An annual health supervision visit, which for many adolescents is their only regular contact with a medical professional, provides an ideal time for the pediatrician or other health care providers to screen for substance use, have a short conversation about the results and intervene accordingly to promote health.

The AAP recommends using a validated screening tool to screen for substance use at every health supervision visit. Research has shown that physicians who rely on clinical impression alone underestimate the extent of adolescent substance use. One study found that when a screening tool was not used, only one-third of patients who engaged in excessive alcohol use were identified.

Screening discriminates among risk levels by identifying substance use along a spectrum from abstinence to substance use disorder, described as:

  • Abstinence — patient has never used drugs or taken more than a few sips of alcohol.
  • Substance use without a disorder — limited use, usually in social situations; typically at predictable times such as on weekends; no associated problems (such as fighting, arrest or school suspension).
  • Mild to moderate substance use disorder (SUD) — use in high-risk situations such as driving or with strangers; associated with problems (as above); or use to relieve stress or depression.
  • Severe SUD — characterized by loss of control or compulsive use, which is associated with neurologic changes in the brain’s reward system.

Screening results guide the pediatrician’s next steps, including Brief Intervention (a follow-up conversation between the provider and patient designed to prevent, delay, reduce or stop substance use) or, if warranted, a Referral to Treatment.

To encourage honest and accurate answers when screening, pediatricians can:

  • Incorporate time alone with the patient into the visit.
  • Explain that unless the patient is in danger, the details discussed will remain private.
  • Assure the patient that screening is a routine part of health supervision visits for all patients, and they are not being singled out.

The value of universal screening extends beyond detecting adolescent substance use. A negative screening result provides the pediatrician with an opportunity to reinforce the patient’s healthful choices and stress the importance of continuing to abstain.

Screening and Assessment Tools Validated for Use with Adolescents

(Note: Inclusion of a tool in this list does not indicate endorsement by the American Academy of Pediatrics.)

S2BI (Screening to Brief Intervention)

  • Frequency screen
  • Screens for tobacco, alcohol, marijuana and other illicit drug use
  • Discriminates between no use, no substance use disorder (SUD), moderate SUD and severe SUD, based on DSM-5 diagnoses

BSTAD (Brief Screener for Tobacco, Alcohol, and other Drugs)

  • Identifies problematic tobacco, alcohol and marijuana use

CRAFFT (Car, Relax, Alone, Friends/Family, Forget, Trouble)

  • Quickly identifies problems associated with substance use

GAIN (Global Appraisal of Individual Needs)

  • Assesses for both substance use disorders and mental health disorders

AUDIT (Alcohol Use Disorders Identification Test)

  • Assesses risky drinking


Confidentiality is an important determinant of whether adolescents will answer questions fully or truthfully and seek help and stay engaged with their pediatricians and other health care providers. Here are some practical recommendations:

  • At the first visit, explain your practice’s confidentiality policies to the patient and caregivers.
  • Set aside private time with the patient during every visit.
  • Decide how and when to break confidentiality. (Clinical judgment and your state’s minor consent laws will inform this decision.) The patient’s age, level of use and risk of injury are all factors. Escalating use or failure to follow through on an agreed plan to reduce or stop substance use may also warrant involving caregivers.