Physicians spot significant substance abuse issues

If a physician suspects a teen patient is using drugs or alcohol, the hunch is usually spot on. But when a doctor determines an adolescent is not a substance abuser, that conclusion might not be entirely accurate, says a study in Pediatrics last month.

"When they thought there was a problem, there was really a problem, and when they thought there was no problem, then often there still was a problem," said Celeste Wilson, MD, the study's lead author and instructor in pediatrics at Harvard Medical School in Boston.

Researchers conducted an analysis of data collected while validating the CRAFFT substance abuse screening test, a six-question tool used to uncover drug and alcohol problems among those ages 14 to 18. They found that physicians were better at detecting such problems in boys than in girls and better at identifying drug rather than alcohol use. Clinicians also tended to underestimate the problem's severity. For example, more than half of adolescents eventually diagnosed as having a substance use disorder were initially thought to use drugs and alcohol, but only infrequently.

Based on these findings, the authors advocate the use of structured screening devices -- such as CRAFFT -- for all adolescents, rather just those seen as high-risk. Also, the paper said, almost all physicians who care for children screen for substance use problems. But most rely on clinical impressions. AMA policy supports the screening of injured adolescents for drug and alcohol abuse issues.

Meanwhile, another study, this one in the November Archives of General Psychiatry, suggested that gambling questions also could give doctors insights into teens' possible drug or alcohol problems. Researchers at Yale University School of Medicine in New Haven, Conn., analyzed data from the federal government's 1998 Gambling Impact and Behavior Study, a phone survey done by random-digit dialing. They found that gambling teens were three to four more times likely than their non-gambling peers to report drinking, drug use and depression.

"Gambling may be a predictor of other problems," said Wendy Lynch, PhD, lead author and associate research scientist at Yale. "We definitely need better tools to assess adolescent gambling."