New Steps Pediatricians Can Take to Reduce Teen Substance Use

Teens who complete a five-minute computer screening program that includes six questions about alcohol and drug use, and who talk with their pediatrician briefly about the results, reduce their risk of drinking up to one year later, according to a new study.

Researchers at Boston Children’s Hospital studied more than 2,000 teens from New England and the Czech Republic. The teens completed the screening program, which asks six questions about alcohol and drug use, and then presents a score and risk level. The teens read through 10 pages with facts and stories that illustrate the serious health effects of substance use.

The teens’ doctors receive a report with the results, and a list of talking points for a two- to three- minute conversation about the risks involved in alcohol and drug use. They tell the teens it would be best for their health not to use alcohol or drugs at all.

The study found that after using the program, teens’ risk of drinking dropped almost in half for three months, and by about one-quarter one year after the doctor’s visit, the researchers report in the journal Pediatrics.

Screening and brief intervention has been shown to be effective in emergency departments and college campuses, but this is the first study published in an English language journal to demonstrate it is effective in adolescent primary care settings, according to senior author Dr. John R. Knight, Director of the Center for Adolescent Substance Abuse Research at Boston Children’s Hospital. “It’s important to get pediatricians involved, because we know 70 percent of high school seniors have started to drink, and almost 60 percent have started to use drugs, but there are few specialists available to deal with early intervention with teens,” he said.
Dr. Knight noted that teens generally see their primary care physician for a yearly physical. “Kids know they can tell the truth to their doctor, and it won’t get back to their parents. They really listen to their doctors’ advice,” he said. “Since substance abuse kills more teenagers than infectious disease, parents should view this screening as another important vaccination.”

Two key factors may prevent a teen’s doctor from asking about drug and alcohol use, and this program addresses both, Dr. Knight says. One is time constraints. “Doctors are pressed for time, and they have a lot of things they need to screen patients for,” he says. By having patients complete the screening before the visit, doctors have more time to interpret the results and discuss them.

The second factor is that doctors who do screen teens for substance use don’t always know what to say to those who admit to using drugs or alcohol.

The screening program is based on the CRAFFT test, a behavioral health screening tool for use with children under the age of 21 that is recommended by the American Academy of Pediatrics (AAP) Committee on Substance Abuse for use with adolescents.

Last fall, the AAP and the National Institute on Alcohol Abuse and Alcoholism unveiled a new tool designed to help pediatricians talk to teenagers about alcohol use. The “Alcohol Screening and Brief Intervention for Youth: A Practitioner’s Guide” provides doctors with basic questions about whether and how much a patient drinks, and how much their friends drink.

“Our program takes a similar approach, but by using a computer, we are saving the doctor time,” observes Dr. Knight.

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    Chudley Werch, PhD

    May 19, 2012 at 11:56 AM

    We’ve developed an alternative evidence-based model to the typical screening and brief intervention described by Dr. Knight. Our brief multiple behavior motivational interventions, like SPORT for adolescents solve the key limitations identified by other brief interventions discussed in this paper. First, SPORT can be implemented by nearly anyone in a clinical setting, saving the physician’s valuable time for other things. Our brief interventions are fully scripted, don’t require extensive training, include step-by-step instructions for implementation, and don’t require previous training or certification to implement. Second, SPORT screens for substance use, but also other key risk behaviors of youth, including physical activity, healthy eating and sleep, thereby addressing a broader number of co-existing risks common among American youth. Third, because SPORT is fully scripted, health, education, medical and fitness professionals and parents are shown exactly what to say. Furthermore, the messages to youth target positive image and behavior attainment, and therefore are more appealing and motivating than negative image or fear-based communication. SPORT and our other evidence-based brief multiple behavior motivational interventions can be easily implemented in clinic, school, community and home settings.

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    Lisa Frederiksen –

    May 18, 2012 at 4:58 PM

    This is so important — especially given early use is the number one risk factor for a person developing alcoholism due to the brain development that’s occurring ages 12-early 20s. Hopefully these kinds of studies will also convince insurance companies of the importance of providing coverage for these kinds of screenings and brief interventions.

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