Screening for cannabis use disorders in an adolescent emergency department sample

Cannabis, more often than alcohol, is the drug mentioned in substance-related reasons for treatment of an adolescent in an emergency department (ED). This study examined the prevalence of DSM-IV cannabis and alcohol diagnoses in an adolescent ED sample, evaluated the performance (i.e. sensitivity and specificity) of DSM-IV cannabis symptoms and other screening items as indicators of cannabis diagnosis status, and examined parent-adolescent agreement on the presence of cannabis and alcohol diagnoses. Adolescents (ages 13-19, n=442) admitted to an ED for a non-substance-related injury were administered the diagnostic interview schedule for children (DISC). Parents (n=272) of adolescents younger than age 18 completed the DISC-parent version to report on their child's drug use. A minority met criteria for a current DSM-IV cannabis or alcohol diagnosis: 7.9% for both alcohol and cannabis, 7.5% for cannabis-only, and 9.0% for alcohol-only. Frequency of cannabis use had the best overall performance in discriminating those with and without a cannabis diagnosis compared with items on perceived risk of cannabis use, peer cannabis use, and alcohol and cigarette use. Parent reports generally underestimated the adolescent's substance use. Questions on level of substance use generally provide an efficient method of screening adolescents for substance-related problems in an ED setting.