The physician should screen parents for substance use and abuse and refer those who screen positive to an adult treatment program. Family therapy is crucial, and the provision of family support and strength building is well within the realm of family practice.
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Peer groups play a vital role in promoting abstinence as well as abuse. Unsupervised adolescents are likely to seek out peers of similar backgrounds. While undergoing treatment, patients will be involved in new peer groups that are committed at least superficially to sobriety and that can support one another in remaining abstinent. The physician can encourage participation in activities such as sports, after-school clubs, and volunteerism to maximize positive peer interactions and healthy lifestyles and minimize antisocial connections.
Early puberty in white adolescent boys increases substance use risk
The physician should be knowledgeable about community programs for children whose parents have substance use disorders. Programs such as Alateen can often be of help to children and adolescents Table 2. Although the family physician may treat adolescents with substance use disorders in the office setting, it is often necessary and prudent to refer them to outside professionals.
Referral depends on the severity of abuse, comorbid psychiatric diagnoses, family and social issues, whether the youth has been involved in the juvenile justice system, motivation, and support, as well as the availability of treatments in the community. Substance Use Disorders. It is imperative that the physician identify a network of competent and trustworthy treatment professionals, including child and adolescent psychiatrists, psychologists, and social workers, who specialize in adolescent addiction, as well as outpatient and inpatient substance detoxification and rehabilitation programs.
This may involve advocating with managed care organizations to get sufficiently intensive and continuing treatment for the patient. There will be many opportunities to follow up with the adolescent referred to outside treatment. For example, when the adolescent presents with an acute medical problem, the physician can ask how substance abuse treatment is progressing.
If the adolescent has discontinued treatment as is often the case , the physician may be able to intervene. It is the physician's responsibility to validate the adolescent's concerns while encouraging compliance. Comorbid Disorders. Because anxiety, depression, and disruptive behavior disorders are common comorbid diagnoses with substance abuse, it can be helpful to determine when the symptoms first occurred.
This may involve a review of school records and reports from other treatment professionals.
Abstinence from substance use for at least one month can help determine whether the substance use disorder or the psychiatric diagnosis is primary. However, this could delay the decision to initiate psychotropic medications, which is unacceptable in adolescents with depression, bipolar disorder, or psychosis, or when there are concerns of lethality.
Therefore, referral to a child and adolescent psychiatrist should be concurrent with ongoing substance abuse treatment in adolescents with comorbidities. If psychiatric consultation is not readily available, the family physician should collaborate closely with therapists, such as child psychologists or social workers, to stabilize the psychiatric condition, and the physician should take responsibility for medication management Table 4 Although abstinence from substance use should precede the use of psychotropic medication, there is a risk that untreated psychiatric illness will impede treatment initiation, precipitate early dropout, or interfere with achievement of abstinence.
Establish mechanisms to closely monitor medication compliance, adverse effects, target symptom response e. Monitor patient treatment motivation, behavior changes, and psychosocial functioning. Provide information about potential interactions between medications and substance of abuse. Use medication with good safety profiles, low abuse potential, and once-a-day dosing. Information from reference When psychiatric stability is achieved, the physician and mental health collaborators should develop a plan for monitoring substance use and for regular exchange of information.
Ongoing lethality assessment is of great importance throughout substance abuse treatment for adolescents. The physician should ask about suicidal ideation, intention, or planning. Adolescents who are intoxicated are at high risk of successful suicide and of hurting others through accidents or violence. The family physician should ask about the accessibility of guns or other weapons and recommend to parents that these be removed from the adolescent's possession.
If the physician determines that harm is imminent, the adolescent should be hospitalized. Already a member or subscriber? Log in. General Hospital. JOAN B. She earned a master's degree and doctorate in anthropology from the University of California, Berkeley. Reprints are not available from the authors. The authors thank Angela Henke for her assistance in the preparation of the manuscript. Contemporary addiction treatment: a review of systems problems for adults and adolescents.
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Adolescent Substance Use and Abuse: Recognition and Management - American Family Physician
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Alcohol screening in young persons attending a sexually transmitted disease clinic.