More teens test positive for drugs, alcohol at sick care visits

The high rates have experts calling for substance abuse screening to be performed whenever possible.

By Victoria Stagg Elliott, AMNews staff. Nov. 26, 2007.

Physicians may need to screen 12- to 18-year-olds for possible drug and alcohol abuse issues any time they present for care and not just at checkups, as recommended by many medical societies, including the American Medical Association. This concept was the take-home message of a study in the November Archives of Pediatrics & Adolescent Medicine.

Still, many physicians agree that although the reasons supporting such screening are clear, implementing it is easier said than done.

The study found that nearly 15% of teenagers coming to a primary care practice would test positive when assessed with the CRAFFT, a tool designed to detect drug and alcohol use in this age group, but these rates varied widely depending on the purpose of the visit. Notably, about 23% of those presenting for sick care screened positive, while only 11% did so in the context of a well-child visit.

"Screening should occur when ever there's an opportunity, not just at the well-child visits," said John Knight, MD, lead author and director of the Center for Adolescent Substance Abuse Research at Children's Hospital Boston. "The earlier we can recognize the problem, the more successful treatment is likely to be."

The type of clinic also made a difference. Nearly 30% of those seeking care at school-based health clinics screened positive along with approximately 24% receiving care in a rural setting. Only 8% in the pediatric setting were positive as were slightly more than 14% of those getting medical services from a health maintenance organization.