Substance Abuse, General Principles

Abstract

1. Kirstin A. M. Nackers, MD* 2. Patricia Kokotailo, MD, MPH* 3. Sharon J. L. Levy, MD† 1. *Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI. 2. †Division of Developmental Medicine, Boston Children’s Hospital, Boston, MA. The American Academy of Pediatrics recommends screening for alcohol and other drug use at adolescent health supervision visits and appropriate acute-care visits, (1) yet many clinicians find addressing substance use with youth to be a challenge. After completing this article, the reader should be able to: 1. Describe the use trends for alcohol and common other drugs by youth in the United States. 2. Explain the primary care clinician’s role in screening and management of alcohol and substance use. 3. Using motivational interviewing techniques, adopt an in-office brief intervention across the spectrum of adolescent substance use. 4. Analyze the utility of urine drug testing in various clinical situations, such as random screening in a low-risk patient/population, testing an adolescent who self-reports ongoing substance use, monitoring adherence to treatment for a substance use disorder, and evaluating a patient with signs/symptoms of acute toxicity. Adolescent drug and alcohol use remains a major issue in the United States. The American Academy of Pediatrics (AAP) recommends screening for use of these substances at adolescent health supervision visits and appropriate acute-care visits. (1) Primary care clinicians (PCCs) serve an important role in both the identification and management of alcohol and substance use disorders (SUDs). This role comes with many challenges, including managing the dynamics of families that may be in crisis, issues of adolescent confidentiality, and high variability of local resources to support patients in need of treatment for SUDs. In this article, we review the epidemiology of alcohol and substance use, the approach to screening and treatment, the issue of adolescent confidentiality, and the role of urine drug testing. ### Epidemiology The epidemiology of adolescent substance use must be …