Approximately 15 percent of teens receiving routine outpatient medical care in a New England primary care network had positive results on a substance abuse screening test, according to a report in the November issue of Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
According to the National Institute on Drug Abuse, addiction is a chronic disease with genetic, environmental and behavioral factors contributing to its cause, manifestations and natural history, the authors write. Addiction often begins during adolescence and can predict future addictive disorders. About 80 percent of teens have begun to drink and half have used an illegal drug by senior year in high school. Substance use is associated with the leading causes of death among U.S. teenagers: unintentional injuries, homicides and suicides. Depression, conduct disorder and unplanned sexual activity are also associated with substance use.
John R. Knight, M.D., of Harvard Medical School and Childrens Hospital Boston, and colleagues administered a substance abuse screening test consisting of six questions focused on the use of alcohol or other drugs and risky behavior to 2,133 adolescents age 12 to 18 who received outpatient medical care from March 2003 to August 2005.
The sample consisted of 56.3 percent female participants and 48.6 percent non-Hispanic whites. Most came from middle-class and upper−middle-class families. In total, 43.5 percent reported any use of alcohol or other drugs and 24.1 percent reported impaired driving risk during their lifetimes.
Overall, 14.8 percent of teens screened positive for substance abuse on the questionnaire. Of these, 29.5 percent were tested at school-based health centers, 24.2 percent at rural family practice facilities, 16.6 percent at adolescent clinics, 14.1 percent at health maintenance organizations and 8 percent at pediatric clinics. Teens who visited their physicians because they were sick were more likely to screen positive for substance abuse than those who went in for well-child care visits (23.2 percent vs. 7.1 percent).
Given the pressures of time on primary care providers, more research is needed on efficient and effective office-based systems for substance abuse screening and therapeutic interventions, the authors conclude. Early identification and intervention of adolescent substance use presents the greatest opportunity for reducing the burden of addictive disorders later in life.
Substance abuse screening should occur whenever the opportunity arises, not at well-child care visits only.