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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 adolescents 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 substance abuse occurs at a higher incidence.
In targeted populations, you would only administer to people that you would consider high-risk.
So these would be those with a prior diagnosis of ADHD, depression, maybe those that may have been to a dentist and gotten prescription opioids, accidents, sexually transmitted disease, or even pregnancy.
These individuals would be 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 are validated 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 year 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 a 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 therefore this would be based on the recommendations and the selection would be based on the provider's preference.
You know some people may like to have a numeric value or 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 paper, sorry, or a computer in the waiting room.
Or the clinician if they prefer to do it - administered 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, but 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 shoulders.
But more importantly, when the provider sits with the individual to review the screening results or the assessment results, I think there needs to be some conversations about what in - in what situations were the adolescents' responses be shared with the parents and when will not be shared.
And there are some state rules where the confidentiality rules do not apply and that's usually when they're 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 are also opportunities for providers to direct the teens to the NIDA teen website.
There are 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 probable age group.
Because most individuals teenagers who are using substances are of the opinion that everybody in their class is using drugs.
And that is really not the case.