Adolescent substance-use screening, brief intervention and harm reduction — formative SAQs

SAQ 1 — Universal screening, the positive lead and the brief intervention (10 marks)

A 15-year-old presents alone for a sports medical. You secure private time and state conditional confidentiality. On universal screening they report vaping nicotine daily and using cannabis "a few times a month." Function and mood are intact. [1] [3]

Questions

1. Outline how you screened this adolescent, naming the validated tools you used and how they tier the response. (3 marks) [1] [3] [2]
2. Describe the structured assessment you would now perform for the positive cannabis and vaping leads. (3 marks) [1] [7]
3. Describe the brief-intervention method you would use and why it fits adolescent development. (4 marks) [4]

Model answer

Screening and tiering (3). Universal screening applies a validated frequency-based tool to every adolescent. S2BI asks past-year use frequency for each substance class and tiers the response: no use (re-screen), 1–2 times (brief advice), monthly or more (full assessment + brief intervention + referral). CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble) is the deeper screen used when S2BI is positive; two or more "yes" items signal high likelihood of a problem. Monthly cannabis use and daily vaping both fall into the monthly-or-more tier, triggering full assessment. [1] [3] [2]

Structured assessment (3). Detail the pattern for each substance: frequency, quantity, route, age of initiation, source, and context. Screen for dependence features (tolerance, withdrawal/craving, loss of control, continued use despite harm) and for co-occurring mood disorder and any psychotic features. Assess harm: for cannabis, educational and motivational decline; for vaping, dependence and any respiratory symptoms and EVALI awareness. Assess fentanyl-exposure risk if any pill or powder use, and overdose history. Build a risk formulation naming drivers, protective factors, and a risk tier. [1] [7]

Brief intervention (4). Use motivational interviewing — open questions, affirmation, reflective listening, summaries (OARS) — to evoke the young person's own reasons for change rather than lecture. Give personalised feedback linking the use to what they care about. Explore readiness and roll with resistance rather than arguing. This fits the dual-systems model: the reward system matures before prefrontal control through mid-adolescence, so under peer and emotional load an adolescent may intend not to use and still use. Willpower-only demands fail and disengage; lowering consequences works with the biology. Meta-analytic evidence supports motivational interviewing for adolescent substance use. [4]

SAQ 2 — Fentanyl-era opioid disclosure, the harm bundle and confidentiality (10 marks)

A 17-year-old discloses that pills shared at a party "to relax" may have contained fentanyl. They have never injected. They ask you not to tell their parent. Separately, a 16-year-old's daily vaping has produced morning cravings and two failed quit attempts. [5] [6]

Questions

1. Describe the harm-reduction bundle you would offer the 17-year-old, including your confidentiality response. (5 marks) [5] [6]
2. Outline the vaping/nicotine harm-reduction approach for the 16-year-old, including pharmacotherapy options. (5 marks) [8]

Model answer

Opioid harm-reduction bundle and confidentiality (5). In the fentanyl era a young person may be exposed to a potent opioid without intending opioid use. Offer take-home naloxone plus overdose education to the young person and, with consent, to family or peers; give safer-use messaging (avoid mixing, start low, never use alone). Assess for opioid-use disorder and link to medications for opioid-use disorder (MOUD). Offer needle–syringe access and safe-disposal advice and blood-borne-virus testing if injecting begins. Bundle sexual-health and mental-health harm reduction into the same plan. On confidentiality: substance-use care can stay confidential unless serious risk overrides; explain the limits, document the reasoning, and use local sensitive-note workflows so the plan is not leaked via a parent portal. The stance is pragmatic and non-judgemental. [5] [6]

Vaping harm-reduction approach (5). Confirm dependence (daily use, morning cravings, failed quit attempts). Offer a structured cut-down plan with step-down nicotine and behavioural support. Consider varenicline where locally approved and the young person meets age thresholds — a 2025 randomised trial demonstrated varenicline's efficacy for youth nicotine vaping cessation above placebo, which has expanded the pharmacotherapy options. Frame relapse as data, not failure, and give a low-threshold way back in. Address any co-occurring mood disorder and EVALI awareness. Follow locally approved prescribing guidance and document the reasoning. [8]