Pediatricians Fail to Recognize Teen Substance Abusers

They underestimate adolescents' alcohol, drug problems

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HealthDay Reporter

MONDAY, Nov. 1, 2004 (HealthDayNews) -- Pediatricians may think they know whether a teenage patient is using alcohol or drugs and to what extent, but a new study finds doctors greatly misjudge the problem.

More than 60 percent of the time, pediatricians knew their young patients had used alcohol or drugs, but in most cases the doctors thought the problem was less severe than it actually was, the study found.

"Providers significantly underestimate the level of adolescent substance use or the severity of adolescent substance use," said lead author Dr. Celeste R. Wilson, an investigator with the Center for Adolescent Substance Abuse Research at Children's Hospital Boston.

"And this is important, of course, because it's these adolescents that, if they're recognized, can be referred or might benefit from early intervention adolescent abuse services," she said.

The study, funded by the Robert Wood Johnson Foundation, appears in the November issue of Pediatrics.

Illicit drug use remains an intractable health problem among America's youth, federal data suggest. In 2003, 11.2 percent of 12 to 17 year olds used drugs, alcohol or tobacco in the prior month, according to a survey by the Substance Abuse and Mental Health Services Administration (SAMHSA), a unit of the U.S. Department of Health and Human Services.

An estimated 17.7 percent of youths in that age group used alcohol in the month prior to the survey, SAMHSA said. Of all youths, 10.6 percent were binge drinkers and 2.6 percent were heavy drinkers.

These percentages were largely unchanged from the prior year's survey.

The American Medical Association recommends that health-care providers screen all adolescent patients annually for alcohol and drug use, the study's authors noted. Most pediatricians say they do screen almost all of their teenage patients, they add, citing a previously published survey.

But are they accurately assessing teen substance abuse?

Wilson's study involved 533 patients aged 14 to 18 years old seeking routine medical care and their 109 medical-care providers. At the time of the visit, each provider completed a form giving their impression of their adolescent patient's drug and alcohol use. After the visit, patients were screened using the Adolescent Diagnostic Interview, a questionnaire Wilson describes as the "gold standard" for diagnosing substance abuse disorders. Then investigators compared providers' clinical impressions with patients' actual diagnoses.

Of the 86 teens with a diagnosis of abuse or dependence, providers correctly identified 75 percent of them as substance users. But the level of use in half of these patients was erroneously reported as minimal.

Providers would do a better job of identifying patients engaging in these risky behaviors if they used a structured screening tool, the authors concluded.

One tool developed by study co-author Dr. John Knight, director of the Center for Adolescent Substance Abuse Research at Children's Hospital Boston, asks teens to answer six questions related to alcohol and drugs. It asks, for example, "Have you ever ridden in a car driven by someone (including yourself) who was 'high' or had been using alcohol or drugs?"

Although Wilson concedes some teens won't truthfully disclose their substance use, she insists a screening tool would help identify some kids the doctors might not think are using drugs or alcohol. "It would certainly give providers a structured way of approaching the subject with the adolescents," she said.

Providers also need to be aware of counseling and treatment resources in their local area so they'll be prepared to make referrals as needed, she added.

"By getting them early intervention, then you will be preventing the sequelae of alcohol and substance abuse," including motor vehicle accidents and addiction, Wilson said.

More information

Check out the American Academy of Child and Adolescent Psychiatry to learn the warning signs of teen substance abuse.

SOURCES: Celeste R. Wilson, M.D., investigator, Center for Adolescent Substance Abuse Research, Children's Hospital Boston, Boston; Substance Abuse and Mental Health Services Administration, Rockville, Md.; November 2004, Pediatrics

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