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TOPLINE:

Although most clinicians caring for youths aged 17 years or younger reported screening for substance use disorders, many did not do so at every checkup, and 36.9% did not use a standardized screening tool — falling short of recommended screening practices.

METHODOLOGY:

• Researchers conducted a cross-sectional survey to describe screening practices for substance use disorders among clinicians caring for youths aged 17 years or younger in the United States.
• They included 1047 clinicians: 467 family physicians, 250 pediatricians, 132 internal medicine physicians, 107 nurse practitioners, and 91 physician assistants. The median duration of practice was 13 years.
• Participants were asked questions about delivering care to adolescents, focusing on substance use screening frequency and types of screening tools used.
• Concordance with the recommended screening practices set by the American Academy of Pediatrics and Substance Abuse and Mental Health Services was defined as screening at every checkup, regardless of purpose, using a screening tool.

TAKEAWAY:

• A majority (56.9%) of clinicians reported screening for substance use disorders at every checkup; the proportion of clinicians who endorsed screening at every checkup was higher among pediatricians than among other specialists.
• Among the 43.1% of clinicians who reported not screening at every checkup, 29.7% endorsed screening at an initial visit, 34.2% endorsed screening at intermittent visits, 61.0% endorsed screening if concerns about risky behaviors existed or when a parent/guardian raised concerns, and 13.8% endorsed never screening for substance use disorders among adolescents.
• Among the clinicians who screened youths for substance use disorders, 36.9% did not use a screening tool. The use of screening tools was associated with greater odds of screening at every checkup (odds ratio, 1.87; 95% CI, 1.44-2.44).
• Only 39.3% of clinicians reported screening at every checkup using a screening tool in line with the recommended screening practices; only 30.7% of clinicians screened youths for substance use, provided brief interventions to those at risk, and referred individuals with more severe issues to appropriate treatment programs.

IN PRACTICE:

“Identifying youths with SUDs [substance use disorders] and referring them to treatment remain crucial components to reduce substance use–related morbidity and mortality, including overdose,” the authors wrote.

“Screening offers opportunities for clinicians to engage in primary prevention of SUDs through anticipatory guidance, refer patients who use substances to appropriate care, and offer interventions to reduce adverse outcomes to all at-risk youth[s],” they added.

SOURCE:

This study was led by Kathleen Ragan-Burnett, MSPH, of the National Center for Injury Prevention and Control, Centers for Disease Control and Prevention in Atlanta. It was published online on May 20, 2025, in JAMA Network Open.

LIMITATIONS:

The results of this study may not apply to all clinicians because only those with a greater chance of responding were contacted first. There were limited details available about screening behaviors, including the motivations for and barriers to specific practices.

DISCLOSURES:

No sources of funding were reported in this study. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.