[acb-hsp] Should Teens Be Screened for Drug Use?

[peter altschul]

Should Teens be Screened for Drug Use?
  Mary Elizabeth Williams, Salon November 7, 2011
  This just in: Teenagers experiment with sex, alcohol and drugs.  
But for the first time, the American Academy of Pediatrics now 
boldly recommends that adolescents be routinely screened for 
illicit-substance use and HIV.  The policy statements suggest 
doctors test kids 16 and up for HIV in communities where more 
than 0.1 percent of the population has the virus -- regardless of 
whether the patient admits to being sexually active.  It also 
states that doctors should ask teens about drug, alcohol and 
nicotine use at every visit.  But while a routine HIV test is a 
fairly straightforward, judgment-free process, frank conversation 
is another one altogether.  Are parents and pediatricians ready 
to get frank with teenagers about their recreational activities?
  As Dr.  Sharon Levy, co-author of the statement on "Substance 
Use Screening, Brief Intervention, and Referral to Treatment for 
Pediatricians," told Reuters, "the recommendation to screen 
adolescents as part of general healthcare is not new." But what 
is new is the way the guidelines acknowledge the unique effects 
of drugs and alcohol on developing brains, and especially 
increased risks of addiction among the young.  They also provide 
a specific protocol for questioning teen patients, from praising 
and encouraging kids who say they don't indulge, all the way to 
"consider[ing] breaking confidentiality to ask parents to monitor 
and insure a follow-through" for those who appear in "acute 
danger." The guidelines suggest offering the patient a contract 
promising to "not drink alcohol, use drugs or take anyone else's 
medication" for a specified amount of time -- and hammering home 
the high risks associated with getting in a car with anyone under 
the influence.
  I have two rapidly growing children who happen to have 
substance abuse galore on both sides of the family tree.  (You're 
welcome, kids!) As a parent, I want them to be encouraged as much 
as humanly possible to make decisions that are in their best 
interests.  I want them to have other adults they can confide in 
and trust.  And I flip myself right out remembering the AAP's 
admonition that "Use of alcohol and other drugs remains a leading 
cause of morbidity and mortality for young people in the United 
States."
  But as a former teenager, I know that boundary pushing and 
experimentation are part of life.  Even the most goody-goody 
honor student rarely makes it to 21 without dabbling.  It's 
fortunate that the AAP acknowledges a wide spectrum of behaviors 
and appropriate professional responses -- and still strongly 
recommends against involuntary drug testing.  We're not in reefer 
madness territory anymore.
  Nevertheless, the adults in our children's lives need more than 
a handy algorithm when dealing with these complicated questions.  
They need training and people skills.  The idea of a doctor 
saying, as the AAP recommends, "Alcoholstdrugs kill brain cells 
and make you do stupid things you will regret" sounds like a 
recipe for a massive adolescent eye rolling.  I wonder what 
happens in those families where a sip of wine at dinner is a 
cultural rite of passage, or why the AAP has no recommendations 
for talking to kids about the distinction between responsible 
adult alcohol consumption and the use of controlled, prescription 
meds for pain management.
  Last week, my 11-year-old watched a drug awareness movie in 
school.  It was filmed in the '80's and was about a "pot party." 
She thought it was hilarious.  I'd like to believe that she got a 
little something about how to respond in that inevitable moment 
when someone offers her something illicit, but I don't know for 
sure.  I can only hope that as my children grow, their doctors 
will speak to them with concern, yes, but also sensitivity, 
intuition and empathy.  That they won't be lame about it.  And 
that when they're engaging them in conversations about drugs and 
alcohol, they're looking at my kids and not a script.
  Mary Elizabeth Williams is a staff writer for Salon and the 
author of "Gimme Shelter: My Three Years Searching for the 
American Dream."
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