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Tools for recognizing substance abuse in pediatric practice

Dr. Jessica Castonguay

Dr. Jessica Castonguay

One in 3 children starts drinking by the end of 8th grade, so it’s important for pediatric primary care providers to know how to recognize substance abuse in their practice.

This was the focus of a presentation by Jessica Castonguay, DO, MPH, at Akron Children’s Hospital’s annual Pediatric Update in April.

Dr. Castonguay described questions she uses in her adolescent clinic to screen for substance abuse.

“At the elementary school level (ages 9-11) and in the middle school years (ages 11-14), you ask if their friends are drinking,” said the adolescent medicine physician. “In the high school years (ages 14-18), you focus on the patient’s own drinking history in the last year.”

For patients at low risk but who have friends who drink, Dr. Castonguay gives them brief advice and follows up in a year. Patients who are at moderate or high risk are given motivational interviewing, which includes creating an action plan that emphasizes personal goals.

An immediate intervention or referral to treatment has to be made when a patient admits driving after substance use or other high-risk behaviors, according to Dr. Castonguay.

She begins these conversations by contracting for safety, such as, “I am really worried about your drinking. Could you agree not to drink at all this weekend until you can speak with your counselor on Monday?”

Dr. Castonguay also recommends the NIAAA Youth Guide as a good starting point for healthcare providers in quickly identifying youth at risk for alcohol-related problems.

Developed in collaboration with the American Academy of Pediatrics, the tool is empirically based with screening questions and risk scale.

Download the 40-page guide or pocket guide.

melo.michelson@gmail.com' About Melonie Michelson

Melonie Michelson is a freelance writer and science educator who spent over 30 years working as a genetic counselor and educator at Akron Children’s Hospital. During that time, she developed and coordinated Akron Children’s fetal treatment center and publications such as Teaching Human Genetics: Resources for Science and Biology. After having a child with a genetic condition, she switched career paths from journalism to medical genetics.

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