You know your own children better than anyone else (you hope). But would you know if your teens were using drugs or alcohol? And if they were — would you know how to talk to them about it?
“Only 10 percent of kids with a substance use disorder ever get any treatment for it,” said one substance abuse expert.
A lot of families don’t. And pediatricians may not press their teen patients on it either, as crazy as that sounds — which is why the American Academy of Pediatrics released an updated policy statement and clinical guidelines this month for the first time since 2011.
The AAP wants pediatricians to expand their efforts to screen and treat adolescents for substance abuse. Why? For starters, teen substance abuse has an enormous public health impact — and the AAP believes more effective intervention strategies are needed.
The latest numbers show that by the eighth grade, 28 percent of adolescents have consumed alcohol, 15 percent have smoked cigarettes, and 16.5 percent have used marijuana. Sixty percent of high school seniors don’t see regular marijuana use as harmful, but THC (the active ingredient in the drug that causes addiction) is nearly five times stronger than it was 20 years ago. And nearly half of high school seniors do not think it’s harmful to try crack or cocaine once or twice — while 40 percent believe it’s not harmful to use heroin once or twice.
“Only 10 percent of kids with a substance use disorder ever get any treatment for it,” said Dr. Sharon Levy, director of the Adolescent Substance Abuse Program at Boston Children’s Hospital. Levy is also an associate professor of pediatrics at Harvard Medical School.
Related: Substance Abuse a Risk for ADHD Teens
“There are a number of reasons for that,” Levy said. “One of them is that the ‘right’ level of care — which for most kids is outpatient counseling — doesn’t exist to any great extent in many communities. In the new statement, we expanded the section on referral to care in an effort to help pediatricians think about the different levels of care and how to find good resources in the community.”
The revised statement doesn’t include any additional screenings. It does reinforce a previous recommendation for universal screening as part of routine health care for adolescents.
“We have simplified the clinical algorithm, using newer screening tools, in order to make the process a bit easier. We also are underscoring that the best health advice for teens is abstinence from alcohol and drug use,” she said.
“Use of marijuana is stubbornly high and we are seeing a trend of more frequent use among kids who do use marijuana.”
The good news: The message may finally be working. New data this month shows that the use of alcohol, tobacco and most illicit drugs is declining among teens. This year’s Monitoring the Future (MTF) survey of drug use and attitudes among 8th, 10th, and 12th graders continues to shows a decrease in the use of alcohol, cigarettes, and many illicit drugs over the last five years — many to their lowest levels since this survey’s inception.
“The bad news is that there is always the ‘next new thing,’ which is hard for us to keep on top of,” said Levy. “Use of traditional cigarettes has dropped substantially over the past generation, but use of newer electronic cigarettes continues to climb. Similarly, use of marijuana is stubbornly high and we are seeing a trend of more frequent use among kids who do use marijuana.”
Levy worries we will have a hard time breaking the opioid epidemic if the U.S. cannot slow things down at the source.
Health care providers need to stop treating each substance as an individual entity; instead, “substance use” needs to be treated as a single unit, she said.
“The best health advice for kids is abstinence. We need to deliver that message very clearly — otherwise we will always be playing catch up.”
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Over 50 percent of high school seniors have used or overindulged in alcohol, said Dr. Timothy Huckaby, medical director of the Orlando Recovery Center. A significant number will progress to having alcohol and drug problems, he told LifeZette.
“We absolutely support and applaud an increased emphasis in adolescent screening. We have applied universal screening procedures for every other significant chronic disease process. It has made a huge difference in terms of adolescent diabetes. You catch something early and to begin to monitor it and treat it — that is a move in the right direction.”
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But parents must do their part. Teens who consistently learn about the risks of drugs from their parents are far less likely to use drugs.
Ask tough questions, the experts advise — and seek help if you need it.
“I hope parents understand the importance of their child having a one-on-one conversation with a health professional, and I hope they trust that their child’s physician has good judgment about what information to share and what to keep confidential. I always tell parents of my patients I will tell them anything I think they need to know, and ask them to trust me to advise their child regarding health behaviors,” Levy added.
The policy statement, “Substance Use Screening, Brief Intervention, and Referral to Treatment,” along with the accompanying clinical guidelines, appears in the July 2016 edition of Pediatrics.
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