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AAP updates substance abuse screening, intervention recommendations

Committee on Substance Abuse. Pediatrics. 2011;doi:10.1542/peds.2011-1754.

Pediatricians should be aware of all facets of substance abuse patterns in adolescents, the American Academy of Pediatrics said in a recent policy statement.

The Committee on Substance Abuse highlighted the strategy of substance use, brief intervention and referral to treatment (SBIRT) as the cornerstone to containing substance abuse issues in adolescent populations. The committee said adolescents are at the highest risk for experiencing substance use-related acute and chronic health consequences.

Pediatricians should be knowledgeable about all aspects of SBIRT, according to the committee. Training programs and continuing medical education are the best way to stay acquainted with best practices.

The spectrum of substance abuse patterns — particularly for nicotine, alcohol and other drug use — should be familiar to all pediatricians.

Confidentiality is encouraged, as is screening all adolescent patients for tobacco, alcohol and other drug use. The CRAFFT tool is the preferred method for substance abuse screening.

Communication is also encouraged, and pediatricians should develop relationships with patients, parents and qualified substance abuse professionals. Familiarity with levels of substance abuse and treatment options available is key to making appropriate referrals, according to the committee, which also said mental health issues often accompany substance abuse in adolescents.

Pediatricians are obliged to be familiar with coding regulations for substance abuse interventions and are encouraged to advocate for coverage of these interventions.

The statement contains details on levels of risk and how to identify them and the corresponding intervention approaches. Adolescents with low risk of abuse should be praised and encouraged, whereas those at high risk should be referred to treatment.

Selection of a treatment program should be based on the level of risk. Interventions ranging from group and family therapy to residential treatment and therapeutic boarding school may be available. Adolescents with a dual diagnosis of psychiatric disorders should be treated accordingly.

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