9th grade is a critical year in a teen’s life. No longer pre-adolescents, their minds and bodies are undergoing profound changes and they begin “feeling their oats,” as the expression goes. It’s also a time when substance use can become a significant presence in their lives. The latest Monitoring the Future survey lays this out quite clearly:
- 23 percent of 8th graders have tried alcohol. That number nearly doubles by 10th grade, at 42 percent, and triples by 12th grade, at 62 percent.
- Binge drinking grows even faster, with only 4 percent of 8th graders binge drinking, compared to 10 percent of 10th graders and 17 percent of 12th graders. (Binge drinking being defined as five or more drinks in a row at least once in the past two weeks.)
- Although only14 percent of 8th graders used marijuana, it jumps to 31 percent in 10th grade and 45 percent in the 12th.
- Fewer than one percent of 8th graders use marijuana daily, but 3 percent of 10th graders and 6 percent of 12th graders are using daily.
The beginning of high school is a pivotal moment when it comes to substance use. Binge drinking or using marijuana at the age of 14 or 15 puts teens at much higher risk of developing full-blown substance use disorder – addiction – in adulthood. If we can prevent this risky behavior while they are young, we reduce the odds of them developing more significant problems with substance use later.
For almost 30 years, Caron’s Student Assistance Program has been in the trenches with schools, educators, school officials, parents and communities providing substance use prevention and intervention programs. These programs work but we can do more. That is why Caron advocates for SBIRT (Screening, Brief Intervention, and Referral to Treatment), a SAMHSA initiative to identify at-risk youth for substance use and mental health issues, for all 9th graders.
SBIRT has been used extensively and successfully by medical professionals over the past decade. Now there is a move to bring SBIRT into school settings. Massachusetts and New Jersey have both made SBIRT screening mandatory in all schools. Pennsylvania is considering doing the same, and Caron’s pilot program is an effort on our part to demonstrate its effectiveness to lawmakers and learn how to best implement the program in Pennsylvania schools. In fact, with the participation of two local high schools, Caron is launching a pilot program this fall that aims to screen all incoming 9th graders to identify at-risk teens and provide early intervention that may head off later problems.
SBIRT has three basic components:
Screening. The American Academy of Pediatrics recommends that every adolescent should be asked about alcohol or other substance use yearly. There are a variety of evidence-based screening tools available to educators. The schools Caron is working with in the pilot program have selected the Global Appraisal of Individual Needs-Short Screener (GAIN-SS), a brief 5- to 10-minute instrument designed to quickly and accurately screen general populations of both adults and adolescents. While identifying possible problems, GAIN-SS also rules out those who should not be identified as having behavioral health disorders.
Brief Intervention. If a student screens positively for potentially harmful and hazardous substance use, they are invited to participate in a brief intervention. As the name implies, brief interventions are intended to be quick and impactful. A brief intervention can occur in a single session only a few minutes long, or across multiple sessions up to an hour long per session. The focus is on increasing the student’s insight on substance use and stimulating motivation for behavioral change.
Referral to Treatment. If attempts to change substance use patterns are unsuccessful, then the student needs to be referred to a specialty substance use disorder provider. Strong referral linkages are critical to make this successful.
In the decade since its introduction, SBIRT has been used to evaluate more than a million people, and follow-up research published in Addiction has determined that those who had intervention were more successful at reducing their harmful and hazardous substance use patterns than those who did not get intervention.
SBIRT is straightforward and effective. Its use in schools should be a no-brainer, as it makes sense that we should invest in early intervention, before substance use has a chance to cause short or longer-term damage.
Yet this is a sensitive subject, and we must always be aware that we are asking students private questions. Students must be assured that their answers will remain confidential, that no record of their responses will be kept. Research suggests that students are most comfortable with a verbal screening rather than a more formal written screen. Students are also more comfortable dealing with someone they trust. The school nurse is often a good candidate for performing the screenings, as students regularly seek out the nurse for help on all sorts of issues. The nurse simply asks the student if they can take a few minutes to answer some important questions.
Parents must also be notified in advance of any screenings, as required by the federal Protection of Pupil Rights Amendment (PPRA), and parents always have the right to opt out. My experience suggests that most parents will want their children to undergo the screening. Parents are very concerned about the substance use landscape their kids are exposed to, and they will likely find it reassuring that schools are taking proactive steps to support kids.
Even more importantly, schools must be prepared to respond if screening identifies a problem. Ethically, and to some extent legally, if you know someone is at risk, you must act. Schools need support structures in place to help those identified in the screening process.
Substance use is a significant concern for adolescents, and we must stop treating it as a rite of passage. Universal screening of all students can help us identify those teens most at risk and help provide them with the tools and the insight to help them make healthy choices. Our pilot program is starting with 9th grade students, because that’s the age where there is the biggest jump in terms of lifetime usage of substances. That is the time to reinforce healthy behaviors for those who haven’t used substances yet, as every year we can postpone that first use reduces a teen’s chances of developing a substance use disorder. Universal screening will enable us to identify and intervene early for those exhibiting risky behaviors. The goal is to help students find strategies and supports to live healthy and productive lives.