substance abuse screen results among adolescent primary care patients.  Arch Pediatr Adolesc Med. 2007;161(11):1035-1041.PubMedGoogle ScholarCrossref
Clark  DB, Chung  T, Martin  C.  Alcohol use frequency as a screen for alcohol use disorders in adolescents.  Int J Adolesc Med Health. 2006;18(1):181-187.PubMedGoogle ScholarCrossref
Original Investigation
September 2014

An Electronic Screen for Triaging Adolescent Substance Use by Risk Levels

Author Affiliations
  • 1Adolescent Substance Abuse Program, Boston Children’s Hospital, Boston, Massachusetts
  • 2Division of Developmental Medicine, Boston Children’s Hospital, Boston, Massachusetts
  • 3Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
  • 4Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
  • 5Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts
  • 6Center for Adolescent Substance Abuse Research, Boston Children’s Hospital, Boston, Massachusetts
  • 7Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts
JAMA Pediatr. 2014;168(9):822-828. doi:10.1001/jamapediatrics.2014.774

Importance  Screening adolescents for substance use and intervening immediately can reduce the burden of addiction and substance-related morbidity. Several screening tools have been developed to identify problem substance use for adolescents, but none have been calibrated to triage adolescents into clinically relevant risk categories to guide interventions.

Objective  To describe the psychometric properties of an electronic screen and brief assessment tool that triages adolescents into 4 actionable categories regarding their experience with nontobacco substance use.

Design, Setting, and Participants  Adolescent patients (age range, 12-17 years) arriving for routine medical care at 2 outpatient primary care centers and 1 outpatient center for substance use treatment at a pediatric hospital completed an electronic screening tool from June 1, 2012, through March 31, 2013, that consisted of a question on the frequency of using 8 types of drugs in the past year (Screening to Brief Intervention). Additional questions assessed severity of any past-year substance use. Patients completed a structured diagnostic interview (Composite International Diagnostic Interview–Substance Abuse Module), yielding Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) substance use diagnoses.

Main Outcomes and Measures  For the entire screen and the Screening to Brief Intervention, sensitivity and specificity for identifying nontobacco substance use, substance use disorders, severe substance use disorders, and tobacco dependence were calculated using the Composite International Diagnostic Interview–Substance Abuse Module as the criterion standard.

Results  Of 340 patients invited to participate, 216 (63.5%) enrolled in the study. Sensitivity and specificity were 100% and 84% (95% CI, 76%-89%) for identifying nontobacco substance use, 90% (95% CI, 77%-96%) and 94% (95% CI, 89%-96%) for substance use disorders, 100% and 94% (95% CI, 90%-96%) for severe substance use disorders, and 75% (95% CI, 52%-89%) and 98% (95% CI, 95%-100%) for nicotine dependence. No significant differences were found in sensitivity or specificity between the full tool and the Screening to Brief Intervention.

Conclusions and Relevance  A single screening question assessing past-year frequency use for 8 commonly misused categories of substances appears to be a valid method for discriminating among clinically relevant risk categories of adolescent substance use.