SBIRT for Alcohol Use in Adolescents

Is SBIRT (i.e., screening, brief intervention, and referral to treatment) effective for reducing alcohol use in adolescents?

It is unclear how effective SBIRT is for reducing alcohol use in adolescents. Elements of SBIRT, including a brief intervention alone with no screening or referral to treatment, may reduce alcohol consumption and alcohol-related consequences in adolescents. (Strength of Recommendation [SOR]: A, systematic review of randomized controlled trials [RCTs].) The use of elements of SBIRT (i.e., brief intervention only or screening plus brief intervention) may reduce alcohol consumption in adolescents with heavy alcohol use at baseline. (SOR: B, RCT.) The use of SBIRT does not reduce alcohol use over 6 to 24 months but may decrease the diagnosis of alcohol use disorder in adolescents over a 7-year follow-up. (SOR: B, RCTs.)

A 2022 systematic review examined the effects of brief interventions on substance use and internalizing symptoms (e.g., depression/anxiety) in adolescents.¹ Participants were between 13 and 21 years of age and had a brief psychosocial intervention, a comparison condition, and at least one treatment outcome evaluating mental health and one treatment outcome evaluating substance use. Six studies met inclusion criteria (n = 2,380 in treatment conditions; n = 1,422 in control groups).

Modalities varied and included brief interventions and motivational interviewing, relaxation training, cognitive behavior therapy, and telephone- and computer-delivered feedback. Interventions ranged from 15 to 240 minutes, comprising one to four sessions over periods ranging from a minimum of 1 day to a maximum of 12 weeks. Five studies used treatment-as-usual control groups; one study used an attention control group. Follow-up periods ranged from 12 weeks to 3 years across the six studies and used self-report measures, including the Daily Drinking Questionnaire, the Young Adult Alcohol Consequences Questionnaire, and reported drinks per week or onset/frequency of binge drinking. In five of the six studies, authors reported significant reductions in self-reported daily drinking or alcohol-related consequences. The findings of two studies (n = 1,210; n = 151) could not be independently confirmed; therefore, the effect size was not reported. One RCT (n = 393) showed one brief intervention condition reduced substance use and substance use–related consequences at the first follow-up only (effect sizes = 3.6 and 0.52, respectively; CIs not reported), and one brief intervention condition reduced substance use and substance use–related consequences at the first follow-up (effect sizes = 0.62 and 0.29, respectively) and the last follow-up (effect sizes = 0.60 and 0.34, respectively).

One RCT (n = 104) showed a significant reduction in drinks per week and drinking days per week at the first follow-up (effect sizes = 0.99 and 0.76, respectively) but not at the last follow-up. Another RCT (n = 1,871) showed a reduction in substance use diagnoses following brief intervention at the 3-year follow-up (effect size = 0.29) but not at the first follow-up. The final RCT (n = 73) did not show a significant independently confirmed treatment effect for telephone-delivered feedback intervention. The authors noted that high variability in the type of intervention limited the generalizability of the findings, and that the treatment effect was inconsistent across follow-up intervals. This systematic review examined only the brief intervention element of SBIRT and lacked the screening and referral-to-treatment components. The brief interventions reviewed were not delivered in a health care setting (e.g., primary care, emergency department), which is generally considered a point of emphasis for SBIRT.