The Kaiser Permanente study tracked adolescent substance use and mood disorders for 7 years after a brief intervention, referral to treatment
By Jan Greene
A long-term Kaiser Permanente study of 1,851 adolescents who reported substance abuse or mood problems to a pediatric clinic found that those who had access to brief intervention and referral to treatment were less likely to to have a related diagnosis 7 years later, in my twenties.
The findings, published in the Journal of Adolescent Health, echo similar findings from the same group of youngsters at 1 year and 3 years after their clinic visits. Those who received the intervention were less likely to have a substance use disorder or be hospitalized as young adults.
“For the first time, we were able to examine outcomes in young adults, long after an intervention had been performed in pediatric primary care,” said lead author Stacy Sterling, DrPH, MSW, researcher at Kaiser Permanente. Division of Research. who co-directs its Center for Addiction and Mental Health Research. “Our results are encouraging, as they document positive outcomes related to the development of future disorders into adulthood.”
Sterling’s research group is studying a three-part process known as SBIRT: screening, brief intervention, and referral to treatment. The brief intervention involves a patient-centered conversation between a clinician and a patient using motivational interviewing techniques. Patients with more severe symptoms may be referred for specialized mental health or addiction medicine treatment.
The team conducted a pragmatic clinical trial between 2011 and 2013 with 1,851 adolescents treated at a Kaiser Permanente General Pediatrics Clinic in Northern California. In this study, researchers compared patients in the SBIRT arm to those in usual care and followed their progress for 7 years, until they were 21 to 28 years old.
Examining the patients as young adults, the investigators found that the SBIRT group had lower risks of being diagnosed with a substance use disorder and risks of hospitalization and fewer psychiatric visits compared to those who were receiving usual care. About a fifth of those who received the intervention (19%) had a diagnosis of substance use, compared to 24% of those who did not.
We have shown that SBIRT is an important and effective prevention and early intervention approach that can produce better outcomes and reduce avoidable healthcare utilization, with lasting effects well into adulthood.
Stacy Sterling, DrPH, MSW
“As most substance use disorders in adults occur in adolescence, this is an ideal time to intervene to completely prevent adolescent alcohol use or prevent the progression of mild problems,” wrote the authors. “We found benefits for the SBIRT group even after 7 years, which argues for making adolescent screening and subsequent brief interventions, if necessary, an important measure of vital signs during well-monitoring visits in this band.”
Risky transition to adult care
Reaching at-risk teens is especially important, Sterling said, because young adults can often fall through the cracks of the healthcare system when they leave pediatric care and sometimes lose health insurance coverage. “We have shown that SBIRT is an important and effective prevention and early intervention approach that can produce better outcomes and reduce avoidable healthcare utilization, with lasting effects into adulthood,” said she declared.
The analysis also looked at different subgroups of the sample and found that among Hispanic teens, those in the SBIRT group had a lower likelihood of any diagnosis of drug and marijuana use disorder as young people. adults compared to usual care. Among black adolescents, those in the SBIRT group had a lower likelihood of alcohol use disorder diagnoses as young adults than those receiving usual care. This is one of the few studies to look at outcomes specifically among these large populations, Sterling said.
The lingering effects of pediatric intervention into adulthood is good news for clinicians, said co-author Katrina Saba, MD, pediatrician at Permanente Medical Group. “For those of us who care for adolescents, the results of this study are exciting,” Saba said. “It’s powerful to see that the intervention we perform during our patients’ healthcare visit can improve their health outcomes 7 years later.”
The study was funded by the National Institute on Alcohol Abuse and Alcoholism and the Conrad N. Hilton Foundation.
Co-authors also included Andrea Kline-Simon, MS, Sujaya Parthasarathy, PhD, Constance Weisner, DrPH, MSW, and Verena Metz, PhD, from the Research Division; Ashley Jones, PsyD, of Kaiser Permanente Addiction Medicine and Recovery Services; and Lauren Hartman, MD, formerly of The Permanente Medical Group.
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About the Kaiser Permanente Research Division
Kaiser Permanente’s Research Division conducts, publishes and disseminates epidemiological and health services research to improve the health and medical care of Kaiser Permanente members and society at large. It seeks to understand the determinants of disease and well-being and to improve the quality and cost-effectiveness of health care. Currently, more than 600 DOR employees are working on more than 450 epidemiological and health services research projects. For more information, visit divisionofresearch.kaiserpermanente.org or follow us @KPDOR.