Adolescence is a critical period of brain development and growth, making youth especially vulnerable to the harms of alcohol, nicotine, marijuana, and other substances. Early use is linked to increased risk of dependence and can contribute to unsafe behaviors, strained relationships, and long-term health consequences. This presents an important opportunity for pediatricians to intervene and help prevent or reduce substance use. 

SBIRT (Screening, Brief Intervention, and Referral to Treatment) is an evidence-based approach used to identify substance use early and connect patients to appropriate support and care. 

FAQs related to substance use can be found on the Adolescent Opioid Use: Frequently Asked Questions page.

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Screening

Annual health visits provide an important opportunity to screen adolescents for substance use, often during their only regular interaction with a health care provider. The AAP recommends using validated screening tools at every visit, as clinical judgment alone often underestimates use. 

Screening helps identify substance use across a spectrum, from abstinence to substance use disorder, and guides next steps such as brief intervention or referral to treatment. Even negative screens are valuable, allowing providers to reinforce healthy choices and prevention messaging. 

To encourage honest responses, providers should include time alone with the patient, explain confidentiality, and normalize screening as a routine part of care. 

Common validated screening tools include:

Confidentiality is critical to effective screening and engagement. Providers should clearly explain confidentiality policies, ensure private time during visits, and use clinical judgment when determining whether caregiver involvement is necessary. 

Brief Intervention

A Brief Intervention is a short, focused conversation between a clinician and a patient designed to prevent, delay, reduce, or stop substance use, guided by screening results. Pediatricians are well positioned to influence adolescent decision-making by providing clear, nonjudgmental guidance, reinforcing healthy choices, and offering tailored support based on the patient’s level of use. 

Approaches range from prevention and positive reinforcement for those not using, to counseling, motivational interviewing, and goal setting for those who are using, and referral to treatment for those with more severe substance use concerns. Motivational interviewing can be especially effective by helping adolescents explore their own reasons for change and supporting their autonomy in decision-making. 

Referral to Treatment

Referral to Treatment is appropriate when screening identifies high-risk substance use or related health concerns. Pediatricians should explain the need for referral to the adolescent, involve parents or caregivers when appropriate, and carefully navigate confidentiality while ensuring safety. Adolescents with more frequent or severe use may require a range of treatment options, from counseling and outpatient care to more intensive services. 

Pediatricians play an important role in helping patients and families understand and accept the need for treatment, as well as connecting them to appropriate resources and specialists. Ongoing communication, coordination with treatment providers, and follow-up care are essential to support engagement, monitor progress, and ensure continuity of care.

Resources for Pediatricians

The resources below are intended to help pediatricians and other health care providers incorporate the elements of the SBIRT approach into their practices to reduce, delay, prevent or stop adolescent substance use.

Implementation Guide Resources

Guides and Fact Sheets

From the AAP

From the Society for Adolescent Health and Medicine

Last Updated

07/20/2026

Source

American Academy of Pediatrics