Screening, brief intervention and outpatient treatment for adolescent substance use in the medical setting: The Children's Hospital Boston model

Prescription drug misuse, abuse and dependence present a significant medical and mental health problem for United States adolescents. Professional guidelines recommend that clinicians screen all adolescents for drug and alcohol use, make brief interventions for those who can be treated in primary care and refer to treatment those who have developed substance dependence as part of routine health care. The goal of this approach is to intervene as early as possible after drug use begins in order to avoid the development of dependence, and to identify and treat those who have already developed substance dependence before health and other consequences accrue. Research suggests that suggests that this paradigm can be effective when appropriate tools and strategies designed for adolescents are used, though barriers to substance use screening and intervention in the medical home remain, including lack training for providers and lack of treatment resources. Opioid dependence is a chronic relapsing neurologically based disorder that can be effectively treated with medication therapy in combination with psychosocial support, though access to adolescents is limited.

The researchers and clinicians at Children's Hospital Boston have been leaders in developing effective strategies for screening and brief interventions for adolescent substance use, and models for outpatient treatment of substance use disorders, including opioid dependence, in the medical setting. This presentation will describe the strategies currently used at Children's Hospital Boston and present the data on which these strategies are based.