Adolescent Substance Use
Screening, brain development risk, substance-specific clinical guidance, and brief intervention techniques for general practitioners working with young people aged 9–21.
Prevalence Overview
Alcohol is still the substance used most often. Cannabis is the most commonly used illegal drug. There has been a growing trend in the use of vaping products and edibles. Current concerns also include the misuse of e-cigarettes, prescription drugs, opioids, stimulants, benzodiazepines, and synthetic cannabinoids.
The CRAFFT tool is validated for screening individuals aged 9 to 21. Screening involves two parts, beginning with questions about the frequency of using alcohol, cannabis, and other drugs. If an adolescent scores 2 or more on Part B, they are considered high-risk and require further evaluation and a brief intervention using the SBIRT (Screening, Brief Intervention, Referral to Treatment) model.
Screening
Annual screening using CRAFFT. Part A: frequency of alcohol, cannabis, and other drugs. Part B: 6 questions. Score ≥2 = high risk.
Brief Intervention
Motivational interviewing techniques. Explore mixed feelings. Assess readiness to change. Non-judgmental feedback linking use to personal goals.
Referral to Treatment
For high-risk patients. Consider family involvement when appropriate and safe. Refer to specialist services for dependency assessment and management.
Clinical Evidence Base
Brain Development Risk
The prefrontal cortex does not reach full development until approximately age 25. Early and consistent use can lead to structural brain changes, impair executive function, and significantly increase the likelihood of addiction disorders in adulthood. Earlier initiation correlates with poorer outcomes.
Vaping & E-Cigarettes
High nicotine concentration in pods (50 mg/mL) can quickly lead to dependence. Vaping is linked to EVALI (e-cigarette/vaping product use–associated lung injury). Manage as tobacco cessation with counselling and nicotine replacement therapy as primary interventions.
Cannabis & Mental Health
Heavy use during adolescence is linked to psychosis, cognitive decline, depression, and anxiety. High-potency THC products notably increase these risks. Screen for co-occurring mental health conditions — treating underlying anxiety or depression frequently helps reduce substance use.
Brief Intervention Principles
- Employ motivational interviewing methods
- Confrontational approaches should be avoided
- Explore the patient’s mixed feelings about use
- Assess their readiness to change
- Provide non-judgmental feedback that connects substance use to their personal goals
- Consider family involvement when appropriate and safe
HEADSS & CRAFFT Integration
Integrate substance use screening into every adolescent psychosocial assessment. Cannabis and alcohol questions should be routine, not reactive.
- ↗Full HEADSS 3.0 interview guide
Dive into relatable content, ask anonymous questions, and explore resources designed just for you.
Yuh Good: Barbados Adolescent Health Hub @ 2026