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History Of Drug Abuse

CHARLESTON, S.C. -- Teen drug abuse should be diagnosed based on a history because "drug screens, by themselves, are not very valuable," Dr. Janice D. Key said at a pediatric meeting sponsored by the Medical University of South Carolina.

Drug screens don't detect regular alcohol use--the first-line drug of abuse among teens--and they detect marijuana use only if chronic. The best way to assess adolescent drug use is with CRAFFT, a brief, psychosocial screen for drug abuse behaviors, said Dr. Key, director of the division of adolescent medicine at the university.

* C: Car. Have you ever ridden in a car driven by someone (including yourself) who was high or had used alcohol or drugs?

* R: Relax. Do you ever use alcohol or drugs to relax, feel better about yourself, or fit in?

* A: Alone. Do you ever use alcohol or drugs when you are by yourself?

* F: Forget. Do you ever forget things you did while using alcohol or drugs?

* F: Friends. Do your family or friends ever tell you that you should cut down on your drinking or drug use?

* T: Trouble. Have you ever gotten in trouble while using alcohol or drugs?

One positive answer is significant. Two positives flag a substance abuse problem.

Once a teen with a substance abuse problem has been identified, the next step is to assess the stage of abuse, she noted. This sequence allows physicians to identify teens who can be counseled in the office, and those who need referral to a substance abuse trreatment specialist.

* Stage 1: Potential for abuse. Adolescents in this stage have decreased impulse control, a need for immediate gratification, an availability of drugs, and a need for peer acceptance.

* Stage 2: Learning the euphoria. This occurs in about 90% of teens during high school. It involves the use of a drug with friends, on weekends, with little behavior change or consequence. These kids need counseling, not a referral.

* Stage 3: Regular use, seeking euphoria. This is the first stage of abuse. It involves use of multiple drugs, increased frequency of use and use alone, buying or stealing drugs or alcohol, and behavior changes that lead to consequences.

* Stage 4: Daily use. The teen is preoccupied with being high, with daily use, loss of control, multiple consequences and risk taking, and estrangement from family and straight friends.

* Stage 5: Burnout. This involves use of drugs to feel normal (dependence), physical and mental deterioration, more risk taking, self-destructive or suicidal behavior, guilt, withdrawal, depression, shame, remorse, and use of multiple substances.

Contracts are a good device for office-based counseling. If an adolescent admits to occasional, weekend use of drugs with friends, discuss the dangers of driving after drug or alcohol use or being in a car driven by a drug user. Have the teen sign a contract about avoiding these situations, and remember to discuss adherence to the contract at the next visit, Dr. Key advised.

About 10% of U.S. teens have a substance abuse problem, most commonly involving alcohol, marijuana, or tobacco. Almost all teens use alcohol at least occasionally and thus many patients are candidates for such contracts.

Risk-taking can start as early as age 12, so start talking with children about substance abuse and other risky behaviors when they reach age 11. This can be hard for doctors who have seen a child grow up. "At 11, we still see them as little, but start your confidential interviews then," she advised. "Every parent appreciates it."

COPYRIGHT 2001 International Medical News Group
COPYRIGHT 2001 Gale Group