Drug use among teens is a common problem.
In the latest drug use survey of high school students:
- 72% stated that they had ever drank alcohol
- 42% had drank alcohol in the previous month
- 24% were binge drinkers, having 5 or more drinks in a row at least once in the past month
- 37% had ever smoked marijuana and 20% smoked marijuana in the past month
- 20% had taken prescription drugs without a prescription
- 11% had used inhalants
- 6% had used cocaine, 4% had used methamphetamines, and over 2% had used heroin
These high rates of alcohol and drug use makes universal screening important. In fact, the American Academy of Pediatrics recommends that all teenagers be screened for tobacco, alcohol, and other drug use at all well child checkups.
It is important to understand that when we talk about universal screening for alcohol and drug use, we are not actually talking about universal drug testing, in which all kids actually have a drug test.
Universal drug screening simply helps you figure out who is at risk for drug abuse by asking them -- but not with an actual blood or urine test.
Many pediatricians use the quick and easy two-part CRAFFT Screening Tool from the Center for Adolescent Substance Abuse Research (CeASAR) at Children's Hospital Boston to screen teens for high-risk drug and alcohol use. It starts by asking three questions about whether a teen drinks alcohol, smokes marijuana, or uses anything else to get high.
If the teen answers yes to any of those questions, they are then asked six other CRAFFT questions, a mnemonic using the keywords in the questions:
- C - Have you ever ridden in a CAR driven by someone (including yourself) who was "high" or had been using alcohol or drugs?
- R - Do you ever use alcohol or drugs to RELAX, feel better about yourself, or fit in?
- A - Do you ever use alcohol/drugs while you are by yourself, ALONE?
- F - Do you ever FORGET things you did while using alcohol or drugs?
- F - Do your family or FRIENDS ever tell you that you should cut down on your drinking or drug use?
- T - Have you gotten into TROUBLE while you were using alcohol or drugs?
One point is given for each yes response to the CRAFFT questions. Those teens with a total score of two or more are thought to have a positive screen, and according to the AAP, "are at high risk of having a substance use disorder." Even a CRAFFT score of one could indicate a moderate risk of having substance use problems, though, and might indicate the need for intervention.
Also keep in mind that even those teens who deny using any drugs or alcohol should still be asked the CRAFFT 'Car' question.
In addition to being able to provide brief advice to encourage teens to stop drinking alcohol or using other drugs, and referring them to treatment when necessary, universal screening also allows pediatricians to provide teens who report no drug or alcohol use with "brief positive feedback about their ability to make healthy choices."
Many parents quickly look to drug testing when they become worried about their kids using drugs. It is important to keep in mind that drug testing teens is much more complicated than simply buying a home drug test, getting your teen drug tested at school, or even taking your teen to his pediatrician for a drug test.
Things to consider include that:
- the AAP is against involuntary drug testing of teens
- a drug test may be negative even if a teen is using drugs if the test was done more than two to three days after the last time drugs were used (window of detection)
- standard drug tests often don't include frequently abused drugs, such as alcohol, ecstasy, and inhalants
- drug tests can be defeated by teens if the urine sample is overly diluted, substituted with someone else's sample, or if the sample is adulterated, especially if the teen isn't directly observed giving the urine sample
- drug testing can be seen as an unwarranted invasion of privacy and could create "an environment of resentment, distrust, and suspicion" among teens and their parents
Also, drug tests can sometimes be hard to interpret, especially when faced with a possible false-positive test -- a drug test that is positive because of an over-the-counter medication or food, such as poppy seeds.
The AAP does state that drug testing can be done as a diagnostic test for teens in drug abuse treatment. Voluntary drug testing may also be used, according to the AAP, "when it is necessary to determine the cause of dysfunctional behavior and other changes in mental status or suspicious physical behavior."
However, instead of a drug test, teens suspected of drug abuse, but who deny drug and alcohol use on drug screening, should likely be referred to a "qualified health care professional for evaluation, counseling, and treatment as needed." Remember, a negative drug test isn't necessarily going to mean that your teen isn't using drugs or alcohol, and a positive drug test will likely prompt a referral anyway.
In addition to home drug tests and school-based drug testing, which the AAP are against, drug tests that can be done when appropriate include drug abuse panels that can test for five to 10 drugs, including:
- Amphetamines (amphetamine and methamphetamine)
- Benzodiazepines (Valium and Xanax)
- Cocaine metabolites
- Marijuana metabolites (at 20, 50, or 100 ng/mL screens)
- Opiates (morphine, codeine, hydrocodone)
Ethyl alcohol can usually be added to most drug abuse panels, too.
Remember to consider the pros and cons before doing a drug test on your teen.
American Academy of Pediatrics Policy Statement. Substance Use Screening, Brief Intervention, and Referral to Treatment for Pediatricians. Pediatrics 2011; 128:5 e1330-e1340.
American Academy of Pediatrics Policy Statement. Alcohol Use by Youth and Adolescents: A Pediatric Concern. Pediatrics 2010 125: 1078-1087.
American Academy of Pediatrics Policy Statement. Testing for Drugs of Abuse in Children and Adolescents: Addendum - Testing in Schools and at Home. Pediatrics Vol. 119 No. 3 March 2007, pp. 627-630.
American Academy of Pediatrics Clinical Report. Tobacco, Alcohol, and Other Drugs: The Role of the Pediatrician in Prevention, Identification, and Management of Substance Abuse. Pediatrics 2005 115: 816-821.
CDC. Youth Risk Behavior Surveillance - United States, 2009. MMWR. Vol. 59. No. SS-5. June 4, 2010.