Docs Miss Teen Substance Abuse

Pediatricians may be overlooking cases of teen substance abuse by relying on their intuition rather than on standard screening tools.

In a new study, researchers found that most of the time pediatricians significantly underestimate the severity of teen substance abuse problems.

Researchers say that although pediatricians were generally aware when teenagers are using drugs or alcohol, they seldom identified cases of teen substance abuse.

"Our study suggests that providers' clinical impressions of adolescents' substance use are not always accurate," says researcher Celeste Wilson, MD, of the Center for Adolescent Substance Abuse Research at Children's Hospital Boston, in a news release.

"We found most pediatricians significantly underestimate the severity of adolescent substance abuse," says Wilson. "Since many pediatricians do not use a structured screening tool, but rely solely on clinical impressions, these findings are of great concern."

Teen Substance Abuse Underestimated

In the study, which appears in the November issue of Pediatrics, researchers compared the results of pediatrician evaluations of more than 500 adolescents aged 14-18 and structured interviews designed to diagnose their level of drug or alcohol use.

Pediatricians evaluated the teens and completed a form with their impressions of the teens' level of substance use (none, minimal, problem use, abuse, and dependence). After the pediatrician visit, the teenagers were formally interviewed about their substance use.

The results showed that pediatricians correctly identified teenagers as having used drugs or alcohol 75 percent of the time, but teen substance abuse was caught only 10 percent of the time, and all 36 diagnosed cases of dependence were missed.

In half of the cases in which pediatricians correctly recognized that the teen was using drugs or alcohol, the doctors characterized the use as minimal.

The study also showed that pediatricians were better able to spot drug use than alcohol use among boys, and they were better at detecting drug use among boys than in girls.

Researchers say several factors may explain the findings. For example, pediatricians may not have directly asked the teens about substance use, or the teens may have not felt comfortable discussing it with them.

But they say that the results suggest that pediatricians should use a structured questionnaire to routinely screen for teen substance abuse.

SOURCES: Wilson, C. Pediatrics, November 2004; vol 114: pp e536-e540. News release, Children's Hospital Boston.

By Jennifer Warner
Reviewed by Michael W. Smith, MD
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