The Essential Role of Health Care Providers
One of the most important trends in health care today is to focus on serious chronic disorders with prevention, early intervention, intensive treatment and long-term monitoring. Substance use disorders are among the most serious chronic diseases that start in adolescence. The fact that 90% of all adults with substance use disorders began smoking, drinking or using drugs before age 18 highlights a vital opportunity for health care providers to actively engage in youth drug prevention through substance use education, identification of early substance use and effective intervention among their young patients.
There are clear health standards that health care providers strongly endorse and talk about easily with their young patients — from using seat belts and wearing bicycle helmets to exercising regularly and avoiding sugary drinks. And yet, for many health care providers, talking with young patients about substance use and the adverse health consequences for the developing brain is difficult.
What Can Health Care Providers Do?
Health care providers are in a unique position to articulate the One Choice prevention goal of no use of any alcohol, nicotine, marijuana or other drugs under age 21 for health.
- Educate patients and their families about the goal of no use for teens and the positive trends in the percentage of youth who are making One Choice.
- Treat pain cautiously and review safe prescribing practices; consider alternative treatments to opioids where appropriate. Understand that adolescents often are initially exposed to opioids through prescriptions: dentist prescriptions account for 31 percent of adolescents’ first exposure to opioids.
- Conduct universal substance use screening of young patients using a validated risk assessment tool. Help patients with substance use disorders get the treatment they need. Engage colleagues in this essential effort to prevent substance use disorders which are chronic diseases that are rooted in adolescence.
““Screening adolescents for drug use is extremely important for early intervention and prevention of the development of substance use disorder. This is critical especially as the transition from adolescence to adulthood, when brain development is still in progress, appears to be a period of high risk for drug use initiation.” ”
Educate Young Patients and Their Families
Health care providers may be surprised to know that most teens are not actively using substances. This message should be shared both with young patients and their parents. Over three decades, more and more American teens have made the choice not to use any substances. Over one third of high school seniors have never used any alcohol, marijuana, cigarettes or other drugs and nearly two thirds have never used any substances in the past month.
Monitoring the Future — Levy, et al., 2018
The National Council for Mental Wellbeing, in collaboration with the Centers for Disease Control and Prevention (CDC), created the Getting Candid message guide and other tools to support youth-serving providers and other adults in their efforts to prevent youth substance use.
““[O]ne of the processes of engaging an individual into changing their use behaviors is to help them understand how infrequent substance abuse is in that age group because most individuals – teenagers – who are using substances are of the opinion that everybody in their class is using drugs and that is really not the case.”
Data from the nationally representative Monitoring the Future study show generally low rates of past month substance use by high school seniors. Marijuana use is the exception to the recent declines seen in use rates of alcohol, cigarettes and other illicit drugs.
Screen Young Patients for Substance Use Disorders
Dr. Geetha Subramaniam of the National Institute on Drug Abuse (NIDA) discusses screening adolescents for substance use and describes the Brief Screener for Tobacco, Alcohol and other Drugs (BSTAD) and Screening to Brief Intervention (S2BI), available on the NIDAMED website.
“[P]ediatric primary care providers have a great opportunity to do this [universal screening] because parents bring their adolescents or preteens into the clinic because they need the physicals before they have sports activities coming up or sometimes even before they send them off to college.”
The American Academy of Pediatrics (AAP) offers guidance on screening for substance use, brief intervention and referral to treatment using a validated risk assessment tool. In both its clinical report and policy statement the AAP identifies the health goal for young patients as no use.
“[I]t is important that this experimentation not be condoned, facilitated, or trivialized by adults. Even the first use of a psychoactive substance may result in tragic consequences, such as injury, victimization, or even fatality. Adolescence extends from approximately 12 years of age into the early 20s and is a time of intensive neurodevelopmental molding and maturation that confers greater neurodevelopmental vulnerability at a time during which risk-taking behaviors are generally more prevalent.”
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References
#1
National Center on Addiction and Substance Abuse at Columbia University. (2011). Adolescent Substance Use: America’s #1 Public Health Problem. New York, NY: Author.
#2
Levy, S. J., & Kokotailo, P. K. (2011). Substance use screening, brief intervention, and referral to treatment for pediatricians. Pediatrics, 128(5), e1330-1340. doi: 10.1542/peds.2011-1754
#3
Levy, S. L., Williams, J. F., & Committee on Substance Use and Prevention. (2016). Substance use screening, brief intervention, and referral to treatment. Pediatrics, 138(1).
#4
Levy, S., Campbell, M. C., Shea, C. L., & DuPont, R. L. (2020). Trends in substance nonuse by high school seniors: 1975–2018. Pediatrics, e2020007187. Doi: 10.1542/peds.2020-007187; Levy, S., Campbell, M. C., Shea, C. L., & DuPont, R. L. (2018). Trends in abstaining from substance use in adolescents: 1975-2014. Pediatrics, 142(2), e20173498.
#5
Johnston, L. D., Miech, R. A., O’Malley, P. M., Bachman, J. G., Schulenberg, J. E., & Patrick, M. E. (2019). Monitoring the Future national survey results on drug use 1975-2018: Overview, key findings on adolescent drug use. Ann Arbor: Institute for Social Research, University of Michigan.