Public Release: 

Teen alcohol and drug disorders more common than previously thought

Accurate new screening tool helps physicians successfully identify adolescents at risk

Boston Children's Hospital

BOSTON, June 11, 2002 - A high proportion of 14-to-18-year-olds have diagnosable disorders related to the use of alcohol or drugs, according to a study to be released this week in the June issue of the Archives of Pediatric Adolescent Medicine (APAM).

"The high prevalence of alcohol and drug disorders in the patients we studied is of great concern. More than half of the teens coming to us for routine health care had used alcohol or drugs during the past year, and more than one in four (26.8 percent) had experienced one or more serious problems associated with their use. Of greatest concern, almost one in six (16.2 percent) had a diagnosis of either substance abuse or substance dependence, according to criteria established by the American Psychiatric Association." said the primary author of the study, John R. Knight, M.D., director of the Center for Adolescent Substance Abuse Research at Children's Hospital Boston and associate director for Medical Education at the Harvard Medical School Division on Addictions. "Dependence, or addiction, is an especially serious disease with potential for lifelong implications. Almost 7 percent of these teens were diagnosed with dependence," said Knight.

The research was funded by several national sources, including the Robert Wood Johnson Foundation, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and the Substance Abuse and Mental Health Services Administration (SAMHSA).

The study also demonstrated the effectiveness of a new screening tool, developed by Knight and his colleagues for use by physicians to identify at-risk teens, called the CRAFFT test. CRAFFT stands for the key words in the six-questions that make up the questionnaire:

  • 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?

Answering "yes" to two or more questions is highly predictive of an alcohol or drug-related disorder. "The beauty of this questionnaire it can be easily added to any office visit as part of the patient's routine physical," said Knight.

This brief screening test, which takes five minutes to administer, is expected to greatly increase the number of providers who screen for substance abuse. If a problem is identified, the health care provider should determine the best next step, be it further discussion in the office or referral to substance abuse specialists," said Knight. At Children's Hospital, patients are referred to the Adolescent Substance Abuse Program (ASAP) for a full diagnostic work-up, including behavioral and developmental assessments, so that the appropriate level of treatment can be recommended.

According to Knight, despite agreement in the medical community that physicians are in an ideal position to identify problems - more so than parents - many health care providers do not routinely ask their patients about alcohol and drug use and those who do so may not know the right questions to ask.

Although the questions appear simple, Knight cautioned parents that the tool is not designed for their use at home. "It's tempting for parents to think that this is a simple questionnaire that can put the issue to rest in their minds. In reality, many will gain a false sense of security when their teens answer 'no' to the questions," he said. "Teens are good at telling their parents what they think they want to hear. We believe and our research shows support for the idea that teens are far more likely to tell the truth to their medical providers than their parents."

Edward A. Jacobs, M.D., chairperson of the American Academy of Pediatrics' Substance Abuse Committee, believes the CRAFFT research will help pave the way for better physician practices when it comes to screening for alcohol and drug use. "The American Academy of Pediatrics (AAP) is deeply concerned about substance abuse among our nation's adolescents and believes that pediatricians can play an important role in screening and intervention efforts. The academy has published policy statements that encourage the pediatrician to be actively involved in screening, early diagnosis and intervention, or referral. The absence of a reliable, field-tested, simple screening instrument, constraints of time, lack of reimbursement and treatment availability, have made this recommendation very difficult to implement. However, with the advent of accurate, brief screening tools such as the CRAFFT, it is my hope that adolescents with substance abuse will now be identified much earlier and receive the assessment and treatment they need."

"This study shows how important it is for physicians to screen all of their adolescent patients for substance abuse just as they routinely check blood pressure and weight. In our clinic setting, one in four patients coming in for routine care - including annual physical exams and minor physical problems - screened positive on the CRAFFT test," said Knight. He said the study's findings suggest a need to increase the capacity for treatment of adolescents who screen positive for substance abuse disorders. "In many communities, current resources are not adequate to meet the need indicated by studies such as this one. New approaches, such as office-based interventions, must be developed to address the magnitude of the problem." Researchers at Children's Hospital are currently studying new ways of treating these adolescents in the next phase of their work.

Knight and his co-authors believe that another important benefit of the CRAFFT tool is that it probes into the incidence of driving or riding in a car while under the influence. This is critical, he said, because automobile accidents are the leading cause of death in teens and substance abuse plays a major role in these crashes. "Our findings show that 43 percent of the teens surveyed answered that they have been in cars when the driver was high or had been using drugs or alcohol. A 'yes' answer to this question is a tremendous cause for concern and warrants immediate further discussion by the professional administering the CRAFFT test."

In the CRAFFT study, researchers interviewed 538 teens arriving for routine health care at the Adolescent/Young Adult Medical Clinic at Children's Hospital Boston between March 15, 1999 and Sept.12, 2000. This practice serves both inner-city and suburban youth from a wide range of ethnic backgrounds, racial groups and social strata. Knight said the findings of this study are applicable to the population at large and particularly important in light of the fact that substance abuse is the number one health problem in the U.S., with an estimated annual cost of over $414 billion. It affects men and women of all races, ethnic groups and ages - including adolescents.

Alcohol is the drug of choice for America's youth, according to the National Institute on Alcohol Abuse and Alcoholism, which provided funding for the CRAFFT study. "Rapid screening in primary care settings can identify adolescents who would benefit from brief intervention for alcohol problems, treatment for alcohol disorders, and even reduced exposure to drinking-driving, a major cause of adolescent death. The CRAFFT tool is a valuable contribution to public health among our nation's adolescents and future adults," said Raynard S. Kington, M.D., Ph.D., Acting Director, National Institute on Alcohol Abuse and Alcoholism.

Charles G. Curie, Administrator of the Substance Abuse and Mental Health Services Administration in the U.S. Department of Health and Human Services, another of the study's funders, noted that "SAMHSA's National Household Survey shows that in 2000 there were 9.7 million people aged 12-20, 27.5 percent of this age group, that reported drinking alcohol in the past month. There were 6.6 million of these teens who were binge drinkers and 2.1 million who were heavy drinkers. We must get pediatricians actively involved in screening their patients and intervening. If we can deal with youth at early stages of alcohol abuse we will protect the health of patients as well as the health of communities."

Children's Hospital Boston is the nation's premier pediatric medical center. The primary pediatric teaching affiliate of Harvard Medical School, Children's is home to the world's leading pediatric research enterprise, and is the largest provider of health care to the children of Massachusetts. For more information visit: http://www.childrenshospital.org. Referrals to the Adolescent Substance Abuse Program can be made by calling 617-355-ASAP (2727).

ADVANCE AND ON-SITE CONTACT:
Susan Lewis or Andrea Obston
Andrea Obston Marketing Communications
860-243-1447 or 860-803-1155 (cell) slewis@aomc.com

Susan Craig
Children's Hospital Boston
617-355-6420, pager 617-355-6369 (beeper # 1641)

*MEDIA ALERT* PHOTO OPPORTUNITY*
Thursday, June 13
10:30 a.m.

Children's Hospital Boston
Patient Entertainment Center
300 Longwood Avenue
Boston

GROUNDBREAKING PRESS CONFERENCE WILL UNVEIL TROUBLING NEW STATISTICS ON TEEN SUBSTANCE ABUSE

Internet-enabled audio webcast will allow media to interact from around the world

The results of a new study about the severity of substance abuse in adolescents will be the subject of a groundbreaking Internet-enabled audio webcast news conference. The event will be presented in conjunction with the Robert Wood Johnson Foundation, the nation's largest philanthropic organization devoted exclusively to health and health care.

The study outlines the high prevalence of substance abuse and dependence among adolescents and the promising results of a new tool that can help screen for this growing problem. The study was conducted by researchers at Children's Hospital Boston and Harvard Medical School and is published in June issue of the Archives of Pediatric Adolescent Medicine.

This Internet-enriched audio webcast will feature live audio coupled with a still visual of the main speaker, the study's author. Reporters may "attend" the news conference via the Internet, phone lines or in person. Either way, they will be able to hear all that goes on at the news conference, see support materials and an interview with the researcher, and ask their own questions. Electronic access to the live news conference will be gained by visiting a web site (http://www.CRAFFT.org) that houses press releases and background materials on the research, including a videotaped interview with the study's primary author.

FOR REPORTERS ONLY: You may join the live, interactive news conference in person or
· On the web at http://www.CRAFFT.com
· On the phone at 800-219-6110 or 800-240-2134.
International callers should dial 303-262-2127 and ask for the "CRAFFT Conference."

All questions submitted will be answered at the news conference or within 24 hours by e-mail.

Parking for the news conference will be available in the Traffic Circle at the Main Entrance of Children's or in the Children's Hospital Patient and Family Garage, located across from the hospital's Main Entrance on the corner of Blackfan Street and Longwood Avenue.

For more information about the upcoming press conference, visit http://www.CRAFFT.org.

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