Paeds · adolescent-and-young-adult-medicine
Adolescent substance-use screening, brief intervention and harm reduction
Also known as Adolescent SBIRT · Youth substance-use screening · CRAFFT and S2BI screening · Brief intervention for adolescent substance use · Adolescent harm reduction · Motivational interviewing for youth substance use
A fellowship approach to adolescent substance-use screening, brief intervention and harm reduction: universal frequency-based screening (S2BI/CRAFFT), motivational-interviewing brief intervention, a domain-specific harm-reduction bundle (naloxone, needle–syringe linkage, vaping cut-down), and the fentanyl-era safety response across ANZ, UK, US and Canada.
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Target exams
Red flags
- Opioid overdose or fentanyl exposure with reduced consciousness or respiratory depression
- Suicidal plan, intent, recent attempt, or access to lethal means during a substance-related visit
- Disclosure of injection drug use with shared equipment or rapidly escalating opioid exposure
- Substance use with medical instability — hypoxia, hypoglycaemia, arrhythmia, seizure, head injury
- Coercion, sexual assault, exploitation or trafficking underlying the substance use
- Acute intoxication with psychosis, severe agitation, or inability to keep safe
Life stages
Care settings
Clinical exam formats
Board mappings
- General and Community Paediatrics
- Adolescent health and substance-use screening
- Current 2026 PREP curriculum — Learning Objective 1.2.1: Communicate with a child or young person in a way which is appropriate to the position of that child within their own culture
- Renewed curriculum for first-year trainees from 2027 — Learning goal 5: Clinical assessment – essential general paediatrics
- Renewed curriculum for first-year trainees from 2027 — Learning goal 6: Clinical management – essential general paediatrics
- Renewed curriculum for first-year trainees from 2027 — Learning goal 12: Communication with patients, families, and health professionals
- Renewed curriculum for first-year trainees from 2027 — Learning goal 15: Essential general paediatrics
- Clinical Applications
- Adolescent medicine, substance-use screening and harm reduction
- Long Cases
- Short Cases
- Communication stations
- 5. Health promotion and illness prevention
- 11. Adolescent health
- General Paediatrics: Screens for substance use with validated tools and applies brief intervention and harm-reduction principles
- Foundation of Practice (FOP)
- Applied Knowledge in Practice (AKP)
- Adolescent health, safeguarding and substance use
- History
- Communication
- Clinical
- General Pediatrics Content Outline — Domain 1: Preventive Pediatrics/Well-Child Care
- General Pediatrics Content Outline — Domain 11: Adolescent Medicine and Gynecology
- General Pediatrics Content Outline — Domain 16: Mental and Behavioral Health
- General Pediatrics EPA 3: Applying SBIRT and harm-reduction counselling for adolescent substance use
- Patient Care 5: Patient Management
- Interpersonal and Communication Skills 1: Patient- and Family-Centered Communication
- Systems-Based Practice 3: System Navigation for Patient Centered Care – Coordination of Care
- Professionalism 1: Professional Behavior and Ethical Principles
- Communicator
- Health Advocate
- Professional
- Pediatrics: Foundations EPA — Assessing and providing care for adolescents including substance-use harm reduction
- Pediatrics: Core EPA — Providing preventive care and substance-use risk-reduction counselling
Overview & Definition
A registrar sees a 15-year-old who vapes "just socially." The screen is skipped, mood is "fine," and the visit closes in eight minutes. Three months later the same teenager is in resus after a fentanyl overdose from a counterfeit pill they never knew was an opioid. The missed work was not a rare diagnosis. It was a screen nobody ran, and a plan that demanded abstinence the young person could not yet give. [1] [8]
Substance-use screening, brief intervention and harm reduction is the clinical workflow that closes that gap. SBIRT (Screening, Brief Intervention, and Referral to Treatment) is the AAP-endorsed structure: screen every adolescent universally, deliver a brief intervention when risk is present, and refer indicated cases to treatment. Harm reduction is the pragmatic stance that lowers the adverse consequences of use even when the use continues, keeping young people alive and engaged enough to take the next step. [1] [7]
The skill is the marriage of the two. Screen thoroughly with validated tools. Meet the young person at their readiness with a brief intervention that evokes rather than imposes change. Then lower the consequences today — naloxone, needle–syringe access, a vaping cut-down, means restriction — while keeping the door open for bigger change later. The goal is any positive change, not perfection. [1] [10]
The SBIRT + harm-reduction sequence
- 1
Engage
Greet the young person first, secure time alone, state conditional confidentiality with its limits, adopt a non-judgemental stance.
- 2
Screen
Universal frequency-based S2BI for every adolescent; CRAFFT as the deeper/back-up screen; pair with mood/suicide and sexual-health inquiry.
- 3
Assess if positive
Structured detail on pattern, frequency, function, harm, dependence, co-occurring mood or trauma, and fentanyl exposure risk.
- 4
Brief intervention
Motivational interviewing — evoke own reasons for change; give personalised feedback; explore readiness.
- 5
Harm-reduction bundle
Domain-specific: naloxone, needle–syringe linkage, vaping cut-down/varenicline, cannabis frequency reduction, BBV testing, means restriction.
- 6
Referral + follow-up
Refer indicated cases to treatment; safety plan; low-threshold re-access; timed review; build transition.
References15ShowHide
- [1]Levy SJ, Williams JF Substance Use Screening, Brief Intervention, and Referral to Treatment. Pediatrics, 2016.PMID 27325634
- [2]Knight JR, Sherritt L, Shrier LA, Harris SK, Chang G Validity of the CRAFFT substance abuse screening test among adolescent clinic patients. Archives of pediatrics & adolescent medicine, 2002.PMID 12038895
- [3]Levy S, Brogna M, Minegishi M, et al. Assessment of Screening Tools to Identify Substance Use Disorders Among Adolescents. JAMA network open, 2023.PMID 37213103
- [4]Levy S, Weitzman ER, Marin AC, et al. Sensitivity and specificity of S2BI for identifying alcohol and cannabis use disorders among adolescents. Substance abuse, 2021.PMID 32814009
- [5]Cushing CC, Jensen CD, Miller MB, Leffingwell TR Meta-analysis of motivational interviewing for adolescent health behavior: efficacy beyond substance use. Journal of consulting and clinical psychology, 2014.PMID 24841861
- [6]Jensen CD, Cushing CC, Aylward BS, Craig JT, Sorell DM, Steele RG Effectiveness of motivational interviewing interventions for adolescent substance use behavior change: a meta-analytic review. Journal of consulting and clinical psychology, 2011.PMID 21728400
- [7]Kimmel SD, Gaeta JM, Hadland SE, Hallett E, Marshall BDL Principles of Harm Reduction for Young People Who Use Drugs. Pediatrics, 2021.PMID 33386326
- [8]Chadi N, Hadland SE Youth Access to Naloxone: The Next Frontier? The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 2019.PMID 31648752
- [9]MacArthur GJ, van Velzen E, Palmateer N, Kimber J, Pharris A, Hope V, et al Interventions to prevent HIV and Hepatitis C in people who inject drugs: a review of reviews to assess evidence of effectiveness. The International journal on drug policy, 2014.PMID 23973009
- [10]Winer JM, Yule AM, Hadland SE, Bagley SM Addressing adolescent substance use with a public health prevention framework: the case for harm reduction. Annals of medicine, 2022.PMID 35900132
- [11]Bagley SM, Hadland SE, Schoenberger SF, Gai MJ, Topp D, Hallett E Integrating substance use care into primary care for adolescents and young adults: Lessons learned. Journal of substance abuse treatment, 2021.PMID 34080547
- [12]Evins AE, Cather C, Reeder HT, et al. Varenicline for Youth Nicotine Vaping Cessation: A Randomized Clinical Trial. JAMA, 2025.PMID 40266580
- [13]Adams ZW, Marriott BR, Hulvershorn LA, et al. Treatment of Adolescent Cannabis Use Disorders. The Psychiatric clinics of North America, 2023.PMID 37879838
- [14]Sterling S, Kline-Simon AH, Jones A, et al Health Care Use Over 3 Years After Adolescent SBIRT. Pediatrics, 2019.PMID 31018988
- [15]Cao DJ, Aldy K, Hsu S, et al. Review of Health Consequences of Electronic Cigarettes and the Outbreak of Electronic Cigarette, or Vaping, Product Use-Associated Lung Injury. Journal of medical toxicology : official journal of the American College of Medical Toxicology, 2020.PMID 32301069