Academic journal article International Journal of Child and Adolescent Health

Substance Abuse and the Primary Care Clinician

Academic journal article International Journal of Child and Adolescent Health

Substance Abuse and the Primary Care Clinician

Article excerpt

Introduction

Adolescence and young adulthood are two developmental periods during which patients are more likely to engage in drug and alcohol experimentation and use (1,2). Nearly half of high school seniors in the United States (US) report having tried at least one illicit drug in their lifetime and almost three quarters have tried alcohol (3). Although many of these adolescents will not go on to develop drug or alcohol dependence, a substantial portion encounters significant medical, social and psychological problems related to their use. According to the 2010 National Survey on Drug Use and Health (NSDUH), 19.8% of young adults between ages 18 and 25 were abusing or dependent on substances in the past year, a rate that is more than double the rate of 7.3% for adolescents aged 12-17 (4).

Early use also increases the risk for later developing a substance use disorder (i.e., substance abuse or dependence). In adults who had their first drink before the age of 14, 15.1% went on to be diagnosed with substance abuse or dependence as compared to only 2.7% of adults who had their first drink after the age of 21 years (4). Adolescence is the primary age of onset for drug abuse and dependence, which reaches peak prevalence around the age of 19 (1). The onset of substance use disorders after the age of 25 is rare. Therefore, addressing substance misuse and substance use disorders in adolescents and young adults is critical in promoting long term health and wellness.

Despite the high rate of substance use disorders in adolescents and young adults, they are often under-recognized in the clinical setting including primary care offices (5-8). Furthermore, even when properly identified, most adults with substance use disorders do not receive needed treatment and the mean age of treatment onset is around 27 (1,4). Adolescents with identified substance abuse or dependence are even less likely to receive treatment. In one US national study, only 15.2% of adolescents identified as having substance abuse or dependence received disorder-specific treatment (9). Adolescents and young adults may not be interested in pursuing treatment on their own, they may not be aware of their treatment options, and they may not have very many treatment options available to them (4). Although access and contact with specialized treatment providers may be limited, most adolescents and young adults do have access to and visit a pediatrician or primary care clinician. The pediatrician and primary care clinician are therefore in the position to play an essential role in the prevention, detection and management of substance use disorders in adolescents and young adults.

Although the importance of pediatricians and primary care clinicians in addressing substance use in adolescents and young adults is widely recognized, there are few practice guidelines that have been developed by leading U.S. national professional organizations that define the exact role of the primary care clinician in substance abusing young adults. The American Academy of Pediatrics (AAP) does have a detailed policy statement from 2005 defining the role of the pediatrician in this population (10) and recently issued a policy statement recommending an algorithm-based approach to universal substance use screening, brief intervention, and/or referral to treatment (SBIRT) as a way of augmenting current assessment and treatment approaches in managing substance use and abuse in adolescents (11). A similar SBIRT framework has also been recommended by the Substance Abuse and Mental Health Services Administration (SAMHSA) as part of routine healthcare for adults (12,13).

Therefore, in this chapter addressing the role of the pediatrician and primary care clinician in substance abusing adolescents and young adults, the discussion will focus on the SBIRT approach and other management issues confronting the pediatrician and primary care clinician with substance abusing patients such as safety, consent and confidentiality in general and specifically for adolescents. …

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