Volume 35, Issue 16, Pages 1-4 (15 August 2005)
Counsel Teens on Drugs and Alcohol
MARY ELLEN SCHNEIDER (Senior Writer)
Family physicians in New York are trying to do a better job of counseling teens on the dangers of drugs
and alcohol.
The New York State Academy of Family Physicians has partnered with the Center for Substance Abuse
Prevention, part of the federal Substance Abuse and Mental Health Services Administration, to get
educational materials on drugs and alcohol into physician offices.
There are plenty of helpful materials available, but they aren't in physician offices, said Norman Wetterau,
M.D., a family physician and an addiction specialist in Dansville, N.Y., who has spearheaded the effort.
As part of a pilot project, which will begin sometime this year, the Center for Substance Abuse Prevention
will mail out a sample of educational materials and information on how to use them to family physicians in
New York.
The idea is to capitalize on “teachable moments,” said Center for Substance Abuse Prevention Director
Beverly Watts Davis.
The short, educational materials will be aimed at teens and parents who can read them while in the
waiting room. And it gives family physicians the opportunity to start a conversation with their patients by
discussing the materials in the exam room. “People will actually listen to their doctor,” Ms. Davis said.
Although this is a pilot project to raise awareness of the materials and get them into use in physician
offices, any physician can order materials from the Center for Substance Abuse Prevention.
The New York State Academy of Family Physicians hopes to be able to offer continuing medical
education credit to physicians who give out the materials and discuss them with their adolescent patients.
If the program is a success, it could be expanded nationally.
Dr. Wetterau already uses this type of literature to start a discussion with his adolescent patients. For
example, he will hand out material on drugs and ask the patient to read it over and tell him what they think
of it at the next visit. It's a nonthreatening way to open up a dialogue on these issues, he said.
And it's critical that physicians cover topics such as drug and alcohol use even with adolescents who
appear to be at low risk, Dr. Wetterau said. When physicians don't ask these questions, he said, they are
saying that they don't care. “That conveys a powerful message that this is not a part of medicine,” he said.
Michael O. Fleming, M.D., board chair of the American Academy of Family Physicians, agrees.
Physicians have a responsibility to screen all their adolescent patients for drug and alcohol abuse since
some may not be savvy enough to figure out which patients might be a high risk, Dr. Fleming said.
The first step is to develop a rapport with the patient, even if it's just during the once-yearly physical, Dr.
Fleming said. From there, physicians should try to be nonjudgmental when giving out information.
The most important thing is to broach the subject early, said J. Edward Hill, M.D., a family physician and
president of the American Medical Association. “You don't get many contacts with teenagers medically,”
Dr. Hill said. He recommended taking advantage of the sports physicals that many physicians do for
teens to bring up drugs and alcohol.
Joan Flender, M.D., a pediatrician in Dansville, N.Y., and head of the department of pediatrics at Noyes
Memorial Hospital in Dansville, asks her patients to fill out the American Medical Association's Guidelines
for Adolescent Preventive Services questionnaire each year. Then she follows up in the exam room.
With teens, Dr. Flender will ask the parents to leave the room and then she'll ask the patients if there are
any answers on the survey they'd like to change. Assuring patients that everything they say is confidential
is key with teens, she said.
Dr. Flender also tries to be practical. For example, she doesn't advise her patients to just say no to
alcohol. Instead, she tries to get them to wait at least until they graduate from high school before they
start drinking. While it's not ideal, 18- and 19-year-olds still make much better decisions than do 13- and
14-year-olds, she said.
There isn't a single correct way to talk to teens about drugs and alcohol, said Alain Joffe, M.D., director of
the student health center at Johns Hopkins University in Baltimore and chair of the American Academy of
Pediatrics' Committee on Substance Abuse.
But he recommended a short questionnaire that can help flag patients who are likely to be abusing drugs
and alcohol. The CRAFFT questionnaire asks adolescents six questions ranging from “Do you ever forget
things you did while using alcohol or drugs?” to “Do you ever use alcohol/drugs while you are by yourself,
alone?” The CRAFFT questionnaire is available online at www.crafft.org.
Another useful approach is to ask about family history, Dr. Joffe said. Many teens who have drinking or
alcohol problems also have a family history.
Physicians can order materials from the Substance Abuse and Mental Health Services Administration by
calling 1-800-729-6686 or atwww.health.org.