Setting the Stage for Screening
For many of your patients, you will be the first one to ask them about substance use.
This may come as a shock to them and cause some initial or ongoing discomfort for them. There are steps that you can minimize the discomfort and maximize the trust between you so that the answers you get are more open and honest.
The discussion involving alcohol and drug use should be held in a private setting and without parents present. Having reading material regarding substance use and abuse on display and at the ready for distribution may be helpful in augmenting or reinforcing your message.
The adolescent patient should be reassured that your discussion is private. Let the patient know that, unless you have concerns about serious health risks or problems, you will not reveal the details of your conversation to parents or family members without the patient’s permission.
Assessing risk factors for substance use or abuse
Inquiring about individual risk factors for adolescent substance use and abuse can help frame your brief intervention after screening takes place. This information may be helpful in determining what preventive or treatment strategies you employ.
Ask questions about self-esteem, family relationships, academic performance and sports and other organized or leisure activities. It is also helpful to learn about other health risk behaviors such as tobacco use or risky sexual activity.
Bringing up the topic of substance use
One of the most important aspects of beginning and continuing a discussion about substance use is the tone that you use. By introducing the topic in a non-judgmental way, you may be able to diffuse some of the emotional charge that can commonly accompany these discussions. Opening up with some statements such as “I know that some kids your age use alcohol, or smoke, or
use other drugs.” You can follow this with offering a reason for discussing their habits, letting them know that you are concerned with their overall health and those things that can affect it.
Assessing problem severity
Of course, the purpose of the screening tool is to efficiently and accurately identify those patients who require more intervention. So the next step after you screen involves a conversation to help you gauge the severity of the problem. Specific follow-up questions can help get you more information to target your intervention appropriately. Ask about:
- Drinking frequency – “Do you drink regularly? About how often?”
- Drinking quantity – “How much did you drink the last time you got drunk? How much to do usually drink?”
- Drug use frequency – “About how often do you use drugs?
- Setting of alcohol or drug use – “Where do you drink/take drugs? Parties only? With friends in cars? Home? School? By yourself at home? At school?”
- Dependence – “Do your social activities usually involve alcohol/drugs? What would happen if you couldn’t have any alcohol/drugs?”
- Social consequences – “What kinds of trouble have you gotten into because of alcohol/drugs? Do your parents suspect that you drink or take drugs?”
Now that you have successfully opened the discussion and completed brief screening and assessment, you are ready to give your patient some feedback. In the next module, we will discuss strategies for brief interventions that are targeted toward prevention and treatment. Even if all you do is reinforce good behavior, your words can make a difference.