LOCAL DOCTORS SUPPORT INCREASED DRUG, ALCOHOL SCREENING FOR TEENS

Detecting drug and alcohol abuse among teenagers may get a boost if
family doctors and pediatricians use screening methods when teens
come in for any medical attention, not just during routine checkups.

A study by Children's Hospital in Boston found that positive
screenings for drug and alcohol abuse among teens went up when
doctors engaged in screening during sick visits and any other
occasion. The study involved 2,133 teens aged 12 to 18 with a 93
percent participation rate at primary-care settings in the Northeast.

Nearly 15 percent of teens screened positive at a primary-care
setting when assessed with a six-question screening tool, called
CRAFFT, but the rates fluctuated based on the purpose of the visit.

About 23 percent of teens screened positive when they were at the
doctor for a "sick visit" vs. 11 percent who screened positively
during a routine checkup.

"Screening should occur whenever there's an opportunity, not just
during well-child visits," said Dr. John Knight, the lead author and
director of the Center for Adolescent Substance Abuse Research at the
hospital, in the study results.

The study was published in November's Archives of Pediatrics and
Adolescent Medicine.

Local pediatricians and substance abuse treatment officials agree
with the recommendation but point out that doctors face time
constraints, coupled with numerous other screenings that they may
want to administer.

"Screening teens during sick visits has some merit, the big question
is the whole issue of time. And you can certainly make the case for
screening teens for other issues, such as depression and suicide,"
said Dr. Todd Vedder, a pediatrician with Anchor Health Centers at
its 1008 Goodlette-Frank Road location. "It boils down to what issues
are important, what pediatricians think is most important to them."

Dr. Jerry Williamson, chief medical officer of Collier Health
Services, is familiar with the study findings and the message that
sick visits by teens to the doctor yield a higher positive screening
for drug and alcohol abuse.

The concept of sick visit screenings could be extended to other
issues, such as making sure kids are fully immunized, he said.

"The implications of the study is that screening should take place
during any visit," he said. "The study was very good but the rubber
meets the road in how to do it in terms of the time available (to the
doctor). In most sick visits, the doctor has 10 or 15 minutes and so
there's very limited time to get a screening done."

The drug and alcohol screening technique used in the study, CRAFFT,
involves six questions and is not diagnostic, he said.

A positive screening will require having the teen return for a
subsequent complete assessment, he said.

In addition, it's crucial that the teen consents to the screening and
knowingly wants to participate, he said. That's in accordance with
practice guidelines from the American Academy of Pediatrics that
screening must be voluntary. That policy guideline was in place in
1996 and reaffirmed in 2006, he said.

Because it is voluntary, teenagers do tend to be honest when
answering the questions; otherwise they wouldn't consent to it, he
said.

The American Medical Association's support of voluntary drug and
alcohol screening of teens at any doctor's visit may be followed by
the pediatrics academy support, he said.

"I suspect that is the direction they are going," he said.

The study's result is music to the ears of Christine Holmes, director
of substance abuse services at the David Lawrence Center on Golden
Gate Parkway, which has inpatient and outpatient substance abuse
treatment programs.

David Lawrence rarely gets referrals from physicians about teenagers
needing treatment, but she said preventive screening techniques are
brief and very effective. David Lawrence assessed 600 kids in 2006
and 60 percent had drug or alcohol issues.

"Studies have shown, like this one, that just providing the
opportunity alone would be a tremendous advantage," she said,
referring to teens opening up and talking. "It gives them the
opportunity to get help if they want help."

She fully supports the idea of doctors doing screening during sick
visits and recognizes their time constraints. There is a perception,
though, that an assessment has to be "all or nothing," she said.

For instance, a four-question screening technique she's familiar with
takes about one minute.

"Sometimes in the area of prevention, doing a little is sometimes
enough," she said. "It's complicated, but it doesn't have to be all
or nothing."