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News:
Physicians Under Diagnose Substance Abuse
Experts agree that adolescent substance abuse is a major public health concern, and the statistics supporting this claim are alarming. Fifty-one percent of high school students have tried an “illicit drug”1 with more than 25 percent of adolescents having used an illicit substance other than marijuana by the end of 12th grade.2 Adding to this issue is a recent study which discovered that pediatricians routinely under-diagnose the substance abuse of adolescents, overlooking serious problems.
The November 5, 2004 edition of PEDIATRICS, the official journal of the American Academy of Pediatrics (AAP), featured a study entitled, “Are Clinical Impressions of Adolescent Substance Abuse Accurate?”3 Participants in this study were 14 -18 years old and were given the Adolescent Diagnostic Interview (ADI), a 30 to 90 minute structured interview that provides alcohol and drug-related diagnoses according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Answering according to their past year of alcohol and drug use, the adolescents were classified into five categories:
- “None” – no reported use of alcohol or drugs.
- “Minimal Use” – use of drugs or alcohol but no report of any substance-related problems.
- “Problem Use” – reporting one or more substance-related problems but no diagnosis of abuse or dependence.
- “Abuse” – meeting any one of the four DSM-IV diagnostic criteria for either alcohol or drug abuse but no diagnosis of dependence.
- “Dependence” – meeting any three of seven diagnostic criteria for either alcohol or drug dependence, with or without a diagnosis of abuse.
Medical care providers (MCP) were given a questionnaire to evaluate the adolescents in a clinical setting, examining their alcohol and drug use based on these five categories. The results of these questionnaires were compared to the previously conducted ADI results. The comparison showed that MCP significantly underestimated the occurrence of substance-related problems, substance abuse, and substance dependence.
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| None
| Minimal
| Problem
| Abuse
| Dependence
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| MCP impressions |
314 (58.9) |
191 (35.8) |
18 (3.3) |
10 (1.9) |
0 |
| ADI diagnoses |
268 (50.3) |
78 (14.6) |
101 (18.9) |
50 (9.4) |
36 (6.8) |
The researchers conducting this study suggested that the use of more structured screening devices would improve identification of adolescents with substance-related problems in their primary care setting. These structured screening devices should be used for all adolescents, and not simply for those who present as being high-risk.
We encourage parents, school staff and community health and safety professionals to ask pediatricians to include routine screening for substance abuse for all adolescent patients. Failure to recognize a substance abuse issue may result in tragedy.
To read the study in its entirety, go to http://pediatrics.aappublications.org/.
¹ SAMHSA (Substance Abuse and Mental Health Services Administration). Overview of Findings from the 2002 National Survey on Drug Use and Health. Rockville, MD: Office of Applied Studies; 2003 (NHSDA Series H-21, DHHS Publication SMA 03-3774).
² Johnston LD, O’Malley PM, Bachman JG. Ecstasy use falls for second year in a row, overall teen drug use drops. Ann Arbor, MI: University of Michigan News and Information Services. Available at www.monitoringthefuture.org. Accessed January 12, 2004.
³ Wilson CR, Sherritt L, Gates E, Knight JR. Are clinical impressions of adolescent substance abuse accurate?
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