Substance
Abuse Prevention and
Management
Epidemiology:
Alcohol,
tobacco, and marijuana are the most commonly abused
substances by adolescents according to the Youth Risk Behavior
Surveillance
System (YRBSS) from the CDC and the Monitoring the Future Survery (MTF)
from
the University of Michigan
·
25% of high
school and college students reported lifetime
cigarette use (at least one cigarette per day for 30 days) (YRBSS)
·
80% of
students have consumed alcohol by the end of high
school, 52% by the end of 8th grade (MTF)
·
47% of
students reported using marijuana in their lifetime,
11.3% before age 13 (YRBSS)
Risk factors
for substance abuse:
·
Behavioral
disorders
·
Psychiatric
illness
·
Genetic
predisposition
·
Chaotic
family or community environment
·
Substance use
by family members
Prevention:
·
The American
Academy of Pediatrics
has strongly advocated the need for health care professionals to
participate in
the promotion substance abuse prevention among children and adolescents.
·
Start early
o
At early
school age visits, pediatricians should discuss
with parents the importance of parental modeling and the role of
exposure to
substances in the media, and encourage parents to initiate
conversations about
substances early
·
Promote open
communication about substances between child,
parents, and physician
o
Help parents
promote factors associated with decreased drug
use such as open communication with parents, involvement with
extracurricular
activities, family involvement in religious/social groups, academic
success,
and self-esteem
o
Starting in
late childhood/early adolescent visits,
pediatricians should have direct and confidential conversations with
children
about substances, and the negative effects and consequences of their use
·
Referral to
community prevention programs
o
DARE
o
Life Skills
Training
o
Project ALERT
o
Project STARR
Screening for
Substance Use
·
Past medical
and psychiatric history, family history of
substance use
·
HEADSSS(Home,
Education, Activities, Drugs, Safety,
Sexuality, Suicide)
·
Guidelines
for Adolescent Preventative Services (GAPS)
questionnaire
Evaluation of
Substance Use
·
Identify
substances, frequency of use, and duration of use
·
Identify
substance related dysfunction: poor school
performance, personality/mood changes, depression, isolation from
family and
friends, changes in sleep or eating habits, engagement in other risky
behaviors
·
Drug
screening outside of emergent situations has limited
use due to issues of consent and confidentiality
Management of
Substance Abuse
|
Stages of
Adolescent Substance Abuse* |
|
Stage 1:
Potential for abuse ·
No personal
experimentation with substances but high risk for future risk due to
availability of substances, and behavioral characteristics such as
decreased impulse control |
|
Stage 2:
Experimentation: learning the euphoria ·
Use of
inhalants, alcohol, tobacco, or marijuana with few consequences and
little to no behavior changes |
|
Stage 3:
Regular use: seeking the euphoria ·
Increased
frequency of use, solitary use, behavioral changes, and some
consequences from substances use. Use of
other substances such as stimulants, LSD, sedatives |
|
Stage 4:
Regular use: preoccupation with the “high” ·
Daily use of
substances with loss of control, multiple consequences and risk-taking
behaviors, isolation from family and sober friends |
|
Stage 5:
Burnout: use of drugs to feel normal ·
Use of
multiple substances with physical and mental deterioration, guilt,
depression, self-destructive behavior, |
*Adapted from
Comerci
·
Early stages
of substance abuse (stage 1 and 2) can be
managed in the outpatient setting through parent and patient education
and
counseling
·
When adverse
consequences are associated with substance use
(injury, decline in school performance, legal problems), physician
counseling
should be augmented with by interventions such as self-help groups,
patient and
family therapy
·
If an
adolescent meets criteria for Stage 3-5 substance
abuse or the DSM IV criteria for substance abuse or substance
dependence,
adolescents should be referred to a treatment program (intensive
outpatient or
inpatient treatment)
Resources:
Comerci, GD.
Recognizing the 5 stages of substance abuse. Contemp
Pediatr. 1985;2:57-68
Barangan CJ,
Alderman EM. Management
of Substance Abuse. Pediatrics in Review.
2002;23(2):123-131