State University of New York at Buffalo, Buffalo, NY, USA.
Am Fam Physician. 2019 Jun 1;99(11):689-696.
Adolescent use of illicit substances imposes an enormous burden on individuals, families, and communities. The types of illicit substances adolescents are using have changed drastically over the past decade with decreases in alcohol use (including binge alcohol use) offset by increases in electronic cigarette, marijuana, and opioid use. Primary care physicians have the opportunity to identify adolescents who use illicit substances. The U.S. Preventive Services Task Force and the American Academy of Family Physicians found insufficient evidence to assess the balance of benefits and harms of primary care-based behavioral interventions to prevent or reduce illicit substance use or nonmedical pharmaceutical use in children or adolescents. The American Academy of Pediatrics recommends that clinicians become familiar with Screening, Brief Intervention, and Referral to Treatment initiatives. Validated screening tools that may be used in primary care include the CRAFFT, POSIT, AUDIT, and NIAAA Screening Guide. During the clinical visit, a split-visit model encourages parents to participate in the visit for a limited time but also allows adolescents to have confidential conversations with physicians. Evidence-based treatment modalities range from school- and parent-based interventions to medication-assisted treatment. Brief interventions using components of motivational interviewing may be suitable for addressing substance use, even among adolescents not seeking treatment. Prevention efforts can supplement cessation programs to maximize program effectiveness.
青少年使用非法物质给个人、家庭和社区带来了巨大的负担。在过去的十年中，青少年使用的非法物质类型发生了巨大变化，酒精使用（包括狂饮）有所减少，而电子烟、大麻和阿片类药物的使用有所增加。初级保健医生有机会识别使用非法物质的青少年。美国预防服务工作组和美国家庭医生学会发现，没有足够的证据来评估基于初级保健的行为干预措施预防或减少儿童或青少年使用非法物质或非医疗药物的益处和危害之间的平衡。美国儿科学会建议临床医生熟悉筛查、简短干预和转介治疗计划。可在初级保健中使用的有效筛查工具包括 CRAFFT、POSIT、AUDIT 和 NIAAA 筛查指南。在临床就诊期间，分阶段就诊模式鼓励父母在有限的时间内参与就诊，但也允许青少年与医生进行保密对话。循证治疗方式包括基于学校和家长的干预以及药物辅助治疗。使用动机访谈内容的简短干预措施可能适合解决物质使用问题，即使是那些不寻求治疗的青少年也是如此。预防措施可以补充戒烟计划，以最大限度地提高计划效果。
