A Brief Intervention is a short conversation between a pediatrician or other clinician and a patient that focuses on preventing, delaying, reducing or stopping substance use. The intervention is guided by the results of the substance use screen, which detects and assesses the patient’s level of experience with substance use.

The pediatrician is uniquely positioned to influence adolescent decision-making about substance use. Adolescents consider pediatricians to be a trusted authoritative source of information about drugs and alcohol and are receptive to having this discussion if they believe it will remain confidential.

The Brief Intervention by the pediatrician and other physicians and nonphysician clinicians is structured in response to the level of substance use revealed by the screening:

  • Patients not using alcohol, tobacco or other drugs will benefit from praise and positive reinforcement about their smart and healthy choices while continued abstention from use and avoidance of risk are emphasized.

    It’s important for these conversations to emphasize that no amount of substance use is safe for adolescents since their brain development is in full force. Care should be taken not to condone experimentation; trivialize drinking, smoking or drug use at any age; or otherwise suggest that substance use is normal or expected, such as by calling use “recreational.” For a patient who is not using, this could mean a statement such as: “I’m glad to hear that you, like most teens your age, don’t drink or use other drugs.”
  • Patients who are using occasionally but show no signs of substance use disorder (SUD), should be prevented from escalating to riskier use levels or circumstances. The patient should be counseled about primary medical harms of the substance being used and provided clear advice to stop. Motivational enhancement can also leverage the patient’s personal strengths and interests to encourage abstention, and emphasize that not using will help those strengths, such as perform better in school, sports, music or other favorite activities.
  • Patients with signs of mild to moderate SUD should benefit from the pediatrician’s counsel about medical harms and clear advice to quit. Together, the pediatrician and patient should devise a plan to stop or reduce use, then follow up on progress toward those goals. A motivational interviewing approach can be effective.
  • Adolescents with severe SUD need intensive treatment as soon as possible. With these patients, the Brief Intervention may best focus on helping the adolescent and their parent(s)/caregivers understand and accept the need for immediate Referral to Treatment.

    This video is an example of Brief Intervention involving an adolescent with a substance use disorder.

Motivational Interviewing

Patients with substance use concerns may respond to motivational interviewing that helps connect them with their own intrinsic motivation to change their behavior, i.e., decrease or stop their substance use. Instead of trying to persuade the adolescent to reduce or stop using, the pediatrician uses this approach to help the patient weigh the benefits of continued use vs. the benefits of decreasing or stopping alcohol or drug use, then make a decision to change or seek treatment. This approach respects patient autonomy and agency. In effect, the adolescent debates himself or herself and then takes action.

This video provides an overview of motivational interviewing. It is excerpted from the BMi2 series produced by the Pediatric Research in Office Settings (PROS)/University of Michigan BMi2 (Obesity Prevention) Study.