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Why screen?

From: Concurrent Substance Use and Mental Health Problems in Youth: Screening for Concurrent Substance Use and Mental Health Problems in Youth (© 2009, CAMH)

The case has already been argued quite strongly that universal screening for mental health and/or substance use disorders should be a routine part of the "care package" for adults in specialized substance use and mental health services, and in other health care services such as primary care. For youth and adolescents, the following factors constitute a strong rationale for effective screening and assessment of mental and/or substance use disorders, particularly in service delivery settings where children, youth and families present themselves for assistance: 

  • co-occurrence of substance use and mental health disorders 
  • early onset of substance use disorders
  • early onset and high recurrence of mental health disorders
  • success of early recognition and treatment.

Co-occurrence of substance use and mental health disorders

A large percentage of children experience multiple disorders. This is a cause for substantial concern largely because of the negative impact on treatment outcome and the challenges faced by young people and their families when navigating disparate service delivery systems. The extent of overlap across mental disorders, including substance use disorders, is considered to be higher among young people than among adults. This requires special attention in screening, assessment and treatment planning.

Early onset of substance use disorders

The earlier the onset of alcohol and/or other drug use (and of a diagnosable substance use disorder), the greater the odds of developing multiple and longer episodes of dependence. Earlier onset is also associated with increased likelihood of accessing treatment, and longer treatment "careers" in the future.

Early onset and high recurrence of mental disorders

Evidence suggests that mental disorders have an early age of onset and high rates of recurrence over the life course. The belief that early disorders strongly predict later disorders is a strong component of broad-based screening programs that are focused on children's mental health/wellness and that aim to deliver preventive interventions.

Early recognition and treatment

Evidence suggests that early recognition and evidence-based treatment of substance use (and probably mental disorders) can make a positive difference to the life course and quality of life of those identified with such problems.

All these factors support clinicians', policy-makers' and researchers' interest in developing and deploying validated screening tools that help identify mental and substance use disorders among children and adolescents. This can also be seen as part of a larger effort to close the gap between research and evidence-based practice for child and adolescent psychiatry.