Health Care Response to Youth Substance Abuse
- Primary care providers should routinely counsel youth and their parents about the hazards of substance use, paying special attention when risk factors are present, such as a family history of alcohol or substance abuse. Parents should also be provided with information about the signs of substance use and what they can do to help prevent their child from using alcohol or other drugs.
- Primary care providers should be able to recognize early signs and symptoms of substance abuse and should screen all adolescents for substance use as part of the overall psychosocial history. One helpful screening tool uses the letters CRAFFT as mnemonic device for a series of screening questions specifically developed for adolescents[1]:
- If a youth is using alcohol or drugs, primary care providers need to be
able to evaluate the seriousness of the problem and to make appropriate referrals
for further assessment and treatment when necessary. If a child has only experimented
with alcohol or drugs, counseling the family about the seriousness of alcohol
and drug abuse, along with providing guidance about communication, limit-setting,
parental monitoring, and effective discipline may be appropriate. For the
young person who has begun to experience adverse consequences of substance
abuse, such as injuries associated with acute intoxication, trouble with the
law, truancy, decline in school performance, or deterioration in physical
or mental health, intervention is indicated. Primary care providers should
make referrals and work with the child or adolescent and family to accept
and follow through with the referral.
Primary care providers need to be aware of the substance abuse treatment programs and resources in their communities (including formal treatment programs, and 12-step groups such as Alcoholics Anonymous and Narcotics Anonymous). If indicated by assessment, they should help the child or adolescent access these and other supports or mentors in the community (e.g., coaches, teachers, relatives, faith-based organizations). - Health care providers should use their unique knowledge, perspective, and training by developing, supporting and participating in school and community substance abuse prevention efforts.
C-Have you have ridden in a CAR driven by someone (including yourself) who was "high" or had been using alcohol or drugs?
R-Do you ever use alcohol or drugs to RELAX, feel better about yourself, or fit in?
A-Do you ever use alcohol or drugs while you are by yourself, ALONE?
F-Do you ever FORGET things you did while using alcohol or drugs?
F-Do your family or FRIENDS ever tell you that you should cut down on your drinking or drug use?
T-Have you ever gotten into TROUBLE while you were using alcohol or drugs?
Two or more "yes" answers suggest a positive screen and that a more thorough assessment is needed.
For more information, see:
Alcohol Use and Abuse. Policy Statement (2001) - American Academy of Pediatrics
Indications for Management and Referral of Patients Involved in Substance Abuse. Policy Statement (2000) - American Academy of Pediatrics
Tobacco, Alcohol, and Other Drugs: The Role of the Pediatrician in Prevention and Management of Substance Abuse. Policy Statement. (1998) - American Academy of Pediatrics
Marijuana: A Continuing Concern for Pediatricians. Policy Statement (1999). American Academy of Pediatrics
Practice parameters for the assessment and treatment of children and adolescents with substance use disorders (1998) - American Academy of Child and Adolescent Psychiatry.
Substance Use Problems and Disorders - Bright Futures in Practice: Mental Health (2002) - Maternal and Child Health Bureau, U.S. Department of Health and Human Services. Provides suggestions for assessment and intervention by primary care health professionals, as well as guidelines for referral.
Bright Futures in Practice: Mental Health. Volume 1, Practice Guide - Maternal and Child Health Bureau, U.S. Department of Health and Human Services