Why We Need Substance Use Screening for All 9th Graders

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 as evidenced by a Monitoring the Future survey.

For alcohol:

For marijuana:

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:

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.