Prevalence of positive substance abuse screen results among adolescent primary care patients

Objectives: To measure the prevalence of positive substance use screen results among adolescent primary care patients and to estimate the prevalence of substance-related problems and disorders. Design: Cross- sectional survey. Setting: A network of primary care practices in New England. Participants: A consecutive sample of 12- to 18- year-old patients ( N= 2133), with a study participation rate of 92.7%. Main Exposure: The CRAFFT substance abuse screening test ( a full description of this screen is given in the "Introduction"). Outcome Measures: Frequencies of positive screen results were computed for the entire sample, each practice, visit type ( well- child care, sick visit, follow- up, or other), and patient status ( new vs established). Generalized estimating equation modeling was used to test for difference in proportions. CRAFFT scores, demographic data, and Diagnostic and Statistical Manual of Mental Disorders ( Fourth Edition) diagnostic data from a previous study were used to estimate the prevalence of problematic substance use, abuse, and dependence. Results: Overall, 14.8% of adolescents had positive results on the CRAFFT screen. Prevalence rates differed significantly across practices ( P <. 001) after adjusting for demographic factors. The highest positive rates on the CRAFFT screen were at school- based health centers ( 29.5%) and the rural family practice ( 24.2%), the middle rate was at the adolescent clinic ( 16.6%), and the lowest rates were at the health maintenance organization ( 14.1%) and pediatric clinic ( 8.0%). Sick visits had the highest rate ( 23.2%). Well- child care visits had a significantly lower rate ( 11.4%, P <. 001). Statistical modeling estimated that 11.3% of all patients had problematic use, 7.1% had abuse, and 3.2% had dependence. Conclusion: Substance abuse screening should occur whenever the opportunity arises, not at well-child care visits only.