Alarming numbers of teen drug, alcohol disorders

A high proportion of 14- to 18-year-olds have diagnosable disorders related to the use of alcohol or drugs, according to a study published by Children’s researchers in the June issue of Archives of Pediatric and Adolescent Medicine.

The primary author of the work, John Knight, MD, director of the Center for Adolescent Substance Abuse Research, says the high prevalence of alcohol and drug disorders in the patients studied is of great concern.

“More than half of the teens coming to us for routine health care had used alcohol or drugs during the past year, and more than one in four had experienced one or more serious problems associated with their use,” says Knight. “Of greatest concern, almost one in six had a diagnosis of either substance abuse or substance dependence. Dependence, or addiction, is an especially serious disease with potential for lifelong implications.”

The study also demonstrated the effectiveness of a screening tool called the CRAFFT test (see box at right), developed by Knight and his colleagues to help physicians identify at-risk teens. Two or more “yes” answers are considered highly predictive of an alcohol or drug-related disorder, researchers found.

This brief screening test is expected to greatly increase the number of providers who screen for substance abuse. “The beauty of this questionnaire is that it can be easily added to any office visit as part of the patient’s routine physical,” says Knight.

According to Knight, physicians are in an ideal position to identify problems — more so than parents. Although the questions appear simple, Knight cautions that the tool is not designed for parents’ use at home. “Teens are good at telling their parents what they think they want to hear,” he says. “Our research shows support for the idea that teens are far more likely to tell the truth to their medical providers than their parents.” Knight says the study “shows how important it is for physicians to screen all of their adolescent patients for substance abuse, just as they routinely check blood pressure and weight.”

The study’s findings suggest a need to increase the capacity for treatment of adolescents with substance abuse disorders. “In many communities, resources are not adequate to meet the need. New approaches, such as office-based interventions, must be developed to address the magnitude of the problem,” says Knight.

Knight believes that another important benefit of the CRAFFT tool is that it probes into the incidence of driving or riding in a car while under the influence. “Our findings show that 43 percent of teens surveyed answered that they have been in cars when the driver was high or had been using drugs or alcohol. A ‘yes’ answer to this question is a tremendous cause for concern and warrants immediate further discussion by the professional.”—CM

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