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Original Investigation |

An Electronic Screen for Triaging Adolescent Substance Use by Risk Levels

Sharon Levy, MD, MPH1,2,3; Roger Weiss, MD4,5; Lon Sherritt, MPH2,3,6; Rosemary Ziemnik, BS1,2; Allegra Spalding, BA7; Shari Van Hook, MPH1,2,3,6; Lydia A. Shrier, MD, MPH3,7
[+] Author Affiliations
1Adolescent Substance Abuse Program, Boston Children’s Hospital, Boston, Massachusetts
2Division of Developmental Medicine, Boston Children’s Hospital, Boston, Massachusetts
3Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
4Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
5Division of Alcohol and Drug Abuse, McLean Hospital, Belmont, Massachusetts
6Center for Adolescent Substance Abuse Research, Boston Children’s Hospital, Boston, Massachusetts
7Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts
JAMA Pediatr. 2014;168(9):822-828. doi:10.1001/jamapediatrics.2014.774.
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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.

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Figure.
Adolescent Screen and Brief Assessment Tool Questions

RAFFT (relax, alone, forget, friends or family, trouble) questions were adapted from CRAFFT. For the question, “Have you had X or more drinks on one occasion on 3 or more days?” X was calculated to reflect a binge based on sex and age.19 The question “Had 10 or more drinks on one occasion?” was adapted from the Alcohol Use Disorders Identification Test.20

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