Using a Brief Assessment Tool to Identify Substance Abuse Disorders in Teens
PI: Sharon Levy, MD & Lydia Shrier, MD
Participants: Current patients in the Adolescent Young Adults Medical Clinic and the Adolescent Substance Abuse Program, ages 12-17
Drug, alcohol and tobacco Screening, Brief Intervention and Referral to Treatment (SBIRT) are recommended as a part of routine healthcare for adolescents. Several screens and assessments have been developed, though all have significant limitations. No screen has yet been validated to identify teens without substance use, and while brief assessments can identify “high risk” use, no tool has yet been validated to quickly identify adolescents with substance dependence. The goal of this project is to develop a step-wise screening algorithm that efficiently triages adolescents into actionable risk categories. The specific aim of this project is to evaluate the psychometric properties of an electronic screening and brief assessment instrument that categorizes adolescents into actionable categories described below. All study activities, including a questionnaire and answering a brief set of questions, will take place during one clinic visit. For more information please contact Rosemary Ziemnik at 857-218-4878.
Validating NIAAA's Brief Screening Guide in Youth with Chronic Medical Conditions
PI: Sharon Levy, MD & Elissa Weitzman, PhD
Participants: BCH patients ages 9-18 who are being treated for asthma, diabetes, ulcerative colitis, or a rheumatic disorder
Youth with chronic medical conditions are a large population uniquely vulnerable to harm from drinking given the potential for alcohol to negatively interact with both their underlying health condition and its treatment. The goal of this project is to validate the NIAAA Guide with this population to facilitate standardized screening and improve the response capability of physicians who regularly interact with them. Participants will complete an electronic version of the NIAAA guide and an assessment battery assessing level of alcohol use, medication adherence and quality of life Information on chronic disease status and alcohol risk factors will be obtained via chart review, with input from a team of clinical collaborators with domain expertise in target conditions. We will also assemble a team of 20 clinician experts to develop recommendations for clinician guidance and health messages for inclusion in the Guide for use with YCMC and field test it with patients. This study is notyet recruiting. For more information please contact Rosemary Ziemnik at 857-218-4878.
Validation of Quick Screen and Brief Assessment for Adolescent Substance Abuse
PI: Sion Kim Harris, PhD & John R. Knight, MD
Participants: Adolescents ages 12-17 being seen for routine care at the Adolescent Center at Boston Medical Center, Cambridge Pediatrics, and the Adolescent Clinic at Tufts Medical Center
This study will test a quick screen and a brief assessment for adolescent substance abuse in primary care. The CRAFFT is a substance use (SU) screener specifically designed for adolescents which is brief enough to be practical for primary care, easy to remember using the CRAFFT mnemonic, simple to score, and has demonstrated reliability and criterion validity among adolescents aged 14-18. It is currently the most widely recommended tool throughout the US and internationally. The goal of the proposed study is to evaluate recent enhancements made to the CRAFFT screening protocol to broaden its utility for primary care, including: 1) the addition of introductory “quick-screen” items assessing any past-12-month substance use; 2) addition of a past-90-day use frequency item for each substance used; 3) addition of tobacco screening; 4) more detailed screening for non-medical use of prescription/over-the-counter drugs, and 5) the development of a computerized, self-administered screening program. All assessments, including a self-administered computerized assessment and brief interview, will be collected at one office visit and participants will receive a $25 gift card as compensation for their time. This study is not yet recruiting. For more information please contact Study Coordinator Tatyana Buynitsky at 857-218-5173.
Prevalence of Psychiatric Disorders in Adolescents Referred for Substance Abuse Assessment and Treatment
PI: J. Wesley Boyd, MD
Data will be extracted from the health records of 400 adolescents seen in the Adolescent Substance Abuse Program (ASAP) at CHB for evaluation of substance use disorders. Data to be extracted are substance use disorder and psychiatric diagnoses made at the time of evaluation, race/ethnicity, gender, age at time of evaluation, and zip code. Data will be analyzed to determine the proportion of adolescents seen in ASAP for substance use disorders who have comorbid psychiatric illness, and to determine possible predictors of comorbidity.
Outcomes of Suboxone Treatment for Opiod-Dependent Adolescents
PI: Ximena Sanchez-Samper, MD
The aims of this study are to: describe the population of opioid-dependent adolescents receiving Suboxone treatment through the Adolescent Substance Abuse Program at Boston Children’s Hospital, describe the usual patterns of Suboxone therapy (doses, dosing, length of treatment), and to determine the 12-month outcomes. We will assess outcomes by means of urine toxocology. We hypothesize that there will be at least four distinct groups: 1) complete abstinence (no positive urine toxocologies), (2) opioid abstinence (no urine toxocologies positive for opioids, but positives for other drugs of abuse), (3) opioid improvement (two or fewer urine toxicologies positive for opioids during the 12-month follow-up period), and (4) no improvement (three or more urine toxicologies positive for opioids during the 12-month follow-up period).
Mentored Clinical Career Award in Adolescent Substance Abuse
PI: Sharon Levy, MD
Participants: Patients in the Adolescent Substance Abuse Program, ages 12-21 years
The goal of this study is to test the use of random laboratory drug testing as a therapeutic intervention for teens with drug problem use, abuse or dependence. Our objectives are: 1) To develop a standardized protocol for random urine drug testing, produce a manual and training protocol, and refine the protocol in preparation for a future efficacy trial. 2) To estimate the cost of a random drug-testing program. 3) To determine the factors that are associated with willingness to be tested, and barriers to enrolling adolescents in laboratory drug testing programs. 4) To perform an initial, small-scale experimental trial of the random drug testing protocol. 5) To determine the potential risks to adolescents who participate in a random drug testing program, including possible breach of confidentiality, greater conflict between the parent and child, more difficulty with communication between clinician and patient, increased use of drugs not detected by routine urine screens (i.e. inhalants), and increased use of strategies and products known to defeat drug tests. Study recruitment is closed and follow up assessments are being completed.