Primary Care Follow-Up Plans for Adolescents with Substance Use Problems

Primary care visits provide an opportunity to screen adolescents for substance use and offer early intervention, but little is known about follow-up plans. The objective of this study was to determine recommendations by primary care physicians (PCPs) and assess the relationship between their diagnostic impressions of substance use severity and plans for intervention.

Data were collected through a prospective observational study conducted at seven primary care practices in New England. Patients aged 12 to 18 years completed an interview that included sociodemographic characteristics and the CRAFFT (acronym for key components in the questions: care, relax, alone, forget, friends, trouble) substance abuse screen. PCPs received screen results, noted their diagnostic impression of participants’ substance use severity, and recorded follow-up plans. Follow-up plans other than “periodic screening” alone were defined as “active intervention.” The authors examined the relationship of provider impressions with follow-up recommendations by using the X2 test.

For 2,034 adolescents, PCPs recommended no plan for 369 patients, periodic screening for 1,557 patients, a return visit for 98 patients, and referral to counseling for 44 patients. PCPs’ diagnostic impressions identified 97 (4.8%) patients with problem use and 19 (0.01%) patients with abuse or dependence. Recommendations for active intervention were more likely with patients’ higher severity of use. However, 1 in 5 patients thought to have problem use did not receive a recommendation for an active intervention. Parent notification was planned for only 13 patients. The study concluded that when concerned about substance use, PCPs recommend a return visit to their office more than twice as often as referral to counseling, and rarely planned to engage parents. PCPs need enhanced training and strategies for delivery of office-based interventions.