Evaluation of substance-abusing adolescents by primary care physicians

Physicians are in a unique position to identify substance-abusing adolescents. To evaluate physician performance from the patient's perspective, we interviewed 54 substance-abusing adolescents and their parents about previous medical encounters. Although nearly all patients had seen a physician during the time they were using drugs or alcohol, 43% did not recall being asked by a doctor about alcohol or drug use. Of the 26 patients who recalled being asked, 12 (46%) stated that they responded dishonestly, usually because a parent was present. Of the 23 who didn't recall being asked, five (18%) wished they had been asked. Physicians tended to ask about substance abuse more often (p = .08) when they had previously discussed the problem with the parents, but many parents did not initiate such discussions. This survey suggests that physicians may not adequately assess high-risk adolescents for substance abuse because of physician-, patient- and/or parent-dependent factors.