In today’s busy medical environment, doctors are asked to do a lot in a short amount of time. The average well visit clocks in at somewhere around 12 minutes these days, which means pediatricians need to screen children for several potential problems in a very finite amount of time.
Because of these time restrictions there simply isn’t enough time to do all the screenings recommended as part of general health care. One area that often gets overlooked is substance abuse among adolescent patients.
Data suggests that many physicians do not routinely broach the topic of alcohol and drug use with their teen patients because there isn’t enough time to bring the subject up, or they don’t always know what to do when a screen suggests a patient may have a problem.
To make the process easier on time starved doctors, the National Institute on Alcohol Abuse and Alcohol Addiction (NIAAA) and the American Academy of Pediatricians (AAP) have both released screening and brief intervention guidelines that will help physicians choose valid screening tools and clearly explain when to suggest appropriate interventions for their patients.Sometimes called Screening, Brief Intervention, Referral to Treatment (SBIRT), the screenings allow doctors to learn about their patients’ substance abuse history quickly, and provides a clear course of action for the doctor to take based on the patients’ answers.
“These guides provide simple strategies for screening and talking to kids about alcohol and drug use. We hope they will reinforce a recommendation that’s been in place for some time, and offer additional advice on making it more efficient,” says Sharon Levy, MD, MPH, director of the Children’s Hospital Boston Adolescent Substance Abuse Program (ASAP), and chair of the AAP Committee on Substance Abuse. “By giving clinicians these tools we hope more physicians will heed the recommendation and be more confident in addressing alcohol and drug use with their adolescent patients.”
The NIAAA guide focuses on alcohol and consists of two questions; one about the patient’s drinking history in the last 12 months, and the other on their friends’ use of alcohol. These questions were selected because data shows they are the two best indictors of a young person’s level of risk associated with alcohol use. The guide recommends screening children as young as 9 years old, or the first time the child spends time alone with his physician.
The alcohol screen can be given when time tight, like during urgent care appointments, or when the physician thinks its needed, like when a patient brings up his or her own questions about alcohol. The NIAAA encourages physicians to complete a more thorough interview, including questions about use of other drugs, whenever an alcohol screen is positive.
The AAP guide screens for alcohol and drug use simultaneously and uses the CRAFFT questions which were developed by John R. Knight, MD, director of Children’s Hospital Boston’s Center for Adolescent Substance Abuse Research(CeASAR). Depending on the patient’s answers, the clinician is given suggestions for responses that focus on positive reinforcement for those who have not used alcohol or other drugs, or medically relevant messages that were designed to reduce alcohol or drug use.
For adolescents with more serious problems related to alcohol or drug use, both guides give suggestions and examples using a simple motivational approach designed to reduce drug use and, when necessary, to help the adolescent get more treatment for a substance use disorder.
The short and clinical tone found in both guides has been carefully crafted, because to be truly effective in reducing underage drinking and drug use Levy believes the medical community needs to focus less on the ethics of substance abuse and stick to their area of expertise: health.
“We want to change the tone of conversations doctors are having with young patients about drug and alcohol so it’s less about judgments and finger waving and more positive interaction,” she says. “This screening has nothing to do with morals or legality of underage drinking, or drug use. It’s strictly about the health risks. By focusing on proven, scientific facts about how substances negatively affects health I think doctors can have much more impact in reducing the behavior.”