A primary inquiry addressing substance use should be a component of each encounter with an adolescent patient. Special attention should be given to adolescents in high-risk groups, including students with school or academic problems, behavior and family difficulties, psychiatric disorders, involvement in the criminal justice system, and adolescents living in families or homes with adults who have substance use problems.

The screening interview should address both alcohol and other drug use as they often co-occur, and the physician should ask specifically about marijuana, cocaine (and crack), methamphetamine, heroin, non-medical prescription drug use (e.g., pain relievers, stimulants), MDMA (Ecstasy), inhalants, hallucinogens, as well as other less commonly used or emerging substances of abuse such as dextromethorphan (e.g., over-the-counter cough medicine), ketamine, spice/k2, and bath salts.

The primary inquiry and screening interview should address any past use as well as recent use, the extent of use, and the acquisition of substances (“Where do you get this and how do you pay for this?”). Additional inquiries should address consequences of substance use, such as change in school performance, family or personal relationship concerns that may be secondary to use, and criminal activity and involvement in the criminal justice system.

The clinician can employ the use of the structured interview, such as the CRAFFT and BI-HEADS, to provide structure and a mechanism to obtain a history from an adolescent.

The CRAFFT is a screening tool that has been validated as an appropriate tool for use with adolescents to screen for substance use.

C - Have you ever ridden in a car driven by someone who had used alcohol or drugs?
R - Do you ever use alcohol or drugs to relax, feel better about yourself, or fit in?
A - Do you ever use alcohol or drugs while you are by yourself or alone?
F - Do you ever forget things you did while using drugs or alcohol?
F - Do your friends or family ever tell you that you should cut down on your drinking or drug use?
T - Have you ever gotten into trouble while you were using drugs or alcohol?

Two affirmative responses is considered indicative of problem substance use in adolescent patients. (22) In the event of two or more affirmative responses, the provider should engage the patient in a brief intervention, providing feedback and advice about the patient’s drug use as well as discussing the potential need for treatment. The provider should also arrange for a follow-up visit to monitor the patient.

BI-HEADS is a structured interview format allowing providers to screen for alcohol or substance use in the context of a full psychosocial interview. The BI-HEADS is not a screening tool developed to identify substance or alcohol use, but the topics it covers may provide a framework for an interview with adolescent patients.

BI - Body Image
H - Home
E - Education (school performance, changes, difficulties)
A - Aspirations, Affect, Alcohol
D - Drug Use, Danger, Driving
S - Sexual Activity, Spirituality