Overdose deaths from opioids – a type of drug that includes prescription pain relievers and heroin – continue to rise in the U.S. and show few signs of slowing down. This has grabbed the attention of many federal and state lawmakers who are crafting laws and regulations to address the epidemic. The President’s Fiscal Year 2016 budget released earlier this month makes a commitment to reducing drug use and its consequences. It is highly unlikely that the President’s budget will be enacted in the current political environment, but it still gives us a roadmap for how key federal agencies plan to tackle the nation’s drug problems.
It’s encouraging to see the public attention and the resources directed at these problems, but we may be missing the mark when it comes to prevention. For example, the National Drug Control Budget includes drug monitoring, law enforcement, evidence-based addiction treatment, and reducing overdose deaths, but only five percent of the total budget is allocated to prevention. Similarly, states across the country are implementing laws and regulations to help first responders and bystanders prevent overdose deaths.
These measures play a crucial role in saving lives and mitigating the consequences of substance misuse, but what are we doing to prevent addiction before it starts?
Parents, teachers and health care providers should be asking young people early and often about their substance use. Drug screening by trusted adults is an important and effective first step for the prevention of drug and alcohol problems. In fact, simply asking about drugs and alcohol can lead young people to reduce substance use. From state and federal policies to local community-based solutions, we need a greater emphasis on screening as a prevention tactic for a few simple reasons:
Young people want to talk about it. As it turns out, young people are willing to talk to adults about their drug and alcohol use. One study found that more than 6 out of 10 adolescents said they wanted to talk about substance use with their primary care doctor. The biggest reason they didn’t talk about it? Nobody asked them.
Young people are truthful when asked. Some providers are skeptical about whether young people will tell the truth about their substance use, which can make adults reluctant to ask. Let’s set the record straight: Young people are overwhelmingly truthful in their self-reports of substance use.
Screening is cost-effective. A recent report coming out of Massachusetts confirms the low cost of screening. Research on the cost of a new Massachusetts’s law requiring insurers to reimburse providers for drug and alcohol screening, shows the cost burden on policy holders would be less than a penny per member per month. While the Massachusetts study was on commercial insurance, it supports other findings about the relatively low cost of screening.
Screening tools can guide the conversation: Numerous tools have been studied and established as powerful indicators of current and future problematic drug or alcohol use. This includes the CRAFFT (see below) or AUDIT, which are designed for youth. These short and effective tools can guide providers and other adults in their conversations with young people about substance use.
From the first time a young person misuses alcohol or drugs, they become susceptible to addiction and its long-term consequences. We need to scale up screening efforts nationwide to reach youth in a variety of health care and community settings. One model doing just that is called SBIRT (screening, brief intervention, and referral to treatment). SBIRT involves asking young people a few questions about their drug and alcohol use and providing guidance or referring to treatment, if a problem exists.
SBIRT has been gaining traction across the country with federal support from the Substance Abuse and Mental Health Services Administration (SAMHSA) since 2003. SAMSHA has issued 75 SBIRT training and implementation grants and included $30 million in the FY2016 budget to continue this work. The Conrad N. Hilton Foundation is also a driving force moving SBIRT forward with an expansive nationwide initiative to bring SBIRT to youth and young adults.
Community Catalyst is among the numerous organizations supported by The Conrad N. Hilton Foundation to expand the use of screening and early intervention to young people. Community Catalyst is currently working with consumer advocates in five states – Georgia, Massachusetts, New Jersey, Ohio and Wisconsin – to educate the public and policymakers about the need to improve health insurance coverage for SBIRT and increase the number and types of locations where it is conducted.
Additional federal and state support is needed for SBIRT and other initiatives that promote screening and brief intervention. We need to talk to young people about their drug and alcohol use more frequently, and in a broad array of settings where youth interact regularly with trusted adults. These conversations are the cornerstone of prevention.
Image Credit: Georgians for a Healthy Future