This is the current release of the guideline.

American Academy of Pediatrics (AAP) Policies are reviewed every 3 years by the authoring body, at which time a recommendation is made that the policy be retired, revised, or reaffirmed without change. Until the Board of Directors approves a revision or reaffirmation, or retires a statement, the current policy remains in effect.

Substance abuse (tobacco, alcohol, and other drugs)

Evaluation
Management
Prevention
Risk Assessment
Screening
Treatment

Family Practice
Internal Medicine
Pediatrics

Physicians
Substance Use Disorders Treatment Providers

To assist pediatricians with the prevention, detection, and treatment of substance abuse

Children and adolescents at risk or suspected of substance abuse (tobacco, alcohol, and other drugs)

Evaluation

1. Obtaining a comprehensive substance-abuse history
   • Use of open-ended questions
   • Use of an empathetic nonjudgmental style of interviewing
   • Use of structured interviews and questionnaires
2. Obtaining an age-appropriate psychosocial history to determine risk and/or protective factors for current or future substance abuse
   • Family and peer relationships
   • Academic progress
   • Nonacademic activities
   • Acceptance of authority
   • Degree of self-esteem
   • Intrafamilial or extrafamilial conflict
3. Obtaining family history
4. Inquiry regarding other risk behaviors
   • Sexual activity
   • Membership in gangs
   • Violence and use of weapons
   • Use of drugs while riding in or driving a motor vehicle
   • Engaging in other illegal activities
5. Identify specific drug use, including tobacco and alcohol, along with the extent of such use; setting in which the use occurs; and the degree of social, educational, and vocational disruption attributable to drug use
6. Drug testing (urine)
   • Obtain patient consent

Management

1. Referral to a mental health professional when necessary
2. Be aware of community services for evaluation and treatment
3. Discussing reasons and motivations to quit using tobacco, alcohol, and other drugs
4. Implementing brief, office-based interventions incorporating motivational interviewing and cognitive-behavioral therapy including 1 or more of the following approaches:
   • Counseling (family or individual)
   • Behavioral therapy
   • Inpatient or outpatient drug therapy
   • Psychologic evaluation and/or testing
   • Psychiatric assessment
   • Drug detoxification
5. Environmental changes (living in a different community. i.e., with a relative)
6. Providing adolescents and their families with accurate information on the health and safety hazards of using tobacco, alcohol, and other drugs
7. Availability to provide aftercare for adolescent patients completing substance-abuse treatment programs

Not stated

Searches of Electronic Databases

Not stated

50

Expert Consensus (Committee)

Not applicable

Review

Not stated

Expert Consensus

Not stated

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

Internal Peer Review

Not stated

Advice for Pediatricians

The American Academy of Pediatrics (AAP) advises the following actions to promote the pediatrician's role in the prevention and management of tobacco, alcohol, and other drug abuse.

1. Pediatricians are encouraged to:
   • Be knowledgeable about the prevalence, patterns, cultural differences, and health consequences of substance abuse in their community; incorporate substance-abuse prevention into anticipatory guidance at routine and episodic office visits; be aware of the manifesting signs and symptoms of substance abuse, the association with other risk behaviors, and the possibility of dual diagnoses with other mental health disorders; be able to screen for and evaluate the nature and extent of substance use among patients and their families; be aware of confidentiality issues related to substance abuse, including obtaining patient consent before drug testing; be aware of community services for evaluation, referral, and treatment of substance-abuse disorders; and be available to provide aftercare for adolescent patients completing substance-abuse treatment programs and to assist in their reintegration into the community.
   • Serve as a community resource for smoking prevention and cessation and as a community resource for evidence-based substance-abuse prevention initiatives.
   • Advocate for community-based prevention and treatment services.
2. Patients and their families should be advised that even casual use of alcohol, tobacco, and other drugs by children and adolescents, regardless of amount or frequency, is illegal and has potential adverse health consequences.

None provided

The recommendations are based on comprehensive review of published reports and consensus of committee members.

The type of evidence supporting the recommendations is not specifically stated.

Pediatricians hold valued, respected positions with their patients and their patients' families and within the community. Armed with the knowledge of normal adolescent development, the pediatrician has the unique ability to provide appropriate anticipatory guidance and counseling in substance-abuse prevention and to place tobacco, alcohol, and other drug use in the context of risk behavior in general, which may lead to the identification of other risk behaviors and provide the opportunity to intervene by encouraging protective behaviors.

Not stated

The guidance in this report does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.

An implementation strategy was not provided.

Getting Better
Living with Illness
Staying Healthy

Effectiveness
Patient-centeredness

Not applicable: The guideline was not adapted from another source.

2005 Mar

American Academy of Pediatrics - Medical Specialty Society

American Academy of Pediatrics

Committee on Substance Abuse

Primary Author: John W. Kulig, MD, MPH

Committee on Substance Abuse, 2003-2004: Alain Joffe, MD, MPH, Chairperson; Marylou Behnke, MD; John R. Knight, MD; Patricia K. Kokotailo, MD, MPH; John W. Kulig, MD, MPH; Janet F. Williams, MD

Past Committee Members: Edward A. Jacobs, MD, Immediate Past Chairperson; Peter D. Rogers, MD, MPH

Liaison: Deborah Simkin, MD, American Academy of Child and Adolescent Psychiatry

Staff: Karen Smith

Not stated

This is the current release of the guideline.

American Academy of Pediatrics (AAP) Policies are reviewed every 3 years by the authoring body, at which time a recommendation is made that the policy be retired, revised, or reaffirmed without change. Until the Board of Directors approves a revision or reaffirmation, or retires a statement, the current policy remains in effect.

This NGC summary was completed by ECRI on March 23, 2005. The information was verified by the guideline developer on May 2, 2005.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions. Please contact the Permissions Editor, American Academy of Pediatrics (AAP), 141 Northwest Point Blvd, Elk Grove Village, IL 60007.