Introduction:
Nearly ten percent of American adolescents have alcohol or drug abuse problems (SAMHSA, 2008). Studies have shown that treatment for these problems is effective in improving health outcomes for adolescents (Brown et al., 2001; Hser et al., 2001; Muck et al., 2001; Winters et al., 2000).
Despite the effectiveness of treatment, less than 10% of adolescents with alcohol or drug problems, also known as substance use disorders (SUD), actually receive treatment services (SAMHSA, 2007b), suggesting that adolescents face substantial barriers to treatment. A considerable barrier is a lack of problem recognition. Most adolescents with SUDs are unlikely to recognize their need for treatment (SAMHSA, 2006). That is why healthcare professionals and healthcare organizations that have routine contact with adolescents need to implement procedures to identify SUDs and refer adolescents to care (McLellan & Myers, 2004). A model of screening, brief intervention, and referral to treatment (SBIRT) is widely advocated for adults with SUDs (Babor et al., 2007; Madras et al., 2009). This model can be used for adolescents, but it is not used as often as it should be. This results in unnecessary barriers to treatment and missed opportunities for early intervention (Halpern-Felsher et al., 2000; Marcell et al., 2002; Young et al., 2007).
In many communities, adolescents with SUDs also face barriers to treatment related to availability and accessibility. Studies have shown that high-quality counseling services and adolescent-only SUD treatment programs are not widely available (Knudsen, 2009; Mark et al., 2006; Terry-McElrath et al., 2005; Young et al., 2007). Even in communities where adolescent-only treatment programs are available, lack of coverage for SUD treatment within health insurance policies may reduce access to these services (Fox et al., 2003). Failure to invest in adolescent SUD treatment services has ripple effects throughout a persons life, since adolescence is a sensitive time period for the development of SUDs (Hingson et al., 2006; Lynskey et al, 2003; Volkow & Li, 2005; Winters & Lee, 2008).
Policy Implications:
Effective implementation of the screening, brief intervention, and referral to treatment (SBIRT) model within organizations serving adolescents may reduce barriers to SUD treatment. Studies have documented the inconsistent use of SBIRT in health care settings and juvenile justice programs (Marcell et al., 2002; Halpern-Fesher et al., 2000; Young et al., 2007). Commonly reported barriers to SBIRT include lack of time and insufficient training as well as lack of familiarity with standardized tools (Barry et al., 2004; Van Hook et al., 2007). However, even brief training can positively impact the implementation of SBIRT by physicians (Buckelew et al., 2008, Ozer et al., 2005). Continued research on strategies for increasing the implementation of SBIRT in diverse settings is warranted.
For the SBIRT model to be truly effective, treatment services must be available and accessible within communities. Adolescents with SUDs face additional barriers when programs are unavailable or when they lack the financial resources (e.g., insurance) to access those services. The expansion of treatment services will likely require substantial financial investment by state and local governments and increased private insurance coverage for SUD treatment. Re-allocation of juvenile justice funding from incarceration to supporting community-based treatment may be one method for encouraging treatment organizations to offer adolescent-only treatment programs. The implementation of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (PL 110-343) in 2010 may also improve access to SUD treatment by reducing insurance limitations on care for addiction and mental health conditions (Shern et al., 2009; Zuvekas, et al., 2009). Research is needed to monitor the resulting changes in health insurance plans and whether these changes increase access to treatment services for adolescents with SUDs.
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