Shari Van Hook

Computer-Facilitated Substance Use Screening and Brief Advice for Teens in Primary Care: An International Trial

OBJECTIVE: Primary care providers need effective strategies for substance use screening and brief counseling of adolescents. We examined the effects of a new computer-facilitated screening and provider brief advice (cSBA) system. METHODS: We used a quasi-experimental, asynchronous study design in which each site served as its own control. From 2005 to 2008, 12- to 18-year-olds arriving for routine care at 9 medical offices in New England (n = 2096, 58% females) and 10 in Prague, Czech Republic (n = 589, 47% females) were recruited. Patients completed measurements only during the initial treatment-as-usual study phase. We then conducted 1-hour provider training, and initiated the cSBA phase. Before seeing the provider, all cSBA participants completed a computerized screen, and then viewed screening results, scientific information, and true-life stories illustrating substance use harms. Providers received screening results and “talking points” designed to prompt 2 to 3 minutes of brief advice. We examined alcohol and cannabis use, initiation, and cessation rates over the past 90 days at 3-month follow-up, and over the past 12 months at 12-month follow-up. RESULTS: Compared with treatment as usual, cSBA patients reported less alcohol use at follow-up in New England (3-month rates 15.5% vs 22.9%, adjusted relative risk ratio [aRRR] = 0.54, 95% confidence interval 0.38–0.77; 12-month rates 29.3% vs 37.5%, aRRR = 0.73, 0.57–0.92), and less cannabis use in Prague (3-month rates 5.5% vs 9.8%, aRRR = 0.37, 0.17–0.77; 12-month rates 17.0% vs 28.7%, aRRR = 0.47, 0.32–0.71). CONCLUSIONS: Computer-facilitated screening and provider brief advice appears promising for reducing substance use among adolescent primary care patients.

An Electronic Screen for Triaging Adolescent Substance Use by Risk Levels

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.

“This is your brain on drugs”: adolescent substance use prevention through neuroscience education

Interest in the brain has risen dramatically in recent decades, suggesting that neuroscience-based information about substance use risks could be a compelling addition to prevention efforts. However, no studies have tested this approach among adolescents. In this study, we tested the effects of a high school science curriculum called “The Brain: Understanding Neurobiology through the Study of Addiction” developed by the U.S. National Institutes of Health (NIH) to teach students about how alcohol and drugs affect the brain. We examined the curriculum’s effects on students’ knowledge, attitudes, and use of tobacco, alcohol, and drugs. Participants were 9th-11th graders attending 2 urban high schools whose parents consented (222/282=79%). We standardized the 5-lesson curriculum and trained 5 science teachers; 8 classes (n=133) received the NIH curriculum, 5 matched-grade comparison classes (n=89) received the usual curriculum. We used a self-administered survey to assess demographics, knowledge, perceived risk of harm from substance use, substance use, peer/family substance use, and prior health education. We collected data 1-2 weeks pre-intervention (T1), immediately post-intervention (T2; 1 month after T1), and 6-8 months later (T3). We used multiple logistic regression with generalized estimating equations for post-test comparisons, adjusting for T1 differences and within-class correlation. 180/222 (81%) students completed all measurements; group completion rates were similar (control=80%, intervention=82%). Compared to control students, intervention students had lower past-30-day cigarette use at T2 (7% vs. 21%, AOR=0.20, 95% CI 0.08-0.49, p=.01), and a marginal trend toward lower alcohol initiation between T1 and T2 (3% vs. 20%; adjusted odds ratio [AOR]=0.09 95% CI 0.01-1.03, p=.052). Among low-frequency marijuana users (1-5 times lifetime at baseline), fewer intervention students had past-30-day marijuana use at T2 (5% vs. 35%, AOR=0.01, 95%CI 0.00-0.30, p=0.03). All between-groups differences were extinguished by T3. Neuroscience education is a promising supplemental strategy for adolescent substance use prevention; however, ongoing reinforcement is needed.