Adolescent Substance Use and Misuse: Recognition and Management

 

Am Fam Physician. 2019 Jun 1;99(11):689-696.

Author disclosure: No relevant financial affiliations.

Adolescent use of illicit substances imposes an enormous burden on individuals, families, and communities. The types of illicit substances adolescents are using have changed drastically over the past decade with decreases in alcohol use (including binge alcohol use) offset by increases in electronic cigarette, marijuana, and opioid use. Primary care physicians have the opportunity to identify adolescents who use illicit substances. The U.S. Preventive Services Task Force and the American Academy of Family Physicians found insufficient evidence to assess the balance of benefits and harms of primary care–based behavioral interventions to prevent or reduce illicit substance use or nonmedical pharmaceutical use in children or adolescents. The American Academy of Pediatrics recommends that clinicians become familiar with Screening, Brief Intervention, and Referral to Treatment initiatives. Validated screening tools that may be used in primary care include the CRAFFT, POSIT, AUDIT, and NIAAA Screening Guide. During the clinical visit, a split-visit model encourages parents to participate in the visit for a limited time but also allows adolescents to have confidential conversations with physicians. Evidence-based treatment modalities range from school- and parent-based interventions to medication-assisted treatment. Brief interventions using components of motivational interviewing may be suitable for addressing substance use, even among adolescents not seeking treatment. Prevention efforts can supplement cessation programs to maximize program effectiveness.

Adolescent use of illicit substances imposes an enormous burden on individuals, families, and communities. Substance use has correlations with violence, including adolescent homicides1 and relationship victimization.2 Adolescence (typically encompassing youth 10 to 19 years of age)3 is a time of development, including ongoing maturing of the brain; therefore, it is essential to consider the pathophysiology of substance use.4,5 Adolescent brains are more vulnerable to the temptation to use substances and to the effects of these substances because reward pathways develop before prefrontal cognition.5 Sustained substance use can affect neuropsychological functioning, resulting in attention deficits, memory problems, and decreased cognitive flexibility.5

WHAT IS NEW ON THIS TOPIC

Adolescent Substance Use and Misuse

In 2017, e-cigarettes were the most commonly used nicotine-delivery product among high school students.

Approximately 27% of adolescents 13 to 18 years of age who drink alcohol mix it with energy drinks. These adolescents are at increased risk for using tobacco and marijuana and for nonmedical use of prescription stimulants.

Seventeen percent of adolescents have taken prescription drugs without a doctor's prescription.

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

The American Academy of Pediatrics recommends that physicians become knowledgeable about the Screening, Brief Intervention, and Referral to Treatment (SBIRT) guidelines.

C

35

The U.S. Preventive Services Task Force and the American Academy of Family Physicians conclude that the current evidence is insufficient to assess the balance of benefits and harms of primary care–based behavioral interventions to prevent or reduce illicit substance or nonmedical pharmaceutical use in children and adolescents.

C

48, 49

Primary care treatment for adolescent substance use should be coordinated with treatment from other mental health experts.

C

50

Brief interventions using components of motivational interviewing may reduce illicit substance use among adolescents.

C

41, 53


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

The American Academy of Pediatrics recommends that physicians become knowledgeable about the Screening, Brief Intervention, and Referral to Treatment (SBIRT) guidelines.

C

35

The U.S. Preventive Services Task Force and the American Academy of Family Physicians conclude that the current evidence is insufficient to assess the balance of benefits and harms of primary care–based behavioral interventions to prevent or reduce illicit substance or nonmedical pharmaceutical use in children and adolescents.

C

48, 49

Primary care treatment for adolescent substance use should be coordinated with treatment from other mental health experts.

C

50

Brief interventions using components of motivational interviewing may reduce illicit substance use among adolescents.

C

41, 53


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality

The Authors

show all author info

JESSICA A. KULAK, PhD, MPH, is an assistant professor in the Department of Health, Nutrition, and Dietetics at Buffalo (NY) State College. At the time this article was written, she was a postdoctorate fellow at the Primary Care Research Institute in the Department of Family Medicine, State University of New York at Buffalo....

KIM S. GRISWOLD, MD, MPH, is a professor at the Primary Care Research Institute in the Department of Family Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo.

Address correspondence to Jessica A. Kulak, PhD, MPH, 205 Houston Gym, 1300 Elmwood Ave., Buffalo, NY 14222 (e-mail: jakulak@buffalo.edu). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

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