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​The Critical Role Any Pediatrician Can Play in Preventing Adolescent Substance Abuse

Sharon Levy, MD, FAAP
April 4, 2017

As a pediatrician practicing in an adolescent substance use disorders program, the patients I see already are dealing with the unhealthy effects of drugs and alcohol on their lives.

There's the teen who had smoked marijuana daily for two years before I met him. His mother recognized falling grades and personality changes but only began to suspect drug use when she stumbled upon a backpack full of marijuana, paraphernalia and cash.

​Another patient of mine, a sophomore, had been binge drinking and blacking out most weekends since she began high school. She was devastated to be kicked off the varsity soccer team when she was caught drinking right after a game.

Successfully treating substance use disorders is possible, and I work hard to help my patients achieve abstinence. But the best outcome, as with many other health conditions, occurs when they are prevented or at least caught early.

"By the end of high school, nearly three-quarters of students have tried alcohol and nearly half have used marijuana​."

Substance use is arguably the most important health risk behavior of adolescence.  By the end of high school, nearly three-quarters of students have tried alcohol and nearly half have used marijuana.  For many kids, substance use continues to rise through adolescence into early adulthood.  Telltale signs and common problems may already be developing by high school, though teens rarely bring these up unprompted.

​Pediatricians are in a perfect position to help families navigate these high-risk years and influence their patients' choices about substance use.  While teenagers may receive considerable information about substance use, talking with their pediatrician is likely their only opportunity to learn from a professional with whom they have a trusting, lasting relationship.  Research shows teenagers feel pediatricians are knowledgeable about substance use, and they're open to having conversations about it when confidentiality is ensured.  Properly executed pediatric practices regarding substance use, including these discussions, can help prevent and reduce substance use.

Recognizing the impact pediatricians can have on such a significant problem, the American Academy of Pediatrics (AAP) is among organizations that call for identifying and addressing substance use as a standard part of adolescent health care.  The AAP recommends providers use a clinical framework called "Screening, Brief Intervention, and Referral to Treatment" (SBIRT), which includes universal screening with a validated tool, followed by tailored and targeted interventions. These include anticipatory guidance for non-users, cessation messages for those with sporadic use, brief interventions focused on behavior change for those with more regular use and referral to treatment for those with heavy use.

"Research shows teenagers feel pediatricians are knowledgeable about substance use, and they're open to having conversations about it when confidentiality is ensured.."

National surveys reveal challenges to incorporating SBIRT in pediatric practices--concerns about adequate time, staff, knowledge of community resources among them, as well as managing confidentiality, patient flow and billing. To address potential barriers, the AAP and partner organizations  offer a plethora of clinical reports, guides, policy statements and other resources to help pediatricians implement and practice SBIRT with confidence and success.  The Substance Use Screening and Intervention Implementation Guide is a great starting point, offering salient information about each component of SBIRT and the importance of addressing adolescent substance use.  The guide is compatible with other AAP materials, including the Screening, Brief Intervention and Referral to Treatment Clinical Report, which reviews literature-informed best practices and includes case vignettes that demonstrate clinically challenging conversations. 

Especially during Alcohol Awareness Month, I encourage pediatricians to use these resources to embrace the pivotal role we can have in preventing, identifying and treating adolescent substance use. A routine pediatrician visit might have helped the patients I see avoid the point where drugs and alcohol began to affect their health and lives.​

The views expressed in this article are those of the authors, and not necessarily those of the American Academy of Pediatrics. ​​​

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​​​Ab​out the ​​Author


Sharon Levy, MD, MPH, FAAP, co-author of the AAP clinical report, "Substance Use Screening, Brief Intervention, and Referral to Treatment," is past chair of the academy's Committee on Substance Use and Prevention. A board-certified developmental-behavioral pediatrician, Dr. Levy also serves as an associate professor of pediatrics at Harvard Medical School, director of the Adolescent Substance Abuse Program at Boston Children's Hospital, president-elect of the Association for Medical Education and Research in Substance Abuse.​


​Additional Information

Substance Abuse (