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Pediatricians often underestimate substance abuse problems in adolescents

Adolescents who have problems with substance use often aren't identified during routine pediatric visits, according to a study to be released in the November issue of Pediatrics, the peer-reviewed, scientific journal of the American Academy of Pediatrics (AAP).

"We found that most pediatricians significantly underestimate the severity of adolescent substance use," said the study's primary author, Dr. Celeste R. Wilson, an investigator with the Center for Adolescent Substance Abuse Research (CeASAR) at Children's Hospital Boston. "Since many pediatricians do not use a structured screening tool, but rely solely on clinical impressions, these findings are of great concern."

The study, funded by The Robert Wood Johnson Foundation, involved more than 500 14- to 18-year-old patients arriving for routine health care at Children's Adolescent/Young Adult Medical Clinic and more than 100 of their medical care providers. The providers completed a form giving their clinical impressions about the adolescent's level of substance use (none, minimal, problem use, abuse, dependence). After the visit, the adolescents underwent structured diagnostic interviews, and their level of substance use was formally classified.

Wilson's analysis found that more than 60 percent of the time, pediatricians knew that adolescents had used alcohol or other drugs, but in most cases the doctors thought the problem was less severe than it actually was. The pediatricians accurately identified substance-related problems less than 15 percent of the time. A clinical assessment of "abuse" was accurately identified only 10 percent of the time and "dependence" was missed in all 36 diagnosed cases. Providers correctly recognized 75 percent of adolescents with substance abuse or dependence as being users, but in half these cases, the providers characterized the level of use as minimal.

These data underscore the relevance of the American Medical Association's guidelines, which r
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Contact: Susan Craig
susan.craig@childrens.harvard.edu
617-355-6420
Children's Hospital Boston
1-Nov-2004


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