What role can medical professionals play in addressing substance abuse (including abuse of prescription drugs) among adolescents?
Medical professionals have an important role to play in screening their adolescent patients for drug use, providing brief interventions, referring them to substance abuse treatment if necessary, and providing ongoing monitoring and follow-up. Screening and brief interventions do not have to be time-consuming and can be integrated into general medical settings.
- Screening. Screening and brief assessment tools administered during annual routine medical checkups can detect drug use before it becomes a serious problem. The purpose of screening is to look for evidence of any use of alcohol, tobacco, or illicit drugs or abuse of prescription drugs and assess how severe the problem is. Results from such screens can indicate whether a more extensive assessment and possible treatment are necessary (see "Screening Tools and Brief Assessments Used with Adolescents,").40 Screening as a part of routine care also helps to reduce the stigma associated with being identified as having a drug problem.
- Brief Intervention. Adolescents who report using drugs can be given a brief intervention to reduce their drug use and other risky behaviors. Specifically, they should be advised how continued drug use may harm their brains, general health, and other areas of their life, including family relationships and education. Adolescents reporting no substance use can be praised for staying away from drugs and rescreened during their next physical.
- Referral. Adolescents with substance use disorders or those that appear to be developing a substance use disorder may need a referral to substance abuse treatment for more extensive assessment and care.
- Follow-up. For patients in treatment, medical professionals can offer ongoing support of treatment participation and abstinence from drugs during follow-up visits. Adolescent patients who relapse or show signs of continuing to use drugs may need to be referred back to treatment.
- Before prescribing medications that can potentially be abused, clinicians can assess patients for risk factors such as mental illness or a family history of substance abuse, consider an alternative medication with less abuse potential, more closely monitor patients at high risk, reduce the length of time between visits for refills so fewer pills are on hand, and educate both patients and their parents about appropriate use and potential risks of prescription medications, including the dangers of sharing them with others.
Screening Tools and Brief Assessments Used with Adolescents
Screening tools are available and outlined in the American Academy of Pediatrics (AAP) publications, Tobacco, Alcohol, and Other Drugs: The Role of the Pediatrician in Prevention, Identification, and Management of Substance Abuse41 and Substance Use Screening, Brief Intervention and Referral to Treatment for Pediatricians.42
In addition, the Alcohol Screening and Brief Intervention for Youth: A Practitioner’s Guide developed by the National Institute on Alcohol Abuse and Alcoholism provides information on identifying adolescents at high risk for alcohol abuse.43