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.

Health care providers would never condone young patients “experimenting” with not using seat belts. Such an experiment would end predictably in both cases: many people would be fine but others would suffer terrible consequences. Why should health care providers treat “experimenting” with substance use any differently? It is not in the interest of health for young patients to use any substances during this critical period of brain development.

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.

What can health care providers do?

  • 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.
  • 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.

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 15 years, more and more Australian teens have made the choice not to use any substances.

aussie 4 line graph 9_15_19.png
“[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.
— Dr. Geetha Subramaniam Deputy Director, US NIDA Center for Clinical Trails Network

Data from the Australian Secondary Students’ Alcohol and Drug survey show decreasing lifetime use of all drugs since 2002 other than ecstasy (now higher in 2017 than in 2002) and an uptick in cannabis use (2017 rate is lower than in 2002).

  • 34% of Australian teens had never used alcohol in 2017 as compared to 12% in 2002 which is roughly three times as many.

  • 83% of teens had never used cigarettes in 2017 as compared to 53% in 2002 which is also a remarkable improvement.

  • 83% of teens had never used cannabis in 2017 as compared to 75% in 2002. Non-use of cannabis peaked in 2008 at 86%, when the Australian Tough on Drugs prevention program had only recently ceased, and has declined slightly since, showing the importance of good and relevant information to help teens make One Choice.

  • 93% of teens had never used other illicit drugs in 2017, up from 87% in 1999.


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.
— Dr. Geetha Subramaniam Deputy Director, US NIDA Center for Clinical Trails Network

The US 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.

 
AAP SBIRT Clinical Report, 2016  — Goals for Brief Intervention (BI)

AAP SBIRT Clinical Report, 2016 — Goals for Brief Intervention (BI)

 
[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.
— AAP Clinical Report on SBIRT, 2016

Help Young Patients with Substance Use Problems Get the Help They Need

When young patients have a substance use disorder, it is likely they will need treatment, long-term recovery support and monitoring.


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. (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.

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