Due to the increasing number of adolescents doing drugs over the years, the American Academy of Pediatrics (AAP) in a new set of reports, has revalidated its recent suggestion to integrate Universal Screening, Brief Intervention and Referral to Treatment (SBIRT) practices for adolescent substance use into routine health care practices.
A policy statement has been revised from a 2011 statement and released in the form of a new clinical report containing updated guidance, including screening tools and intervention procedural techniques. The policy and report from the Committee on Substance Abuse, both titled Substance Use Screening, Brief Intervention and Referral to Treatment, will appear in the July issue of Pediatrics.
According to the clinical report 28% of eighth-graders and more than 68% of 12th-graders have tried alcohol. Additionally 50% of high school students have reported ever using illicit drugs, and 41% have tried cigarettes. Moreover, according to the clinical report, half of all adolescents visiting the emergency department for trauma-related injury test positive for alcohol use compared to only 5% of adolescents seeking emergency care for other reasons.
A survey of pediatricians found that an estimated of 50-86% of the respondents performed routine adolescent drug use screenings, but only a few used screening tools and techniques that were validated, with most relying on clinical impressions.
According to the lead author of the study, Dr Sharon J. Levy, M.D., M.P.H., FAAP, the report contained validated screening tools and prioritized asking questions about frequency of use, which had been found to be highly successful at predicting the risk of developing or having developed a substance use disorder.
Levy said, “Substance use is one of the most important modifiable behaviors adolescents engage in, and as guardians of children’s health, it is critically important for us to keep talking about this topic with them.”
The issue lies in placing focus on intervention methods and not just on screening results. The clinical report calls for a unique screening technique which gives attention to promoting healthy dialogue and responsive behavior and encourages healthy choices and behavior, thereby highlighting any risky behavior. Naturally, adolescents will deny using drugs once confronted and will either avoid further questioning or change the topic. Dr Levy believes the best course of action in this situation is to speak to the patient alone and calmly explain to them why the parents are concerned.
According to Janet F. Williams, MD, FAAP, co-author of the reports, there is no need for extreme reinforcement when patients are not risking their own health or the safety of others. Instead, pediatricians should try and accept the circumstances of the children and provide positive feedback similar to non-drug users. Dr. Williams emphasized that positive reinforcement is the key to bringing about change. Parents can respond to their children by telling them that they are making healthy choices and are open to drug-related questions. Additionally, confidence-building and instilling in a sense of responsibility in them will automatically make children question their decisions, motivating them to change their lifestyle habits.
Patients who have used drugs occasionally in the past year will be more open to change, should be informed about potential negative health effects and should be urged to limit their drug use. Moreover, patients who use drugs frequently may have a serious problem and it is important for parents to figure out the root cause of the problem. When patients have a substance abuse disorder, convincing them to change is rather difficult and a more effective approach is to motivate them to change their choices.
When drug use gets out of control and becomes so severe the patient might be at a health risk to himself or others, strict action needs to be taken and confidentiality needs to be broken. In such cases, patients should be warned beforehand so that they can self-assess themselves and experience the potential fear of embarrassment, which may completely force them to quit their habits. However, instead of admitting to using drugs, adolescents are more likely to give up their friends or reveal the drug source.
The clinical report includes a chart with the various levels of treatment care, including outpatient and residential care. Research reports that only 10% of adolescents requiring treatment receive coping services, which can be associated to a lack of treatment knowledge and patients who do not admit they have a substance abuse problem.
Dr Levy said she hopes the policy and clinical report help pediatricians look at the bigger picture when referring patients for intervention- based counseling to treat underlying reasons that may have led them to start using drugs in the first place. Instead, she hopes that medical professionals will pinpoint and analyze the root cause of the problem. The policy advises pediatricians to continue research and adequate payment for SBIRT-related issues and allow better access to mental health and substance use disorder treatment.