addiction in this country since the consequences
of risky use of addictive substances among
adolescents are so profound and individuals with
addiction typically began engaging in risky use
in adolescence.^122
The U.S. Public Health Service’s clinical
practice guideline for tobacco use and
dependence recommends that clinicians ask
adolescent patients about their tobacco use and
provide them with brief interventions to aid in
quitting.^123
Professional medical associations such as the
American Medical Association (AMA) and the
American Academy of Pediatrics (AAP) support
screening adolescent patients for substance use,
and promote the use of screening and brief
intervention techniques among their
constituents:^124
The AMA’s Guidelines for Adolescent
Preventive Services recommend that
physicians ask all adolescents annually
about their use of tobacco, alcohol and other
drugs, including over-the-counter drugs,
controlled prescription drugs and anabolic
steroids.^125
The American Academy of Pediatrics
(AAP) encourages pediatricians to:
Be knowledgeable about addiction and
skilled in recognizing the risk factors for
substance use among young people; Screen all patients for substance use at
annual medical examinations and, if
possible, at other medical visits as well
using screening methods that are
validated, nonjudgmental and that
protect confidentiality; Provide brief interventions and refer
patients, when necessary, to treatment or
specialty care; Consider and address co-occurring
disorders; and Promote substance use prevention
programs and media responsibility with
regard to depictions of substance use.^127Emergency and Trauma Care.......................................................................................
Emergency Departments (EDs) and trauma
centers are particularly critical venues for
screening and brief intervention since so many
emergency and trauma cases involve risky
substance use. One study found that up to 31
percent of all patients treated in hospital EDs*
who were screened for risky alcohol use† had a
positive result.‡ 128 Many trauma patients meet
criteria for addiction; a study of seriously injured
trauma patients shows that 24.1 percent of them
met diagnostic criteria for alcohol dependence
and 17.7 percent for other drug dependence.^129
Further, substance-using individuals frequently
rely on EDs for much of their health-care
needs.^130* Fifty percent of severely injured trauma patients and
22 percent of minor trauma patients receive their
injuries under the influence of alcohol.
† Based on the CAGE questionnaire.
‡ This most likely is a conservative estimate since
many EDs do not screen for alcohol or other drug use
because of insurance laws (i.e., the Uniform Accident
and Sickness Policy Provision Law-UPPL) restricting
payment if the reason for admission was substance
related.^The primary care office is a key setting for
adolescent screening and brief intervention
related to substance use; using computer
technology to achieve these ends meets the needs
of both patients and physicians by making the
process more efficient and easier for physicians,
producing more honest responses from patients,
and increasing both providers’ and patients’
satisfaction with the encounter.^126--John R. Knight, MD
Director,
Center for Adolescent Substance Abuse Research
Associate Professor of Pediatrics,
Harvard Medical School
Senior Associate in Medicine,
Associate in Psychiatry,
Children’s Hospital Boston