Thursday, September 7, 2017

Physicians Can Help Stop Teen Drug and Alcohol Abuse

By James Baker, MD
Austin Psychiatrist
Member, TMA Council on Science and Public Health

It takes a community to prevent adolescent substance abuse, and physicians can play an important part in that community effort.

While parents are the most important role models for their children, as physicians, our goal should be to help delay the age when teens first use alcohol or drugs. In addition to all of the problems related to underage drinking — sexual assaults, accidents, poor school performance — research suggests that teens who start drinking early are much more likely to have an alcohol use disorder as adults.

How can physicians help?

Prevention requires a community focus on the many risk factors that often lead to early drinking and drug use. Physicians can be mindful of these factors when they see teens in their practice. Here are some things physicians can look for and, when present, encourage teens and their parents to get help for:

  • Family history of drug or alcohol use,
  • Family problems or disruptions,
  • Low motivation at school,
  • Behavior problems at school, and
  • Friendships with other teens with problem behaviors.

When these issues are present, doctors can encourage interventions to address them. For example, poor school performance warrants an evaluation for undiagnosed learning disorders. Family issues warrant an evaluation to see if family therapy is recommended. Motivation issues and behavior problems might indicate an underlying mood or other emerging psychiatric disorder. The local community mental health center is a good resource for all of these problems.

In addition, physicians can adopt the practice of routinely screening for alcohol and drug abuse in their young patients. Screening for depression, anxiety, stress disorders, and substance use ought to be just as routine as taking vital signs. One possible screening tool is CRAFFT. CRAFFT is just six questions shown to be effective in assessing whether a referral is indicated for a longer evaluation of alcohol or drug use. CRAFFT stands for:

Car (Have you been in a car with a driver — including yourself — on drugs or alcohol?),
Relax (Do you use drugs/alcohol to relax?),
Alone (Do you use drugs/alcohol while alone?),
Forget (Do you forget things while on drugs/alcohol?),
Friends (Are your friends concerned about your drugs/alcohol use?), and
Trouble (Have you gotten into trouble while on drugs/alcohol?).

Finally, because they are community leaders, physicians can encourage the entire community — parents, teachers, coaches, and religious and civic leaders — to give children the same messages discouraging alcohol and drug abuse, starting very early in childhood.

We can help teens — and their families — avoid long-lasting consequences of alcohol and drug use through a collective and consistent message, universal screening, and early and aggressive intervention.

Dr. Baker is associate chair of Clinical Integration and Services in the Department of Psychiatry at Dell Medical School and systems chief medical officer at Austin Travis County Integral Care.

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