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You are on the front lines of the prevention, screening, and treatment decisions for adolescent substance use disorders. You often must choose whether to disclose information about substance use to parents and other concerned adults.
The risk of developing a substance use disorder increases dramatically the earlier an individual begins using a given substance.1 The neurobiology behind this risk is becoming increasingly clear. Young brains are undergoing crucial developmental processes, including synaptic pruning and myelination. The brain increasingly becomes more efficient in a staggered pattern, with limbic regions preceding frontal and executive regions, so we see adolescents with “more gas than brakes.” This has wisely been identified as developmentally appropriate, and even beneficial, rather than evidence that adolescents are somehow broken.2
Age-appropriate screening for substance use should occur as early as the preteen years and continue throughout adolescence. The most widely studied screening tools include the CRAFFT screening instrument and the Screening, Brief Intervention, and Referral to Treatment (SBIRT) approach.3,4 During formal and informal screening, you should lead with genuine concern for the well-being of the adolescent. Beginning a discussion with open-ended questions about substance use in the school and home is a way to build understanding of an adolescent’s environment prior to asking about personal use. While screening, consider well known risk factors including family history of substance use disorders, poor parental supervision, childhood maltreatment or abuse, low academic achievement, and untreated psychiatric disorders such as ADHD, depression, or anxiety, which may contribute to a higher likelihood or more rapid progression of a substance use disorder. Adolescents are more likely to disclose substance use when screening is done in private, rather than in the presence of a parent.5
Discussing the limits of confidentiality (generally when there is substantial risk of harm to self or others) with an adolescent shows respect and can be an expression of genuine care and concern. Once substance use or other risk-associated behaviors and choices are disclosed, you often may be asked not to share the information with parents. In some instances, privacy cannot be broken without consent. Be aware of your state laws governing parental and adolescent rights related to confidentiality.
You should strongly consider discussing substance use with the concerned adults when there are these red flags: daily use of any substance, any intravenous substance use, a score of 2 or higher on the CRAFFT, prescription medication misuse, or any change in medical status resulting from substance use, such as alcohol-related blackouts.
In most cases, adolescents should be informed of a decision to disclose substance use to their parents. Inviting adolescents to discuss how this will be done, including if the adolescent will be present, and whether you or the adolescent will disclose the use can be an opportunity to discuss their concerns. You should seek to understand if an adolescent has specific fears related to such a disclosure including careful consideration of any history of domestic violence or abuse.
Although adolescents increasingly identify with the opinions and values of their peers, it is a mistake to assume that they therefore do not value the opinions of their parents and the concerned adults in their lives. Parents play an integral role in preventing and treating adolescent substance use disorders. Except in rare instances of severe parent-child relationship problems or abuse, parents can and should be engaged as invaluable participants
Being aware of the legal and ethical obligations in treatment of adolescents presenting with any level of substance use, you can improve outcomes by thoughtfully inviting the participation of parents and other concerned adults into the prevention, screening, and treatment of adolescent substance use disorders.
Dr. Jackson is a child and adolescent psychiatrist at the University of Vermont, Burlington.
References
1. “Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings.” NSDUH Series H-46, HHS Publication No. (SMA) 13-4795. (Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013).
2. “The Amazing Teen Brain,” Jay N. Geidd, Scientific American, May 2016.
3. Pediatrics 2011 Oct. doi: 10.1542/peds.2011-1754.
4. Alcohol Screening and Brief Intervention for Youth: A Practitioner’s Guide.
5. Pediatrics. 2016 Jul 1. doi: 10.1542/peds.2016-1211.
6. J Fam Commun. 2014 Jan 1:14(4):328-51.
7. J Clin Child Adolesc. Psychol. 2008;37(1):236-59.
8. J Child Adolesc Subst Abuse. 2015 May 4;24(3):155-65.
9. Arch Pediatr Adolesc Med. 2012;166(12):1132-9.
You are on the front lines of the prevention, screening, and treatment decisions for adolescent substance use disorders. You often must choose whether to disclose information about substance use to parents and other concerned adults.
The risk of developing a substance use disorder increases dramatically the earlier an individual begins using a given substance.1 The neurobiology behind this risk is becoming increasingly clear. Young brains are undergoing crucial developmental processes, including synaptic pruning and myelination. The brain increasingly becomes more efficient in a staggered pattern, with limbic regions preceding frontal and executive regions, so we see adolescents with “more gas than brakes.” This has wisely been identified as developmentally appropriate, and even beneficial, rather than evidence that adolescents are somehow broken.2
Age-appropriate screening for substance use should occur as early as the preteen years and continue throughout adolescence. The most widely studied screening tools include the CRAFFT screening instrument and the Screening, Brief Intervention, and Referral to Treatment (SBIRT) approach.3,4 During formal and informal screening, you should lead with genuine concern for the well-being of the adolescent. Beginning a discussion with open-ended questions about substance use in the school and home is a way to build understanding of an adolescent’s environment prior to asking about personal use. While screening, consider well known risk factors including family history of substance use disorders, poor parental supervision, childhood maltreatment or abuse, low academic achievement, and untreated psychiatric disorders such as ADHD, depression, or anxiety, which may contribute to a higher likelihood or more rapid progression of a substance use disorder. Adolescents are more likely to disclose substance use when screening is done in private, rather than in the presence of a parent.5
Discussing the limits of confidentiality (generally when there is substantial risk of harm to self or others) with an adolescent shows respect and can be an expression of genuine care and concern. Once substance use or other risk-associated behaviors and choices are disclosed, you often may be asked not to share the information with parents. In some instances, privacy cannot be broken without consent. Be aware of your state laws governing parental and adolescent rights related to confidentiality.
You should strongly consider discussing substance use with the concerned adults when there are these red flags: daily use of any substance, any intravenous substance use, a score of 2 or higher on the CRAFFT, prescription medication misuse, or any change in medical status resulting from substance use, such as alcohol-related blackouts.
In most cases, adolescents should be informed of a decision to disclose substance use to their parents. Inviting adolescents to discuss how this will be done, including if the adolescent will be present, and whether you or the adolescent will disclose the use can be an opportunity to discuss their concerns. You should seek to understand if an adolescent has specific fears related to such a disclosure including careful consideration of any history of domestic violence or abuse.
Although adolescents increasingly identify with the opinions and values of their peers, it is a mistake to assume that they therefore do not value the opinions of their parents and the concerned adults in their lives. Parents play an integral role in preventing and treating adolescent substance use disorders. Except in rare instances of severe parent-child relationship problems or abuse, parents can and should be engaged as invaluable participants
Being aware of the legal and ethical obligations in treatment of adolescents presenting with any level of substance use, you can improve outcomes by thoughtfully inviting the participation of parents and other concerned adults into the prevention, screening, and treatment of adolescent substance use disorders.
Dr. Jackson is a child and adolescent psychiatrist at the University of Vermont, Burlington.
References
1. “Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings.” NSDUH Series H-46, HHS Publication No. (SMA) 13-4795. (Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013).
2. “The Amazing Teen Brain,” Jay N. Geidd, Scientific American, May 2016.
3. Pediatrics 2011 Oct. doi: 10.1542/peds.2011-1754.
4. Alcohol Screening and Brief Intervention for Youth: A Practitioner’s Guide.
5. Pediatrics. 2016 Jul 1. doi: 10.1542/peds.2016-1211.
6. J Fam Commun. 2014 Jan 1:14(4):328-51.
7. J Clin Child Adolesc. Psychol. 2008;37(1):236-59.
8. J Child Adolesc Subst Abuse. 2015 May 4;24(3):155-65.
9. Arch Pediatr Adolesc Med. 2012;166(12):1132-9.
You are on the front lines of the prevention, screening, and treatment decisions for adolescent substance use disorders. You often must choose whether to disclose information about substance use to parents and other concerned adults.
The risk of developing a substance use disorder increases dramatically the earlier an individual begins using a given substance.1 The neurobiology behind this risk is becoming increasingly clear. Young brains are undergoing crucial developmental processes, including synaptic pruning and myelination. The brain increasingly becomes more efficient in a staggered pattern, with limbic regions preceding frontal and executive regions, so we see adolescents with “more gas than brakes.” This has wisely been identified as developmentally appropriate, and even beneficial, rather than evidence that adolescents are somehow broken.2
Age-appropriate screening for substance use should occur as early as the preteen years and continue throughout adolescence. The most widely studied screening tools include the CRAFFT screening instrument and the Screening, Brief Intervention, and Referral to Treatment (SBIRT) approach.3,4 During formal and informal screening, you should lead with genuine concern for the well-being of the adolescent. Beginning a discussion with open-ended questions about substance use in the school and home is a way to build understanding of an adolescent’s environment prior to asking about personal use. While screening, consider well known risk factors including family history of substance use disorders, poor parental supervision, childhood maltreatment or abuse, low academic achievement, and untreated psychiatric disorders such as ADHD, depression, or anxiety, which may contribute to a higher likelihood or more rapid progression of a substance use disorder. Adolescents are more likely to disclose substance use when screening is done in private, rather than in the presence of a parent.5
Discussing the limits of confidentiality (generally when there is substantial risk of harm to self or others) with an adolescent shows respect and can be an expression of genuine care and concern. Once substance use or other risk-associated behaviors and choices are disclosed, you often may be asked not to share the information with parents. In some instances, privacy cannot be broken without consent. Be aware of your state laws governing parental and adolescent rights related to confidentiality.
You should strongly consider discussing substance use with the concerned adults when there are these red flags: daily use of any substance, any intravenous substance use, a score of 2 or higher on the CRAFFT, prescription medication misuse, or any change in medical status resulting from substance use, such as alcohol-related blackouts.
In most cases, adolescents should be informed of a decision to disclose substance use to their parents. Inviting adolescents to discuss how this will be done, including if the adolescent will be present, and whether you or the adolescent will disclose the use can be an opportunity to discuss their concerns. You should seek to understand if an adolescent has specific fears related to such a disclosure including careful consideration of any history of domestic violence or abuse.
Although adolescents increasingly identify with the opinions and values of their peers, it is a mistake to assume that they therefore do not value the opinions of their parents and the concerned adults in their lives. Parents play an integral role in preventing and treating adolescent substance use disorders. Except in rare instances of severe parent-child relationship problems or abuse, parents can and should be engaged as invaluable participants
Being aware of the legal and ethical obligations in treatment of adolescents presenting with any level of substance use, you can improve outcomes by thoughtfully inviting the participation of parents and other concerned adults into the prevention, screening, and treatment of adolescent substance use disorders.
Dr. Jackson is a child and adolescent psychiatrist at the University of Vermont, Burlington.
References
1. “Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings.” NSDUH Series H-46, HHS Publication No. (SMA) 13-4795. (Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013).
2. “The Amazing Teen Brain,” Jay N. Geidd, Scientific American, May 2016.
3. Pediatrics 2011 Oct. doi: 10.1542/peds.2011-1754.
4. Alcohol Screening and Brief Intervention for Youth: A Practitioner’s Guide.
5. Pediatrics. 2016 Jul 1. doi: 10.1542/peds.2016-1211.
6. J Fam Commun. 2014 Jan 1:14(4):328-51.
7. J Clin Child Adolesc. Psychol. 2008;37(1):236-59.
8. J Child Adolesc Subst Abuse. 2015 May 4;24(3):155-65.
9. Arch Pediatr Adolesc Med. 2012;166(12):1132-9.