Selection of Substance Abuse Treatment Programs

BACKGROUND Substance use by young people can markedly affect the physical and psychosocial health of both the individual who is using drugs and his/her entire family. Recent studies continue to show an unacceptably high level of substance use in spite of the leveling off and slight overall downturn in the frequency of substance use by high school seniors.1 The continuing trend toward an earlier age for first experience with drugs (including alcohol) is cause for alarm and concern; the current mean age for first experience is 12 years of age.2 Because many youngsters who initiate drug use at this early age may drop out of school before they become high school seniors and thus will never participate in the high school senior surveys, it is apparent that such surveys tend to underestimate drug usage.3 Because the pediatrician is often called upon to diagnose the problem and to recommend an appropriate plan from diverse and often conflicting treatment options, pediatricians must become knowledgeable about the early diagnosis and treatment options of this prevalent and complex disease. The object of treatment in substance abuse is to eliminate usage of the offending agent, whatever it may be. With some patients, this may be accomplished in the office by means of counseling, written contracts, and appropriate laboratory use to assure compliance. It may, however, be necessary to refer the adolescent and the family for outpatient treatment by a professional who is knowledgeable about drug counseling and therapy. The following factors are an indication that referral to an inpatient therapy unit is necessary: 1. The patient is unable to discontinue his or her abuse in spite of appropriate interventions by the physician and the patient's family.