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Doctors should be asking adolescents about their drug and alcohol use at every visit and screening for any signs of dependence or addiction, the American Academy of Paediatrics said in a new policy statement.
In the statement, published online in Paediatrics, the AAP points out that developing brains are particularly vulnerable to addiction – and so it's important for doctors to take a firm and proactive stance when teens use drugs and alcohol.
Dr Sharon Levy, co-author of the statement and director of the Adolescent Substance Abuse Program at Children's Hospital Boston, said "the recommendation to screen adolescents as part of general healthcare is not new."
But the AAP believes a clear, step-by-step guide of how to ask about and address alcohol and drug use would be helpful because studies showed many doctors were not asking the important questions.
"People feel it takes too long, and they're not really sure what to do with the screening results," Dr Levy said. "They don't feel comfortable talking about drugs and alcohol with their adolescent patients."
But screening in teens can catch unhealthy behaviour and dependence before it turns into a full-blown addiction, she said – so it's an especially beneficial time for doctors to bring up those difficult topics.
Illicit drugs
In a 2010 study from the National Institute on Drug Abuse, 30% of 10th graders reported using illicit drugs in the past year, and 52% had drunk alcohol.
At every primary care appointment and whenever else doctors see their adolescent patients, the statement says, they should be asking teens whether or not they use alcohol and drugs, and if so, under what circumstances.
Then, doctors should give encouragement or advice based on teens' responses, and refer those who need it to extra treatment.
Teens who report using drugs or alcohol, but not in especially risky ways, should be given advice on how to stop, as well as information on the negative health effects of drugs and alcohol – but not in a way that sounds like "preaching", Dr Levy said.
Paediatricians should go further and make a written contract with teens who use drugs and alcohol in risky situations – such as while driving – stating that they will avoid that behaviour in the future, according to the AAP. If teens are unwilling to make that commitment, doctors should consider breaking confidentiality to talk to their parents.
Psychiatric conditions
The AAP adds that paediatricians also need to watch for other psychiatric conditions that can occur in cases of drug and alcohol abuse and addiction, such as attention-deficit hyperactivity disorder and anxiety disorders.
Not everyone agrees that there's a clear benefit to all teens being screened for their drug and alcohol use every time they see a doctor.
The US Preventive Services Task Force says there isn't enough evidence to recommend for or against alcohol or illicit drug screening and counselling interventions for adolescents by primary care doctors.
Recommendations
Still, said Task Force chair Dr Virginia Moyer, the AAP may find it helps paediatricians for the organisation to make recommendations based on a consensus between doctors that this is the right thing to do.
"This is really an extremely important topic, and we hope that good evidence becomes available," Dr Moyer said.
Dr Levy said she thinks there is emerging evidence that brief talks and interventions with adolescents can in fact be helpful for addressing drug and alcohol use. In most teens who don't use drugs or alcohol, she added, the screening would only take a few seconds.
Adolescents are "an ideal group to screen," she concluded. "The risk of this is very low, the cost of this is trivial... and the potential benefit is huge."
(Reuters Health, Genevra Pittman, November 2011)
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