CENTER CITY, Minn., Dec. 12, 2019 /PRNewswire/ -- Growth charts, hormones, risky behaviors … pediatricians have a lot to cover in the 20 minutes they spend with their patients, and yet a simple conversation can help thwart a wayward youthful trajectory. The most recent Emerging Drug Trends report from the Hazelden Betty Ford Foundation distinguishes pediatricians as the central figures in early detection and prevention of substance use in adolescents and suggests that too many children with problems go undetected because of a lack of routine, formal screenings.
The report—produced by Hazelden Betty Ford in collaboration with the University of Maryland School of Public Health—highlights the range of roles that pediatricians can play to help prevent substance use and related problems. In addition to screening their patients for risk factors, the report says, pediatricians can encourage youth who have not initiated substance use not to start; conduct brief interventions with youth who have initiated substance use; and facilitate access to treatment for youth who may meet criteria for a substance use disorder.
The unique access and influence that pediatricians have on health behaviors throughout the early stages of life make them an essential point of intervention for adolescent substance use, the report concludes.
"The opioid crisis has ravaged our country with tragedy in its wake," said Joseph Lee, M.D., medical director of the Hazelden Betty Ford Foundation Youth Continuum. "Yet, 10 or 20 years from now, there may be another epidemic involving other chemicals, coupled with more heartache, loss, and anguish. Even as we struggle now to overcome this epidemic, we must not forget that there are generations of youth incubating right now in our school systems and we are not doing nearly enough to prevent the same mistakes that have so dearly cost us in the present. Without aggressive and strategic investment in our youth, we are bound to suffer again."
The American Academy of Pediatrics has issued specific recommendations for pediatricians to routinely screen for alcohol and other forms of drug use among adolescent patients, conduct brief interventions, and refer to more intensive treatment when needed. Unfortunately, new research shows this prevention strategy has not been fully embraced nor widely implemented by providers.
"Standing at the front line of where the neurodevelopmental disease of addiction starts, pediatricians are in the unique position of being able to practice primary prevention of a disease that begins in adolescence," said Stephen Delisi, M.D., medical director of Hazelden Publishing's Professional Education Services. "Our focus needs to be on prevention at the societal level, targeting young people who have not yet fully expressed the disease of addiction, but who are at greater risk of doing so."
The U.S. Preventive Services Task Force—an influential group of health experts—has recommended that doctors screen all adults for illicit drug use but has stopped short of making a similar or related recommendation for children and adolescents—despite the fact that addiction most typically begins in the teenage years. The task force has cited insufficient evidence to support the time and cost of such screenings.
Hazelden Betty Ford's new Emerging Drug Trends report—part of a series providing front-line treatment and research perspectives on America's No. 1 public health problem, addiction—reviews the evidence and posits a different conclusion. The report looks in detail at the following:
Research showing that substance use screening, intervention and referral-to-treatment strategies are not being implemented routinely in "well-child" visits, acute illness visits or any other pediatric settings, despite the American Academy of Pediatrics' recommendations;
The need for more training and education due to barriers frequently cited by physicians, such as time constraints and insufficient knowledge and skills; and
Areas where more research is needed to further establish the importance of having early dialogues to delay or prevent initiation of substance use.
"Addiction is a developmental disorder, with risk factors that can be detected years before substance use," said Dr. Lee. "Due to stigma, so much of our dialogue about addiction is about drugs. We fret about which drugs and what drug and how to rank drugs. We anthropomorphize drugs as if they have personalities or moral qualities. In this tragic satire, we have lost our focus on people. People develop addiction but addiction is not about drugs; it's about people. If we are brave enough to invest in people, especially our youth, we can transform our approach to addiction forever."
Starting conversations about substance use at a young age helps normalize the topic and sets the stage for better patient-physician dialogue throughout the lifetime, said Alaina Steck, M.D., assistant professor of emergency medicine at the Emory University School of Medicine in Atlanta.
"If substance use is addressed regularly and non-judgmentally, this topic becomes less stigmatized, and discussions regarding use come to be an expected part of the health maintenance conversation, like seatbelt use and safer sex practices," Dr. Steck said. "Hopefully with time and repetition, adolescents and young adults may become more able to discuss and seek treatment for themselves and for others when problematic substance use arises, rather than living in shame with a disorder that not even their doctors would address."
The full report, with additional expert commentary, is available here.
About the Hazelden Betty Ford Foundation The Hazelden Betty Ford Foundation is a force of healing and hope for individuals, families and communities affected by addiction to alcohol and other drugs. As the nation's leading nonprofit provider of comprehensive inpatient and outpatient treatment for adults and youth, the Foundation has 17 locations nationwide and collaborates with an expansive network throughout health care. With a legacy that began in 1949 and includes the 1982 founding of the Betty Ford Center, the Foundation today also encompasses a graduate school of addiction studies, a publishing division, an addiction research center, recovery advocacy and thought leadership, professional and medical education programs, school-based prevention resources and a specialized program for children who grow up in families with addiction. Learn more at www.HazeldenBettyFord.org and on Twitter @hazldnbettyford.