Pubdate: Sat, 08 Dec 2007 Source: Naples Daily News (FL) Copyright: 2007 Naples Daily News. Contact: http://www.naplesnews.com/ Details: http://www.mapinc.org/media/284 Author: Liz Freeman LOCAL DOCTORS SUPPORT INCREASED DRUG, ALCOHOL SCREENING FOR TEENS Detecting drug and alcohol abuse among teenagers may get a boost if family doctors and pediatricians use screening methods when teens come in for any medical attention, not just during routine checkups. A study by Children's Hospital in Boston found that positive screenings for drug and alcohol abuse among teens went up when doctors engaged in screening during sick visits and any other occasion. The study involved 2,133 teens aged 12 to 18 with a 93 percent participation rate at primary-care settings in the Northeast. Nearly 15 percent of teens screened positive at a primary-care setting when assessed with a six-question screening tool, called CRAFFT, but the rates fluctuated based on the purpose of the visit. About 23 percent of teens screened positive when they were at the doctor for a "sick visit" vs. 11 percent who screened positively during a routine checkup. "Screening should occur whenever there's an opportunity, not just during well-child visits," said Dr. John Knight, the lead author and director of the Center for Adolescent Substance Abuse Research at the hospital, in the study results. The study was published in November's Archives of Pediatrics and Adolescent Medicine. Local pediatricians and substance abuse treatment officials agree with the recommendation but point out that doctors face time constraints, coupled with numerous other screenings that they may want to administer. "Screening teens during sick visits has some merit, the big question is the whole issue of time. And you can certainly make the case for screening teens for other issues, such as depression and suicide," said Dr. Todd Vedder, a pediatrician with Anchor Health Centers at its 1008 Goodlette-Frank Road location. "It boils down to what issues are important, what pediatricians think is most important to them." Dr. Jerry Williamson, chief medical officer of Collier Health Services, is familiar with the study findings and the message that sick visits by teens to the doctor yield a higher positive screening for drug and alcohol abuse. The concept of sick visit screenings could be extended to other issues, such as making sure kids are fully immunized, he said. "The implications of the study is that screening should take place during any visit," he said. "The study was very good but the rubber meets the road in how to do it in terms of the time available (to the doctor). In most sick visits, the doctor has 10 or 15 minutes and so there's very limited time to get a screening done." The drug and alcohol screening technique used in the study, CRAFFT, involves six questions and is not diagnostic, he said. A positive screening will require having the teen return for a subsequent complete assessment, he said. In addition, it's crucial that the teen consents to the screening and knowingly wants to participate, he said. That's in accordance with practice guidelines from the American Academy of Pediatrics that screening must be voluntary. That policy guideline was in place in 1996 and reaffirmed in 2006, he said. Because it is voluntary, teenagers do tend to be honest when answering the questions; otherwise they wouldn't consent to it, he said. The American Medical Association's support of voluntary drug and alcohol screening of teens at any doctor's visit may be followed by the pediatrics academy support, he said. "I suspect that is the direction they are going," he said. The study's result is music to the ears of Christine Holmes, director of substance abuse services at the David Lawrence Center on Golden Gate Parkway, which has inpatient and outpatient substance abuse treatment programs. David Lawrence rarely gets referrals from physicians about teenagers needing treatment, but she said preventive screening techniques are brief and very effective. David Lawrence assessed 600 kids in 2006 and 60 percent had drug or alcohol issues. "Studies have shown, like this one, that just providing the opportunity alone would be a tremendous advantage," she said, referring to teens opening up and talking. "It gives them the opportunity to get help if they want help." She fully supports the idea of doctors doing screening during sick visits and recognizes their time constraints. There is a perception, though, that an assessment has to be "all or nothing," she said. For instance, a four-question screening technique she's familiar with takes about one minute. "Sometimes in the area of prevention, doing a little is sometimes enough," she said. "It's complicated, but it doesn't have to be all or nothing." - --- MAP posted-by: Derek