Screening, brief Intervention, and referral to treatment: Persistence of effects in adolescents at risk.

This observational longitudinal study examines substance use reduction following implementation of screening, brief intervention, and referral to treatment (SBIRT) in a specialized foster care clinic. Following SBIRT we expected to observe reductions in past 30-day use of alcohol, tobacco, and cannabis, sustained to 6 months post-intervention. Adolescents (10-20 years) received standardized screening via the CRAFFT2.1 + N. An interventionist trained in the brief negotiated interview delivered brief intervention. Enrolled participants completed surveys in REDCap that assessed past 30-day use of alcohol, tobacco, and cannabis at baseline and 30-, 60-, and 180-day post-brief intervention. Generalized linear mixed-effects models estimated change over time, clustered by person. Poisson regression estimated change in use over 6 months of enrollment; negative binomial logistic regression models estimated any use. Covariates included demographics, placement history, mental health diagnoses, and parental substance use. Among 287 adolescents, significant, non-linear reductions in alcohol, tobacco, and cannabis were identified, with a decline in use noted in the first 60 days of intervention, followed by a plateau and increase to near baseline by 6 months. This pattern persisted with the addition of covariates. The benefits of SBIRT are observed in the first 60 days following intervention. Findings suggest that the delivery of SBIRT to adolescents in healthcare settings, including to young people in foster care, may be beneficial to reduce substance use. Repeat brief intervention after 60 days may be especially important for those who continue to use substances, and for older adolescents.