TEEN DRUG USE UNDETECTED

Medical Staffs Often Fail To Notice Problem During Routine Exams

Severe alcohol and drug abuse by teenagers may be easily missed during
routine and urgent-care medical visits, particularly in girls.

In a study published in the November issue of Pediatrics, researchers
highlighted not only how often clinicians fail to notice the chronic
problem in routine examinations, but also how seldom they seem to ask
teens structured questions to determine how frequently they take drugs
or alcohol.

In 2002, examinations of 500 urban adolescents, ages 14 to 18, at
Children's Hospital Boston failed to detect use in about 40 percent of
the more than 100 teens who were later determined to have serious
problems. In the 60 percent of cases in which clinicians correctly
identified some use of alcohol or other drugs, they vastly
underestimated the severity: Only 10 percent of recurrent "abusers"
were correctly identified while "dependence" was missed in 36 cases
later diagnosed.

Yet, when the teenagers were asked specific questions about
drug-and-alcohol related behavior in separate interviews after their
exams, they were likely to talk about their use of alcohol or drugs.

"While a structured screening tool won't necessarily make the
adolescent reveal the problem, it hopefully would give the provider a
structured way to ask about it," said lead author Dr. Celeste Wilson,
a pediatrician and researcher at Children's Hospital Boston.

Adolescent substance abuse is a chronic problem that contributes to
automobile accidents, unwanted pregnancies, sexually transmitted
diseases, suicide and crime, and can also be a symptom of underlying
mental problems such as depression.

Some studies indicate that the majority of adolescents have tried
alcohol or another drug by the time they reach 12th grade. Some
studies estimate that about 1.4 million teens regularly abuse illicit
drugs. As a result, the American Medical Association recommends that
health-care providers screen all adolescents for substance abuse
during routine physical exams.

The authors of the study recommended that medical staff routinely ask
teenagers five questions, which they called CRAFFT.

C: Have you ever ridden in a CAR driven by you or someone else who was
using alcohol or drugs?

R: Do you ever use alcohol or drugs to RELAX, feel better about
yourself, or fit in?

A: Do you ever use alcohol or drugs while you are ALONE?

F: Do you ever FORGET things you did while using drugs or alcohol?

F: Do your family or FRIENDS ever advise you to cut down on drinking
or drug use?

T: Have you gotten into TROUBLE while you were using alcohol or
drugs?

Funded by the Robert Wood Johnson Foundation, the study involved more
than 100 physicians, residents, medical students and nurse
practitioners who completed a form giving their impressions about each
teen's degree of substance use (none, minimal, problem use, abuse,
dependence) after a physical exam with the patient. (The residents
were not told the purpose of the evaluation.)

The problems were more likely to be identified in boys, perhaps
because boys are more likely to abuse substances than girls and so
clinicians may be more likely to suspect them to be substance abusers,
while inaccurately giving the girls the benefit of the doubt.