Risk Levels

As we just saw, it’s important to use screening tools exactly as written to accurately gather information about the teen’s substance use. There are four possible options that result from screening. Some tools define results by risk categories like lower risk, low risk, moderate risk, and high risk. Others categorize based on frequency of use, like no use, once or twice a year, monthly, or weekly or more.

CHANGE CONCEPT: Use the Screening to Brief Intervention or S2BI (self-administered version) to screen for substance use risk in adolescents.

Never / No Use

If a teen does not use alcohol or other substances, you may be tempted to just move on to the next part of their appointment. But this is a great opportunity to provide genuine, positive reinforcement for their good decisions. Phrasing their abstinence as a decision acknowledges the challenges involved, and empowers teens to continue delaying their use of substances. Let’s see an example.

PROVIDER: You’ve made some very good decisions in not using drugs or alcohol.That’s one of the best ways to protect the development of your brain For the sake of your health, I hope you’ll keep that up until you’re an adult. And you can always ask me if you have any questions.

TEEN: Okay, thanks!

Once or Twice / Low Risk

If a teen is low-risk and used alcohol or drugs only once or twice in the past year, provide brief advice that it would be best for their health if they abstain. First, ask permission to give your opinion, and then keep a non-judgmental tone to respect a teen’s autonomy. Here’s an example.

PROVIDER: Your form shows that you drank alcohol once or twice in the last year. Thanks for being honest about that. I have some information I could share about how drinking affects the body. Would that be okay?

TEEN: Yeah, sure.

PROVIDER: Drinking alcohol as a teen, even when it’s not very often, makes it more likely for you to be hurt or in an accident … 200,000 teenagers visit the emergency room each year due to a substance use related injury.

TEEN: Wow, I didn’t know that.

PROVIDER: The decision is ultimately yours, but for your health, I recommend that you don’t drink alcohol at all. Wait until you’re older, and then, if you do make the decision to drink, do it in moderation, just one or two drinks at a time. You’re a good student and I would hate to see alcohol get in the way of your future and the things you care about. And you can always ask me if you have any questions.

TEEN: Okay, sounds good.

Monthly / Moderate Risk

Adolescents identified as moderate-risk, or monthly use of drugs or alcohol, should receive a brief intervention with the goal of engaging them to make a behavior change plan. Most brief interventions are delivered to people in this category. And you’ll have the opportunity to practice this later.

With the teen’s permission, consider a referral for further support by involving parents, guardians, or other adults in their lives. Other options include in-person support groups or professionals like psychologists, clinical social workers, school counselors, pastoral counselors, or peer specialists.

Weekly or More / High Risk

If a teen is using substances weekly or more, also known as high-risk use, you’ll engage in a brief intervention. Those who seem ready to change should also be given a referral for treatment to receive a comprehensive assessment.

CHANGE CONCEPT: Establish criteria for referral to treatment linked to patient substance use, and physical and mental health.

If possible, use a warm hand-off to facilitate the introduction between the adolescent and the specialist. Having a pre-existing relationship with behavioral and medical professionals is key so the adolescent feels supported and guided through the hand-off process.

Familiarize yourself with options, such as outpatient facilities and peer support groups in your area, and identify colleagues who can help assess the level of care needed.

You’ll see an example of a referral later, but this is a skill that can take time to develop. Consult the Resources section to learn more.

CHANGE CONCEPT: Develop protocol and procedures to link patients to internal and/or external care, leveraging provider/organizational partnerships.