Although the scientists said they were surprised and alarmed by the findings, they did see reason for encouragement: A simple, six-question screening tool they've devised helps doctors identify adolescents at risk of drug and alcohol trouble with what researchers say is a high degree of certainty.
More than 80 percent of teens who answer "yes" to two or more of the questions have significant drug and alcohol problems, says Dr. John Knight, a Harvard University pediatrician who helped develop the test.
The researchers called on pediatricians to make the tool -- which has the acronym CRAFFT -- as routine a part of a teen exam as checks of weight, height, and blood pressure already are.
"These are severe problems, they may have lifelong implications, and they certainly require intervention," said Knight, who presented the findings at a press conference Thursday in Boston.
CRAFFT reminds doctors to ask their teen patients if they've ever driven a car while intoxicated or ridden with an intoxicated driver; if they drink or take drugs to relax; if they drink or take drugs alone; if they forget things that happen while using substances; if they have family or friends who've told them to cut back on their drinking or drug use; and have they ever gotten into trouble while intoxicated.
A CRAFFT score of two or more is a strong sign of trouble, and the risk of abuse or addiction nears 100 percent as the number of positive answers rises. But a score or one or zero on the test isn't necessarily an all-clear, Knight said. A small number of these children "may still be at substantial risk" of drug and alcohol trouble, he said.
Knight said a positive response to the first question, about cars, should be especially concerning because motor vehicle wrecks are the single leading cause of death and the "greatest public health problem" for American teen-agers.
A similar but shorter set of questions exists for young adults, Knight said, but it has failed to prove useful for identifying drug and alcohol problems in adolescents.
The new study included 538 teens, ages 14-to-18, who visited Children's Hospital Boston's adolescent and young adult clinics for either routine care or specific health problems.
More than half said they'd used alcohol or illegal drugs in the past year, and nearly 27 percent said they'd had a serious problem -- such as trouble in school, with family members, or run-ins with the police -- as a result. Most troubling, the researchers said, 9 percent had clinically defined substance abuse and 7 percent were addicts, the researchers found.
When Knight's group administered the CRAFFT test, they found that 43 percent of teens said they'd either driven while intoxicated or ridden in a car with a driver who'd been drinking or using drugs.
Dr. Judith Palfrey, chief of general pediatrics at Children's Hospital Boston, says it's "critically important" for doctors who treat teens to catch signs of substance abuse. "This problem is desperately important to us and to our patients," who, if untreated, can face a lifetime of emotional and physical hardships and health problems.
"We must get pediatricians actively involved in screening their patients and intervening. If we can deal with youth at early stages of alcohol abuse we will protect the health of patients as well as the health of communities," Charles Curie, administrator of the Substance Abuse and Mental Health Services Administration, a division of the U.S. Department of Health and Human Services, said in a statement released Thursday.
The agency, which helped fund the study, has found that 6.6 million Americans between the ages of 12 and 20 are "binge" drinkers and 2.1 million report drinking heavily.
Dr. Edward Jacobs, chairman of pediatrics at the Everett Clinic in Everett, Wash., called CRAFFT a "good tool. It's simple to use, simple to score," Jacobs, who is also chairman of the American Academy of Pediatrics' committee on substance abuse, said.
And with only six questions, the screening test takes only a minute or two to administer -- quick enough to meet the time pressures of managed care, Jacobs added.
What To Do
To find out more about CRAFFT, try the Center for Adolescent Substance Abuse Research. For more on drug and alcohol abuse, check out the Substance Abuse and Mental Health Services Administration or the National Institute on Alcohol Abuse and Alcoholism.