Pediatricians should use a series of simple questions to quickly screen for drug and alcohol use in teenagers, and intervene and find treatment options if necessary, a new policy statement recommends.

Such screening should be a routine part of regular doctor's office visits and could help reduce the effects of substance use, one of the leading factors linked to death, injury and illness in teenagers, according to the American Academy of Pediatrics. The policy statement appears today (Oct. 31) in the journal Pediatrics.

Pediatricians sometimes have a hard time fitting substance abuse screening into routine office visits, said Dr. Sharon Levy, policy statement co-author and director of the Adolescent Substance Abuse Program at Children's Hospital Boston.

“The recommendation has been out there, but people have been applying it inconsistently,” Levy said.

Indeed, several studies over the past 10 years have found a substantial percentage of pediatricians don't regularly screen for drug and alcohol use. “It pretty much boils down to there are too many things to screen for, and we don't screen for substance abuse because we don't know what to do with the information once we get it,” Levy said.

Determining drug and alcohol use

The policy statement suggests a flow chart of questions designed to ferret out whether teenagers have tried drugs and alcohol and, if they have, their level of use.

“One of the points that we make is that confidentiality helps kids give honest answers,” Levy said. “We're hoping that parents can let that happen, and even encourage that to happen.”

If the teen's answer is “no,” pediatricians can offer praise and encouragement such as, “You have made some very good decisions in your choice not to use drugs and alcohol, I hope you keep it up.”

If the teenager tells his pediatrician that he has used drugs or alcohol, the flow chart suggests a series of questions to determine whether the teenager is in acute danger, or at risk of addition from drug or alcohol use. Such questions include: “Do you ever use alcohol or drugs to relax, feel better about yourself or fit in?” and “Do you forget things that you did while using alcohol or drugs?”

“It's showing [pediatricians] how they can structure a conversation without preaching to kids,” Levy said.

Depending on the answers, the pediatrician might suggest that the teenager stop or cut down substance use. If the problem is more serious, the pediatrician might choose to break confidentiality and discuss treatment options with the teenager's parents.

The policy statement goes on to suggest resources that the pediatrician can use if she decides to refer the teenager for treatment.

Address a need

The guidelines address a need in adolescent health care, said Dr. Marvin Belzer, director of the Division of Adolescent Medicine at Children's Hospital Los Angeles. “I think that leaders in adolescent health have always known that the teenage years are very important years to be screening for a number of potential health problems,” he said. “Substance abuse is one of them.”

Pediatricians see a lot of teenagers for urgent care and sports physicals, Belzer said. “It's a perfect time to screen and, if there's a problem, to do that brief counseling or referral. Lots of teens are going to have drinking and driving accidents, fights, trauma and even gang-related stuff [because of substance abuse]. Here's a great chance to reduce that.”

“What I really like about this article is that it makes it really simple,” Belzer continued. “Pediatricians are given very little time to do this kind of work.”

Many people don't think of substance use screening as a regular part of health care, but the American Academy of Pediatrics wants that to change, Levy said.

“What we'd really like is for the general [public] to think of screening and intervention as part of good health care for kids,” she said. “It would be great if people just expected that … from their pediatricians.”

Pass it on: The American Academy of Pediatrics has developed easier ways for pediatricians to screen teenagers for drug and alcohol use, and parents should expect and welcome those confidential screenings as part of regular office visits.

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