The goal of screening is to assess an adolescent’s substance use in the past year.

Patterns of substance use generally fall under the following categories:

  • No use
  • Sporadic use
  • Regular use
  • Regular use with repeated negative consequences (disorder)

Screening for substance use informs and guides the response of the provider, and should be:

  • Universal. The prevalence of substance use among adolescents coupled with long term negative consequences justifies screening every student who visits the SBHC, regardless of medical complaint, reason for visit, or suspicion of use by the clinician. An additional benefit of universal, routine screening is that it can help normalize the screening process and reduce stigma among adolescents.
  • Standardized. SBHCs should use a tool validated for adolescents by peer-review to screen for substance use, as opposed to using un-tested questions or improvised conversations.
  • Routine. Rates and types of substance use may change throughout adolescence, justifying screening for substance use on a regular basis. As such, SBHCs should develop and implement a protocol for periodicity of screening for substance use.
  • Confidential. In addition to protecting confidentiality of patient information as required by state and federal law, SBHC staff should be mindful of additional substance use-specific confidentiality concerns. For example, providers should be familiar with their state’s laws about the limits of confidentiality with respect to discussions about drug/alcohol use.

We encourage SBHCs to use the most recent version of a validated screening tool.


The following video explains the Screening component of SBIRT.

Given the high co-occurrence of substance use, trauma, and mental health challenges, screening for depression and other co-occurring conditions is an essential component to adolescent substance use screening. Providers must be knowledgeable about available comprehensive psychosocial screens, as well as equipped to identify and treat (or refer to treatment for) co-occurring conditions, diagnoses, and other issues needing support.

SBHCs may choose to use a validated tool for assessing depression, anxiety, and suicide risk.

The following video addresses suicide assessment and its relationship to SBIRT.