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New Steps Pediatricians Can Take to Reduce Teen Substance Use

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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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