FROM PEDIATRICS

While the overall American Academy of Pediatrics policy objectives on screening for pediatric substance use have not changed, the academy is highlighting streamlined screening tools in a new clinical report.

The AAP remains focused on pushing for abstinence. That being said, the organization recommends “that pediatricians screen kids for substance use and talk about substance use,” lead author Dr. Sharon Levy said in an interview. “The big picture, bottom line, [is that] nothing has changed. It’s just an opportunity to reemphasize that we think talking about substance use is an important part of pediatric care.”

What has changed are the tools highlighted in the clinical report, published online June 20 (Pediatrics. 2016 Jul. doi: 10.1542/peds.2016-1211).

“We simplified the algorithm quite a bit,” said Dr. Levy, director of the adolescent substance abuse program at Boston Children’s Hospital. “We demonstrated use of more screening tools that are a bit simpler to use, a bit shorter, and lead more directly to intervention. For people who are using the older tools, that’s fine if that’s really been established in their practice and [they] are doing a good job with [those tools].”

However, Dr. Levy noted that many of the established screening tools were not being used, or were being shortened or modified in others ways to render them less effective.

“We recommend … new tools that we call frequency-based screening tools,” she explained. Pediatric patients are given a risk level based on their answer to a question regarding how many times in the past year they’ve used alcohol, marijuana, or tobacco.

Slightly different interventions are recommended based on the child’s risk level, including counseling about substance use and some strategies, especially with kids with heavier use, for conducting the conversation in a way that will make kids more likely to consider behavior change, she said.

The clinical report suggests that when no substance use is disclosed, doctors should offer positive reinforcement about smart decision making. For patients disclosing one or two uses per year with a low likelihood of having a substance use disorder, doctors should be promoting abstaining from use to support a healthy lifestyle, as well as discussions on the negative health effects of substance use. As the response to frequency of use increases and the greater likelihood of substance abuse disorder grows, so does the level of questions, including understanding the types of substances being used, coupled with more counseling on quitting use, and, in severe cases, referring for treatment.

The common theme in all the advice given to patients, though, is the importance of abstinence from substance use.

“The American Academy of Pediatrics recommends abstinence as the best health recommendation for adolescents,” Dr. Levy said. “That sometimes gets lost in the shuffle. That really is something that stands out in the policy, and that substance use is such an important health risk behavior that it should be addressed as part of routine health care for adolescents.”

The authors disclosed no relevant financial conflicts.

gtwachtman@frontlinemedcom.com

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