Key questions for detecting substance abuse

With the high injury rate and high mortality associated with substance abuse in teenagers, John R. Knight, MD, of Harvard Medical School, Cambridge, Mass., told an audience of pediatricians attending the AAP's Annual Conference that screening for substance abuse should be a part of every practice. He recommended a screening tool he has been working on at Harvard's Center for Substance Abuse Research.

That tool is called the CRAFFT questionnaire, the acronym representing the key words in the six questions used in the screen. CRAFFT is sensitive enough, said Knight, for physicians to be able to tell with 80% certainty that a teen has a substance abuse problem if he or she answers "Yes" to two of six questions. Those questions include, for example: "Have you ever ridden in a car driven by someone (including yourself) who was 'high' or had been using alcohol or drugs?" and "Do you ever use alcohol or drugs to relax, feel better about yourself or fit in?"

That first question about driving in a car is first for a reason, Knight indicated. The experience is the one that is most likely of all substance abuse problems to kill a child very quickly, even though no addiction may be involved. He also warns pediatricians they must be prepared for the fact that when a teenager has had that experience, the driver may have been the child's parent.

A positive result from the screening tool, Knight noted, should be considered preliminary to further assessment and, possibly, counseling and treatment.

Rogers in particular urged pediatricians not to think that they will be able to "just tell" if a patient has a substance abuse problem. Research has shown physicians to be poor at spotting such problems on their own.

Knight also told the audience that one of that most heart-breaking moments he hears about is when a young person tells him that his or her pediatrician used the occasion of their substance abuse becoming evident to "fire" them from the practice, usually, gently suggesting that it was time for the teenager to move to a physician who treats adults. Knight urged the audience not to reject the young person at that point.