Role of Pediatricians in the Prevention, Assessment &Treatment of Substance Use Disorders (1.5 CME)
Nearly all substance use disorders (SUDs) can be traced to adolescence, when the vulnerable adolescent brain is first exposed to psychoactive substances. Most adolescents have annual pediatric visits throughout their youth, presenting an important opportunity for pediatricians and adolescent medicine physicians to deliver prevention and early intervention messages in an effort to reduce substance use and SUDs. In June 2016, the American Academy of Pediatrics (AAP) Committee on Substance Use and Prevention released a clinical report "Substance Use Screening, Brief Intervention, and Referral to Treatment" to guide physicians in implementing substance use prevention, detection, assessment and intervention in settings in which adolescent receive health care. In this report, the AAP presents a new vision for physicians to routinely counsel their young patients about the medical impacts of substance use, stressing the importance of not using any alcohol, tobacco, marijuana or other drugs for reasons of health. This contrasts strongly with earlier more passive strategies for pediatricians. New analyses of data from the National Survey on Drug Use and Health (NSDUH) show the use of alcohol, tobacco and marijuana is closely linked among young people. Use of one of these three substances significantly increases the likelihood of using the other two. Further, the no-use goal for health can be achieved as evidenced by data from the Monitoring the Future study showing a dramatically increasing percentage of young people refraining from using alcohol, cigarettes, marijuana or other drugs. Screening patients for substance use is only the first step. The goals of the brief interventions which follow screening range from providing positive reinforcement and prevention messages for patients who abstain from substance use, to encouraging patients with moderate and more severe substance use disorders to reduce their use and accept a referral to treatment with follow-up to ensure compliance with treatment. The ultimate health goal for adolescents is no use of any substance for health. With a backdrop in brain biology, this presentation will present the clinical and policy implications for managing the highly prevalent chronic and serious problem of substance use disorders in this high-risk population. We will review the AAP guidance for pediatricians and discuss strategies for providing SBIRT (Screening, Brief Intervention and Referral to Treatment) in primary care clinical settings.
Robert L. DuPont
For more than 40 years, Robert L. DuPont, M.D. has been a leader in drug abuse prevention and treatment. He served as the first Director of the National Institute on Drug Abuse (1973-1978) and as the second White House Drug Chief (1973-1977). From 1968-1970 he was Director of Community Services for the District of Columbia Department of Corrections, heading parole and half-way house services. From 1970-1973, he served as Administrator of the District of Columbia Narcotics Treatment Administration. Following this distinguished public career, in 1978 Dr. DuPont became the founding president of the Institute for Behavior and Health, Inc., a non-profit organization that identifies and promotes new ideas to reduce illegal drug use. He has been Clinical Professor of Psychiatry at the Georgetown University School of Medicine since 1980.
A graduate of Emory University, Dr. DuPont received an M.D. degree in 1963 from the Harvard Medical School. He completed his psychiatric training at Harvard and the National Institutes of Health in Bethesda, Maryland.
Dr. DuPont is a Life Fellow of the American Society of Addiction Medicine. His activities in ASAM include chairing the forensic science committee from 1995 to 2004, and serving as Co-Chair of the two White Paper writing committees that produced The Role of the Physician in “Medical” Marijuana in 2010 and State-Level Proposals to Legalize Marijuana in 2012. He served as Chair of the writing committee that produced Drug Testing: A White Paper of the American Society of Addiction Medicine in 2013. He is also a Life Fellow of the American Psychiatric Association and was chairman of the Drug Dependence Section of the World Psychiatric Association from 1974 to 1979. In 1989 he became a founding member of the Medical Review Officer Committee of ASAM."
Sharon Levy, MD, MPH, is a board certified Developmental-Behavioral Pediatrician and an Assistant Professor of Pediatrics at Harvard Medical School; she also has a Master's degree from the Harvard School of Public Health. She is the Director of the Adolescent Substance Abuse Program in the Divi-sion of Developmental Medicine at Boston Children's Hospital where she has evaluated and treated hundreds of adolescents with substance use disorders. She has published extensively on the outpatient management of substance use disorders in adolescents, including screening and brief advice in primary care, the use of drug testing and the outpatient management of opioid de-pendent adolescents. She is the PI of the SAMHSA-funded medical residen-cy SBIRT project at Children's Hospital Boston and an NIAAA-funded study validating the youth alcohol screening tool in a population of youth with chronic medial illness. Dr. Levy currently serves as the chair of the American Academy of Pediatrics Committee on Substance Abuse.