Ninety percent of people addicted to substances started drugs before they were 18, and anxiety, depression and even suicide are often linked with addiction. That’s why early detection is crucial, said Caitlyn Johnson and Kim Shuler, licensed social workers with Arkansas Behavioral Health Integration Network.
They presented evidence-based adolescent substance use screening tools such as the SBIRT model (Screening, Brief Intervention and Referral to Treatment) at the UAMS 29th Annual Family Medicine Update Oct. 29, 2025.
The event was sponsored by the UAMS Department of Family and Preventive Medicine’s Community Health and Education division. Arkansas Children’s National Center for Opioid Research and Clinical Effectiveness sponsored the first day, “Opioids and the Young.”
Trends in Teen Substance Use: Alcohol Still Leads
The social workers surprised the primary care audience by revealing that alcohol trumps nicotine and THC as adolescents’ most used substance because it is readily accessible and culturally accepted. But the good news is that binge drinking is trending down, according to the National Institute on Drug Abuse, even though it’s still a contributor to 74% of premature deaths among teens.
“Substance use can contribute to feeling more uninhibited and having suicidal thoughts,” said Shuler. “Suicide is something that we need to have in the forefront of our minds.”
How SBIRT Works in Primary Care
“The key is to be as preventative as possible and provide education and tools for these teens,” Johnson added, referring to SBIRT, which stands for screening, brief intervention and referral to treatment. SBIRT screening tools often take five minutes or less to administer. Substance Abuse and Mental Health Services Administration (SAMHSA) recommends starting at age 12, but children as young as 10 are using substances
“Think about using universal screening for substances, meaning at every visit, use a screener. One of the things we know is that sometimes, when we’re asking someone (about their substance use), they may not tell us the first time. So, it’s important to continually bring this up,” said Shuler.
The CRAFFT is one of the more common screening tools. There are others such as anxiety screener Generalized Anxiety Disorder, called GAD, and the PHQ-9A which screens for depression.
Whatever tool is chosen, it’s important to let the teen know that the provider is asking everyone about substance use and not singling them out. The provider must establish confidentiality, that the patient can be honest and trust them.
Clinicians should talk with the parent or caregiver first, conveying the importance of the screening and the need for confidentiality. This will settle the parent’s mind when asked if the teen can step out for a few minutes to speak privately.
Once that confidentiality is set, what if the young patient answers “yes” to any of the questions on the screener? Johnson said many providers feel they don’t have the tools to take the next step of intervention. One solution is to hire behavioral health consultants in the clinic, but providers have been hesitant to move to integrated care because of financial, training and space issues. Video on Arkansas providers who are taking the step toward behavioral health integration.
Brief Intervention Steps
Johnson and Shuler walked through the conversational steps for brief intervention when a behavioral health professional isn’t available.
If the CRAFFT screening score is low (0-2), the intervention may require only one to three minutes since the patient is low risk. If moderate to high risk, the intervention will take 15 – 30 minutes. Johnson said to allot enough time to complete the intervention.
“There are barriers to seeing the doctor, such as missing school and insurance being able to pay and things like that. So you want to make sure you give as much as you can in one session,” said Johnson. She added that the intervention can be extended to several sessions with either the provider or medical team. “If you run into an adolescent or young adult that is not ready to make behavior change, that is OK. That’s to be expected. Their brains are still developing, and they are learning how to make those educated decisions,” said Johnson.
The social workers covered a step-by-step example of brief intervention called the Brief Negotiated Interview model, created by the Boston University School of Public Health. It has six stages.
- Build engagement and rapport – Show interest in them as a person, the things they’re putting in their body and the risks. “Would it be OK if we spent a few minutes talking about your alcohol or drug use?” If “yes,” go to question two, but if the answer is “no,” offer to be available to talk if needed.
- Pros and Cons – Ask what is enjoyable about using the substance and what’s difficult. “What else comes to mind when you think about how using the drug may impact your life, goals or wellbeing?”
- Feedback – Ask if they mind some education or thoughts on the situation. If “yes,” share one or two facts and ask their thoughts. If “no,” emphasize autonomy by saying the patient knows what’s best for them regarding the drug use.
- Readiness Ruler – Gauge their motivation for change, whether it’s low on the scale or high, and what can be done about it. “If you were to place yourself on a scale of 1 – 10 regarding how important it feels to make any change in your use of the drug, where would you be?” If the answer is four or above, ask why they chose that number and not a lower one. If the answer is 1 – 3, probe with the question, “What would have to happen to feel like making a change?”
- Negotiate Action Plan – Formulate goals with them. “So, now that we’ve had a few minutes to talk, what would you like to do, if anything? Would it be OK if I share some options?” Have them write down their goals and next steps. Focus on one to two short-term goals with specific steps.
- Summarize and Thank – They took a chance on being vulnerable with the provider, which can be painful. Ask, “Is this what you agree we went over? How do you feel about these goals that we set?”
Shuler noted that one powerful preface to a question is, “I’m curious,” because curiosity invites openness and doesn’t equal judgment.
When to Refer for Substance Use Treatment
If the brief intervention reveals a need for more intensive care, Johnson said the referral needs to be to a licensed substance use professional at a treatment facility. Cost, insurance, school or parents’ work schedule are some potential barriers.“It’s not going to be the smoothest process,” said Johnson, “but it is worth a try to see if we can overcome those barriers through conversations or connections to resources.”
The Arkansas Department of Human Services Office of Substance Abuse and Mental Health oversees prevention, treatment and recovery programs in the state and can help locate providers by area.
An educational video from Dr. Aaron Weiner on youth substance use and mental health.
Kim Shuler, LCSW, has more than 20 years of experience in clinical practice and leadership within integrated behavioral health. As CEO of ABHIN and project director for several HRSA-funded initiatives, she leads statewide efforts to advance access and quality. She is a certified behavioral health consultant with expertise in workforce training, coalition-building and strategic planning.
Caitlyn Johnson, LCSW, has 10 years of experience in integrated behavioral health, care coordination and medical social work. She earned her bachelor’s and master’s degrees in social work from the University of Arkansas at Little Rock and serves as a project manager on multiple grants for the Arkansas Behavioral Health Integration Network. Johnson specializes in program development, brief intervention, harm/stigma reduction and suicide prevention.
