Despite a government panel's conclusion that there isn't enough evidence about the best way for doctors to persuade children and teens not to use drugs, a leading expert on teen substance abuse says pediatricians should continue to talk to their patients about drug and alcohol use.
"I believe most pediatricians now think addressing substance use is part of good routine health care for adolescents," said Sharon Levy, MD, Director of the Adolescent Substance Abuse Program at Boston Children's Hospital and Chair of the American Academy of Pediatrics (AAP) Committee on Substance Abuse. "Given what we know about the impact of drugs, alcohol and tobacco on health and the developing teen brain, it's hard to believe any pediatrician would say we shouldn't address substance use in adolescent primary care."
In March, the U.S. Preventive Services Task Force, which issues guidelines for doctors, said they did not find enough reliable studies to make a firm recommendation on the effectiveness of "brief interventions."
They reviewed studies on brief counseling sessions during an office visit, which is sometimes combined with computer-based screening. They also looked at studies of computer-based programs that children or teens access at home.
In the Annals of Internal Medicine, the panel concluded, "Studies on these interventions were limited and the findings on whether interventions significantly improved health outcomes were inconsistent."
While the group did not find enough evidence to recommend brief interventions, Dr. Levy said "the task force is not in any way signaling physicians and the public that substance abuse is not an appropriate topic to discuss in medical care."
She noted, "While the evidence for reducing high-risk alcohol use in adults with brief interventions is very good, there have been few studies looking at the same interventions with kids in primary care. The task force didn't say brief interventions aren't effective, we just said we don't have enough evidence to make that judgment yet, and we still have questions that need to be answered. It may be that brief interventions aren't the answer, and we need more intensive interventions.
Even if brief interventions are not found to be effective for teen substance abuse, screening will always be important, she added. "Drug and alcohol use impacts a patient's health in many ways, and a pediatrician needs to know about it, because it can impact treatment or other recommendations. For example, a doctor will think about inattention differently if he or she knows the teen is smoking marijuana several times a day." Drinking can affect a teen's management of chronic medical conditions such as diabetes, and can be dangerous for a young person prescribed a number of medications.
In 2011, the AAP produced a policy statement recommending routine screening for alcohol and other drug use with a validated tool as part of routine health care for adolescents. The AAP also recommends that physicians provide medical advice, a "brief intervention" to decrease use or a referral for specialty treatment based on the screen response.
The AAP reviewed many of the same studies as the U.S. Preventive Services Task Force, and concluded that brief interventions, which are effective at reducing heavy drinking with adults and promising when used with adolescents to come to the emergency department, may be useful in primary care as well, Dr. Levy said. "The AAP points out that discussing alcohol and drug use in primary care is a real opportunity, and it's critical that it's done," she said. "We haven't resolved the best way to do it, but we're using the best information we have available."