«THE ABAM FOUNDATION NATIONAL CENTER FOR PHYSICIAN TRAINING IN ADDICTION MEDICINE Identifying and Responding to Substance Use among Adolescents and ...»
Identifying and Responding
to Substance Use among
Adolescents and Young
Adults: A Compendium of
Resources for Medical
THE ABAM FOUNDATION
NATIONAL CENTER FOR PHYSICIAN
TRAINING IN ADDICTION MEDICINE
Identifying and Responding to Substance
Use among Adolescents and Young Adults:
A Compendium of Resources for Medical
The National Center for Physician Training in Addiction Medicine
The American Board of Addiction Medicine Foundation Copyright@2015 The National Center for Physician Training in Addiction Medicine The ABAM Foundation The National Center for Physician Training in Addiction Medicine 4300 Montgomery Avenue, Suite 206 Bethesda, MD 20814 Tel: (301) 656-3378 Fax: (240) 762-5422 www.abamfoundation.org About The National Center for Physician Training in Addiction Medicine The American Board of Addiction Medicine Foundation’s National Center for Physician Training in Addiction Medicine was created to expand workforce capacity within the medical system to meet the needs of the American public for prevention, intervention, treatment and management of the disease of addiction. This requires building and sustaining a credentialed workforce of addiction medicine physicians capable of providing specialty care for addiction prevention and treatment, consultation with other health care practitioners, and training of primary and affiliated health care providers. Primary activities of the
Expanding and supporting existing fellowship training programs and helping them achieve ACGME accreditation;
Creating academic units of addiction medicine in accredited U.S. medical schools;
Developing and maintaining a functioning pipeline of physicians for training in addiction medicine;
Creating sustainable mechanisms for ongoing professional support and development for fellowship directors, faculty and diplomates;
Developing core clinical competencies in addiction for health professionals, and working with other organizations to integrate them as required components into curricula, training, licensing, certification and continuing education;
Working with the American Board of Addiction Medicine to achieve recognition of the field of addiction medicine by the American Board of Medical Specialties (ABMS).
Key components of the Center’s work are a focus on prevention of both risky substance use and addiction as well as treatment and disease management, and a comprehensive approach including attention to all addictive substances (nicotine, alcohol, controlled prescription and other drugs). Physician training and core clinical competencies reflect these priorities. Because of the high rates of risky substance use in the adolescent and young adult populations and the fact that addiction can be viewed as a developmental disease, effective prevention requires a specific focus in the medical profession on patient education, screening and early intervention, particularly for adolescents and young adults, as well as effective treatment and disease management for all with the disease.
The National Center has offices in Bethesda, MD and the State University of New York (SUNY) at Buffalo Department of Family Medicine. For further information, contact: Andy Danzo at AddictionMedicine@buffalo.edu.
I. Screening Tools
1. S2BI (Screening to Brief Intervention)
2. Brief Screener for Tobacco, Alcohol, and Other Drugs (BSTAD)
For Adolescents / Older Youth and Adults
1. Michigan Alcoholism Screening Test (MAST)
2. Drug Abuse Screen Test (DAST-10)
National Institute on Drug Abuse’s Quick Screen
National Institute on Alcohol Abuse and Alcoholism’s single question screen
3. The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST)
4. The Alcohol Use Disorders Identification Test (AUDIT)
5. TWEAK Questionnaire
Additional Screening Tools and Resources
1. Screening, Assessment, and Drug Testing Resources
2. The Substance Use Screening and Assessment Database
II. Training Materials for Delivering Screening and Brief Interventions
1. Introduction to SBIRT for Adolescents
2. Teen Substance Abuse Screening
3. Substance Use Disorders in Adolescents: Screening and Engagement in Primary Care Settings
4. Alcohol Screening and Brief Intervention for Youth: A Practitioner’s Guide
For Adolescents and Adults
1. Substance Use in Adults and Adolescents: Screening, Brief Intervention and Referral to Treatment (SBIRT)
For General Population or Not Specified
1. Screening, Brief Intervention and Referral to Treatment
2 Guide to Screening, Brief Intervention, and Referral to Treatment (SBIRT): An Introduction to Screening
3. SBIRT Oregon Primary Care Residency Initiative
4. SBIRT Core Training Program – Whole Program: Screening, Brief Interventions, and Referral to Treatment
5. Alcohol Screening and Brief Intervention Curriculum for Generalist Clinician Educators............. 14
6. Talking to Patients about Health Risk Behaviors
7. ADEPT – Alcohol and Drug Education for Prevention and Treatment
III. Treatment and Referrals
1. More Information on Treatment of Adolescents with Addiction
For General Population or Not Specified
1. Patient Guide to Finding Quality Addiction Treatment
2. How to Locate a Trained Addiction Physician Specialist
SAMHSA’s Resources to Assist in Smooth, Effective Referrals
4. Behavioral Health Treatment Services Locator
5. Brief Treatment Manual
IV. Comprehensive SBIRT Websites
1. Teen Substance Abuse Screening (Boston Children’s Hospital – Adolescent Substance Abuse Program)
2. Yale School of Medicine
3. University of Maryland SBIRT Modules & Training Videos for Medical Residents & Faculty........ 16
4. SAMHSA-HRSA Center for Integrated Health Solutions (CIHS)
5. Substance Use Disorders in Adolescents: Screening & Engagement in Primary Care Settings.. 17
6. SBIRT Oregon
10. New York State Office of Alcoholism and Substance Abuse Services (OASAS) SBIRT.............. 19
V. SBIRT Reimbursement and Billing Codes
1. SBIRT Reimbursement Map
2. Coding for Screening and Brief Intervention Reimbursement
3. Medicare Physician Fee Schedule Search
4. SAMHSA – Paying for Primary Care and Behavioral Health Services Provided in Integrated Care Settings
VI. Materials to Recommend or Provide to Teen Patients
3. Educational Pamphlets
VII. Resources for Families, Friends and Educators
VIII. Related Educational Course Offerings
On behalf of The National Center for Physician Training in Addiction Medicine, I am pleased to bring you this Compendium of resources for identifying and responding to substance use in healthcare and medical practice, with particular attention to the adolescent and young adult population.
This Compendium has been prepared for addiction medicine faculty and primary care providers. It provides links to screening tools, brief intervention guides and education and training materials that have been developed by a wide variety of institutions, organizations and medical practitioners for use with patients of varying ages. An attempt has been made to highlight materials appropriate for use with adolescents and young adults in all areas of medical practice.
A note of caution: Many of the tools and curricula that have been developed and validated have
• They may not screen for risky use of all addictive substances—nicotine, alcohol, controlled prescription and other drugs.
• Positive screens using many of these instruments may be calibrated more closely to the disease end of the spectrum and thus fail to pick up early signs of risky use, missing important opportunities for prevention.
• Screening for adolescents may use measures of use relevant to adults rather than measures based on the understanding that any use of these substances by adolescents is risky behavior.
• Brief interventions are often developed with the adult population; modified versions are being developed and should be used with adolescents.
• Distinctions are not always clearly made between patients who engage in risky use of addictive substances but do not meet medical criteria for the disease and the types of interventions that are appropriate for them, and those who do meet medical criteria for addiction who require a careful diagnosis, comprehensive assessment and plan for tailored treatment and disease management.
We encourage faculty and treatment providers to keep these limitations in mind in selecting education, screening and brief intervention materials for use. We further strongly encourage the development of new screening and intervention approaches that address these limitations and are grounded in science.
We plan to continually update these materials in order to disseminate best practices, and we ask that you provide us with any improvements that you develop and validate to help fill these gaps.
This document is based on research by Joan Kernan at the National Center for Physician Training in Addiction Medicine (National Center). I would like to thank all those who contributed to this work, including from The National Center Richard Blondell, MD, Medical Director, Andy Danzo, Center Coordinator, Shannon Carlin-Menter, PhD, Director of Evaluation, Urmo Jaanimagi, MA, MS, Associate Evaluator, Rachel Rizzo, Fellowship Training Data Specialist, and Erin O’Byrne, Project Assistant; and from The American Board of Addiction Medicine Lia Bennett, MPH, Maintenance of Certification Director, Michelle Lyons, MS, MOC Manager, Deborah Bryant, MS, MOC Assistant, and Catherine Saunders, Certification Program. Finally, we extend our appreciation to the researchers and practitioners who have brought us the many useful products included in this Compendium.
Sincerely, Susan E. Foster Executive Director, The National Center for Physician Training in Addiction Medicine
Scope of the Problem One in six people in the United States age 12 and older meet medical criteria for addiction. Another third of the population engages in use of addictive substances in ways that can threaten their health and safety or that of others. Risky substance use and addiction constitute the largest preventable and the most costly health problems in the country.
Despite these facts, people are not routinely screened for risky use and most screening that occurs is not comprehensive, primarily focusing on alcohol or tobacco. For those who are screened and show signs of risky use, few receive any services designed to reduce such use — such as brief interventions. If signs of addiction are present, few receive a diagnosis and comprehensive assessment to determine the presence, stage and severity of disease and appropriate treatment options.
In total, in 2010 14.3 percent of all 12 – 17 year olds and 40.9 percent of 18 – 25 year olds engaged in risky use of addictive substances but did not meet medical criteria for addiction. Another 8.0 percent of 12 – 17 year olds and 26.4 percent of 18 – 25 year olds met medical criteria for addiction.