Common screening tool accurately identified moderate-to-severe cannabis use disorder in teens | Research

The takeaway

The S2BI screening tool showed excellent sensitivity (90%) and specificity (89%) for identifying moderate-to-severe cannabis use disorder among adolescents in primary care, but was less accurate for mild cases.

Pediatricians, adolescent medicine providers, and anyone interested in substance use screening tools for young people.

90% sensitivity for moderate-to-severe cannabis use disorder

What the researchers found

Using monthly or more frequent use as the threshold, S2BI had 90% sensitivity and 89% specificity for moderate-to-severe CUD, and 100% sensitivity and 93.6% specificity for moderate-to-severe AUD. Sensitivity dropped to 81.4% for any CUD and 53.3% for any AUD.

Why it matters

Primary care visits represent a key opportunity to identify adolescents with substance use disorders. Validating a brief, practical screening tool against the diagnostic gold standard helps clinicians know how much to trust the results.

The numbers in context

517 adolescents aged 14-18; CUD prevalence 8.3%; AUD prevalence 2.9%; moderate/severe CUD sensitivity 90.0%, specificity 89.0%; any CUD sensitivity 81.4%, specificity 92.0%

How the study worked

Researchers administered the S2BI screening tool and the gold-standard Composite International Diagnostic Interview (CIDI) to 517 adolescents aged 14-18 presenting for primary care, then calculated sensitivity, specificity, and predictive values.

What this study cannot tell us

Single-site study. Low prevalence of AUD limited statistical power for alcohol-specific analyses. Cross-sectional design cannot assess how screening performance changes over time.

How to read the evidence

Well-designed diagnostic validation study with gold-standard comparator, though single-site and relatively low disorder prevalence.

When this study was published

Published in 2021.

The bigger picture

Brief screening tools that can be integrated into routine primary care visits are essential for early identification of substance use disorders. This validation study suggests S2BI works well for the cases clinicians most need to catch: moderate and severe disorders.

Questions still open

Could modifications to S2BI improve detection of mild use disorders? How does screening performance differ across racial and socioeconomic groups? What percentage of positively screened adolescents actually receive follow-up care?

Common questions

What is the S2BI?

The Screening to Brief Intervention (S2BI) is a brief screening tool designed to identify substance use disorders in adolescents during primary care visits.

Was it better at detecting cannabis or alcohol problems?

It performed well for both at moderate-to-severe levels (100% sensitive for moderate/severe AUD, 90% for moderate/severe CUD), but was notably less sensitive for any AUD (53.3%) compared to any CUD (81.4%).

Read the original research

Sensitivity and specificity of S2BI for identifying alcohol and cannabis use disorders among adolescents presenting for primary care.

Substance abuse, 42(3), 388-395

View on PubMed ↗Publisher’s paper ↗

Citation

Levy, Sharon; Weitzman, Elissa R; Marin, Alexandra C; Magane, Kara M; Wisk, Lauren E; Shrier, Lydia A. (2021). Sensitivity and specificity of S2BI for identifying alcohol and cannabis use disorders among adolescents presenting for primary care.. Substance abuse, 42(3), 388-395. https://doi.org/10.1080/08897077.2020.1803180