Brief Intervention in an office setting is appropriate for most adolescents regarding their substance use. When screening identifies high-risk behaviors or the adolescent presents with a substance use-related health problem, such as suicidal ideation, then a Referral to Treatment is warranted.

At this stage, it is advisable to involve the parent(s)/caregivers whenever possible. The pediatrician should first explain to the patient why a referral is needed and ask their permission to include parent(s)/caregivers in the plan. If permission is not granted and the patient’s behavior puts him/her or others at risk, the pediatrician or other physician should discuss the need to break confidentiality.

Adolescents who report weekly or more-frequent substance use are likely to meet criteria for having a substance use disorder (SUD). It’s likely that the parent(s)/caregivers are aware of the substance use by this point, though they may underestimate the extent of it. The patient and family may resist intensive treatment.

Pediatricians have two roles in the referral process:

  • To work with the patient and family to ensure that they accept the need for treatment. Brief Intervention incorporating motivational interviewing can help the patient and parent(s)/caregivers accept the need for treatment.
  • To facilitate the referral by matching the patient to the appropriate professionals and programs. A comprehensive biopsychosocial assessment by a mental health or addiction specialist can help make this determination. Treatment options range from motivational interviewing and individual, family or group counseling to intensive outpatient, hospital or residential treatment. The availability of treatment, insurance coverage and patient and family preferences all are considerations. Adolescents should be treated in the least restrictive setting possible. 

It’s important although sometimes difficult for the pediatrician to remain informed and supportive once the patient has been referred to treatment. The pediatrician should stay in touch with the family during treatment, obtain permission to speak directly with program staff whenever possible and provide follow up patient care after discharge to assure compliance with treatment and provide continuing care aligned with the treatment plan while addressing other health needs.