Adolescent substance-use screening, brief intervention and harm reduction — formative SAQs

SAQ 1 — Universal screening, the positive lead and the brief intervention (10 marks)

A 15-year-old presents alone for a sports medical. You secure private time and state conditional confidentiality. On universal screening they report vaping nicotine daily and using cannabis "a few times a month." Function and mood are intact. ^{[1] [3]}

Questions

1. Outline how you screened this adolescent, naming the validated tools you used and how they tier the response. (3 marks) ^{[1] [3] [2]}
2. Describe the structured assessment you would now perform for the positive cannabis and vaping leads. (3 marks) ^{[1] [7]}
3. Describe the brief-intervention method you would use and why it fits adolescent development. (4 marks) ^[4]

Model answer

Screening and tiering (3). Universal screening applies a validated frequency-based tool to every adolescent. S2BI asks past-year use frequency for each substance class and tiers the response: no use (re-screen), 1–2 times (brief advice), monthly or more (full assessment + brief intervention + referral). CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble) is the deeper screen used when S2BI is positive; two or more "yes" items signal high likelihood of a problem. Monthly cannabis use and daily vaping both fall into the monthly-or-more tier, triggering full assessment. ^{[1] [3] [2]}

Structured assessment (3). Detail the pattern for each substance: frequency, quantity, route, age of initiation, source, and context. Screen for dependence features (tolerance, withdrawal/craving, loss of control, continued use despite harm) and for co-occurring mood disorder and any psychotic features. Assess harm: for cannabis, educational and motivational decline; for vaping, dependence and any respiratory symptoms and EVALI awareness. Assess fentanyl-exposure risk if any pill or powder use, and overdose history. Build a risk formulation naming drivers, protective factors, and a risk tier. ^{[1] [7]}

Brief intervention (4). Use motivational interviewing — open questions, affirmation, reflective listening, summaries (OARS) — to evoke the young person's own reasons for change rather than lecture. Give personalised feedback linking the use to what they care about. Explore readiness and roll with resistance rather than arguing. This fits the dual-systems model: the reward system matures before prefrontal control through mid-adolescence, so under peer and emotional load an adolescent may intend not to use and still use. Willpower-only demands fail and disengage; lowering consequences works with the biology. Meta-analytic evidence supports motivational interviewing for adolescent substance use. ^[4]