An Alternative to ‘Just Say No’

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BianchiTeraStarting my career as a direct service social worker, I quickly learned that teens don’t like being told what to do. Let’s face it, who does?

Teachers, counselors, pediatricians and mentors regularly wrestle with the best ways to convey messages to youth, and when it comes to substance use this can be a deadly problem.

Unfortunately, many of us have not been trained to have conversations about substance use, making it an uncomfortable topic. How do we know when substance use is a problem? And even if we know, what do we do about it?

While substance use is not a new problem, more and more young people are experimenting and becoming addicted to prescription medications.

In many communities, while drug use rates have gone down during the last decade, overdose deaths are on the rise. In the United States, there are approximately 100 deaths from drug overdoses each day — that’s more than car accidents or gun-related homicides.

Conversations are a powerful tool in prevention

Ninety percent of people who develop an addiction to drugs or alcohol started in their teens. That is to say, if we aren’t talking to teens about substance use we are missing a crucial opportunity to intervene and leaving too much up to chance.

An intervention strategy called Screening, Brief Intervention and Referral to Treatment (SBIRT) is flipping the script of “just say no” by giving people the tools they need to have successful conversations about drugs, alcohol and other risky behavior. This is a simple approach that involves three key components:

  • Screening: The screening is a series of validated questions that allow trusted adults to identify when youth are involved in risky behavior.
  • Brief Intervention: Trained in brief interventions, such as motivational interviewing, these trusted adults can then reinforce positive behavior and discuss risky behavior through age-appropriate conversations about responsible use or avoidance of alcohol and drugs.
  • Referral to Treatment: When youth show signs of moderate- to high-risk behaviors, they are referred for additional services or treatment.

SBIRT is an evidence-based intervention that eliminates some of the guesswork and empowers youth workers, doctors and faith leaders to ask the needed questions.

[Related: How to Talk to Kids about Drugs — and How Not to]

SBIRT at work in Massachusetts

Massachusetts has become a leader in youth prevention through their school SBIRT initiatives. The Massachusetts Department of Health is training school nurses to deliver SBIRT universally to students in middle and high schools across the state. With training and technical assistance support from the state, Massachusetts school nurses have screened more than 3,000 students using the SBIRT approach.

“Adolescent youth know more than we think. They are exposed to drugs and alcohol in their community and in the media. Many are considering trying substances and some of them have already experimented,” said Lee Ellenberg, LICSW, training manager of the MASBIRT Training and Technical Assistance Program at Boston Medical Center.

Too often, the adults young people trust most don’t know how to begin the conversation. SBIRT gives them the framework they need.

“This is really about creating open, nonjudgmental dialogues that help young people make good choices. Providers I have trained, even those that are skeptical, have reported SBIRT has allowed them to be more accessible and build individual relationships with students, even ones that weren’t on their radar screen before,” Ellenberg said.

True Talk: Power of Prevention

Massachusetts is part of the True Talk: Power of Prevention project, which also includes Georgia, New Jersey, Ohio and Wisconsin. Consumer health advocates in these states are educating the public and policymakers about the need to improve public and private health insurance coverage for SBIRT, and increase the number and types of locations where SBIRT is conducted with young people.

Led by the national consumer advocacy group Community Catalyst, the project is part of a multiyear Youth Substance Use Prevention and Early Intervention initiative of the Conrad N. Hilton Foundation. Additional support for the Community Catalyst project is provided by Shatterproof and the Peter and Elizabeth C. Tower Foundation.

Tera Bianchi, MSW, serves as senior state advocacy manager for the Substance Use Disorders Project, supporting Community Catalyst partners in their regional, state and national initiatives.  To learn more about these projects or SBIRT you can contact Bianchi at

The Conrad N. Hilton Foundation also supports Youth Today’s coverage of substance use disorder as part of its national approach to reduce youth substance use and promote health and well-being.

More related articles:

Convicted on Drug Charges, Georgia Youth Faces Life After Rehab

Unspoken Truths: Young People in Recovery

The Recovery Diaries: Jessica