Guidelines for Screening Adolescents for Substance Use Disorders
The problem of substance abuse among adolescents is sufficiently widespread to warrant concern. Nearly half (47%) have tried an illicit drug by the time they finish high school. If inhalant use is included in the definition of illicit drug use, almost a quarter (28%) have used as early as the 8th grade-when most students are only 13 or 14 years old. Monitoring the Future national results on adolescent drug use: Overview of key findings, 2008). Adolescents differ significantly from adults in their physiological, mental and emotional development as they make the transition from childhood to adulthood. Experimentation with substances is common through out this transition and many times lead to serious impairment in development which leaves adolescents unprepared for the challenges of adulthood. Given these factors and the need for early detection, it is critical that a wide range of professionals who come into regular contact with adolescents be able to recognize the signs of substance use. This information focuses on the most current procedures and instruments for detecting substance abuse among adolescents and how the information is to be utilized.
- The purpose of conducting a screening is to evaluate the possible existence of a problem for which further assessment is indicated. It
does not establish definitive information about diagnosis and possible treatment needs. Screening for substance abuse, mental health, or other disorders is usually done through a brief interview and/or the use of a screening instrument.
- Any adolescent involved in at risk activities should be screened. This includes screening all juveniles at the time of arrest or detention, adolescents receiving mental health assessments, those entering the child welfare system, and youth that present with behavioral problems in the educational system ( e.g. school drop outs, significant changes in grade point average, a great number of unexcused school absences.) and students involved in special education settings.
- It is critical that all health, clinical, and judicial professionals have expertise in screening adolescents for substance use disorders.
- The screening process should last no more than 30 minutes and the instruments used should be simple enough that a wide range of service providers can administer them.
- Drug monitoring is a useful adjunct to screening and should be conducted at an appropriate point during the screening process. Any drug monitoring is best conducted in a manner consistent with accepted standards and guidelines and must always be conducted with the knowledge and consent of the adolescent.
- The selection of a screening instrument for use with adolescents should be guided by the following factors:
- reliability and validity of the tool
- its appropriateness to an adolescent population
- the intended purpose of the instrument
- The screening instrument should identify markers or “red flags” that focus on the adolescent's substance use severity (primarily consumption patterns) and other associated factors such legal problems, mental health status, educational functioning, and living situation.
- The indicators that generally determine a need for further assessment include:
Substance Use Disorder-Related:
Use of substances during childhood or early teenage years
Substance use before or during school
Peer involvement in substance use
Daily use of one or more substances
Physical or sexual abuse Parental substance abuse
Sudden downturns in school performance or attendance
Peer involvement in serious crime
Significant change in physical health
Involvement in serious delinquency or crimes
HIV high-risk activities (e.g., intravenous drug use, sex with intravenous drug user)
Indicators of serious psychological problems (e.g., suicidal ideation, severe depression)
- There are no definitive rules as to how many uncovered red flags indicate a need for a comprehensive assessment. However, any time there are several red flags or a few that appear to be meaningful, the screener should refer the adolescent for a comprehensive assessment.
- An adolescent showing warning signs of substance use is not a confirmation that he/she has a problem severe enough to warrant a formal diagnosis or referral to intensive drug treatment. Therefore, professionals conducting screenings for substance use disorders must be sensitive to stigmatizing youth with an unconfirmed label of a substance abuse or substance dependence diagnosis or as having a "disease."
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- Staff that is screening adolescents for substance use disorders need to be aware of legal issues that affect the screening process and
confidentiality is of priority concern.
- 42 U.S.C. §290dd-2 as well as 42 Code of Federal Regulations (C.F.R.) Part 2 are the
legal citations for the guarantee of confidentiality of information about adolescents receiving substance use prevention and substance use disorder treatment services. These regulations restrict communications more tightly in many instances than for either the doctor/client or the attorney/client privilege.
- The adolescent client must sign a consent form (please refer to the section on examples of recommended forms) in order for any information that is protected by the Federal confidentiality regulations to be disclosed, even to parents or guardians.
- The consent form must include a statement indicating that the client may revoke the consent at any time and this revocation
need not be in writing. In cases of consent revocation, the screener involved is not required to try to retrieve the information it has already disclosed.
- The form must also contain a date, event, or condition on which it will expire if not previously revoked and the consent must last "no longer than reasonably necessary to serve the purpose for which it was given.
- The adolescent must always sign the consent form in order for the screener to release information The screener must get the parent's signature in addition to the adolescent's signature only if the screener is required by State law to obtain parental permission before providing treatment to the adolescent (§ 2.14).
- If a screener routinely needs to share certain information with an outside agency that provides services to the screener, they can enter into what is known as a
qualified service organization agreement (QSOA). (Please refer to the section on examples of recommended forms.)
- Only adolescents who have "applied for or received" screening services are protected. If an adolescent has not yet been screened or otherwise evaluated a program staff, the screener is free to discuss the adolescent's substance use disorders with others.
But, from the time the adolescent applies for services or the program first conducts an evaluation or begins to counsel the youth, the Federal regulations govern.
Source: CSAT TIP-31 Screening and Assessing Adolescents for Substance Use Disorders
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