Severe alcohol and drug abuse by teenagers may be easily missed during routine and urgent-care medical visits, particularly in girls.
In a study published in the November issue of Pediatrics, researchers highlighted not only how often clinicians fail to notice the chronic problem in routine examinations, but also how seldom they seem to ask teens structured questions to determine how frequently they take drugs or alcohol.
In 2002, examinations of 500 urban adolescents, ages 14 to 18, at Children's Hospital Boston failed to detect use or recurrent abuse in about 40 percent of the more than 100 teens who were later determined to have serious problems. In the 60 percent of cases in which clinicians correctly identified some use of alcohol or other drugs, they vastly underestimated the severity: Only 10 percent of recurrent "abusers" were correctly identified while "dependence" was missed in all 36 cases later diagnosed.
Yet, when the teenagers were asked specific questions about drug-and-alcohol related behavior after their exams, they were likely to talk about their use of alcohol or drugs.
The authors of the study recommended that medical staff routinely ask teenagers six questions:
- Have you ever ridden in a car driven by you or someone else who was using alcohol or drugs?
- Do you ever use alcohol or drugs to relax, feel better about yourself, or fit in?
- Do you ever use alcohol or drugs while you are alone?
- Do you ever forget things you did while using drugs or alcohol?
- Do your family or friends ever advise you to cut down on your drinking or drug use?
- Have you gotten into trouble while you were using alcohol or drugs?
Funded by the Robert Wood Johnson Foundation, the study involved more than 100 medical staff who completed a form giving their impressions about each teen's degree of use.
Of the more than 100 teens who were later identified to have "problem use," the providers correctly identified just 18. Of the 86 most serious abusers, providers underestimated their problem, categorizing the teens as having no use (24 percent); minimal use (50 percent); problem use (15 percent); abuse (10.5 percent) and dependence (0 percent).
The problems were more likely to be identified in boys, perhaps because boys are more likely to abuse substances than girls and so clinicians may be more likely to suspect them to be substance abusers, while inaccurately giving the girls the benefit of the doubt.
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