Interviewing guidelines for the clinical evaluation of adolescent substance abuse.

Pediatricians can learn to assess adolescent patients' use of drugs and alcohol. Their most important task is to determine whether use of chemicals is causing behavioral impairment. A general psychosocial assessment of an adolescent's functioning is the most important component of an evaluation for substance abuse. It provides the foundation for determining whether behavioral dysfunction exists. The pediatrician should address several topical areas: family relationships, school performance and attendance, peer relationships, legal difficulties, leisure activities and employment, and self-perception. The chemical use history helps the pediatrician in two ways. In general, it helps to provide focus to the pediatrician's educational counseling about the risks of chemical use. It also helps the pediatrician to determine whether substance abuse is the cause of any behavioral dysfunction that the pediatrician may have discovered during the general psychosocial assessment. Strategies to enhance more accurate disclosure of substance use by adolescents include postponing this section of the interview until rapport has been developed with the teenager, ordering questions so that illicit substances are addressed later, exploring peer involvement with chemicals as an antecedent to discussing the adolescent's personal use, and using an historical perspective, so that the teenager is asked to describe his or her initial experience with each substance class prior to addressing current use patterns. Dysfunctional consequences of chemical use may present an opportunity for adolescents and their families to accept intervention. If the pediatrician believes that an adolescent patient would benefit from a formal treatment program, the following steps help to ensure successful completion of the referral. The pediatrician should first summarize information learned during the evaluation that is relevant to the problem behaviors. Try to outline the dysfunctional behavior in the context of chemical use. Communicate concern for the teenager's well-being. Provide information without moralizing or lecturing. Clarify your role as pediatrician. Try to personalize the referral process to prevent feelings of rejection by the adolescent and family. If necessary, provide concrete assistance to the family to facilitate the referral process.