A-START: Adolescent Substance Use Treatment at CHOP

Adolescent substance use is a complex health issue requiring specialized care. The Adolescent Specialized Treatment and Recovery Team (A-START) at Children’s Hospital of Philadelphia (CHOP) offers a holistic and family-centered approach to address the unique needs of young people struggling with substance use disorders.

A Comprehensive, Family-Centered Approach

A-START recognizes that substance use in adolescence isn’t simply a behavioral issue, but one deeply intertwined with developmental stages and family dynamics. The program’s foundation lies in providing strength-based care, meaning it focuses on identifying and building upon existing strengths within the adolescent and their family, rather than solely focusing on deficits. This approach extends beyond traditional pediatric care models, tailoring support to the specific needs of each patient and their family.

Housed within the Craig-Dalsimer Division of Adolescent Medicine, A-START operates as an interdisciplinary team. This team provides a range of services, beginning with intake, evaluation, and referral, and extending to ongoing medical management. The program aims not only to prevent and reduce harm associated with substance use but also to empower young people and their families on the path to recovery.

Services Offered by A-START

A-START’s services are multifaceted, encompassing both medical and psychosocial support. Key components include:

• Medical and psychosocial assessments: Thorough evaluations to understand the extent of substance use and any co-occurring mental health conditions.
• Medication-assisted treatment: Utilizing medications, when appropriate, to manage withdrawal symptoms and reduce cravings.
• Medication for withdrawal symptoms: Providing pharmacological support to ease the physical and psychological discomfort of withdrawal.
• Naxolone (Narcan®) provision: Equipping patients and families with naloxone, a life-saving medication that can reverse opioid overdoses.
• In-office urine drug testing: Monitoring substance use and treatment progress.
• Referrals to drug and alcohol counseling: Connecting patients with specialized counseling services.
• Additional support through Adolescent Medicine specialty services: Offering integrated care for co-occurring conditions such as LGBTQ+ health needs, HIV prevention and treatment, eating disorders, and adolescent gynecology.

Substances Addressed

A-START addresses a wide range of substances, including cannabis, nicotine/tobacco (including vapes), alcohol, opiates, benzodiazepines, psychedelics, inhalants, and polysubstance use – situations where an individual uses multiple substances concurrently. This broad scope reflects the evolving landscape of adolescent substance use and the need for comprehensive care.

The Importance of Early Intervention

Recognizing substance use disorders in adolescents can be challenging. Pediatricians are uniquely positioned to play a crucial role in early identification and intervention. According to research from December 3, 2024, pediatricians can effectively screen for substance use disorders using validated tools like the 7-item Screening to Brief Intervention (S2BI) and the 9-item CRAFFT questionnaires. These tools are easily incorporated into routine check-ups and are currently utilized at CHOP primary care sites as part of the Adolescent Health Questionnaire (AHQ).

When a screening indicates potential substance use, providers assess the level of use – experimental, daily, problematic, or indicative of a substance use disorder. The key distinction for a diagnosis, according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), is whether the patterns of behavior impair daily functioning, manifesting as cravings, lack of control, and continued use despite negative consequences.

Beyond Screening: Bridging the Treatment Gap

While screening is essential, initiating treatment remains a critical step. Primary care pediatricians can bridge the gap in accessing care for adolescents and young adults by integrating mental health into their practices and building upon existing screening practices. This includes gathering a thorough social history to understand the context of substance use and providing brief interventions when appropriate.

A-START’s comprehensive, family-centered care model exemplifies this integrated approach. By addressing the multifaceted needs of adolescents and their families, the program aims to empower young people to navigate the challenges of substance use and embark on a path toward lasting recovery. Resources are available to help families keep their children safe and well, as highlighted by A-START experts.