The abuse of medications and legal as well as illicit substances is a continuing medical problem among adolescents. According to the 1999 Youth Risk Behavior Surveillance that was conducted by the Centers for Disease Control and Prevention, 61.7 percent of high school seniors were using alcohol, 41.6 percent were binge drinkers and 31.5 percent were currently using marijuana. A significant minority of high school seniors used illicit drugs including stimulants, inhalants or hallucinogens.
As a result of substance abuse, teens may develop changes in their behavior. Mood swings, depression, peer and family problems, risk taking and stealing could result from substance abuse. Academic performance may also be unfavorably affected by drug abuse. Some teens have impaired memory, poor judgment, falling grades, truancy and problems with their teachers due to drug usage. Personal habits may also be affected: adolescents who abuse drugs may have altered sleep patterns, change in their appetite, less interest in hygiene and other life activities, changes in their dress, interests, friends and even the type of music they enjoy.
Parents who suspect their teen is abusing drugs may ask the teen’s clinician to order a drug test. There are four urine drug-screening tests that are commonly used. Each is highly sensitive and will detect ten different drugs with less than a teaspoon of urine. The results are usually available quickly. Marijuana may be etected up to fourteen days after last use for teens who chronically use pot. Evidence of cocaine, opiates, amphetamines or barbiturates is present up to two to four days after use. False positive drug results may occur in screening due to a cross reaction with other medications or some naturally occurring compounds in food. A drug abusing teen may attempt to alter the accuracy of drug screening by drinking excessive amounts of water, taking diuretics, ingesting interfering substances or even substituting a clean sample from an individual who does not abuse drugs.
Prior to testing an adolescent for drug use, one should consider whether the testing is to be involuntary or voluntary. Involuntary testing of youth for drug usage is considered in two circumstances. To help identify teens that need treatment for drug abuse, diagnostic testing for substance abuse may be justifiable only if the teen is at risk of serious harm if the offending substance can be identified. If the treatment and therapy will not be changed by drug testing, then involuntary testing is not justified. The other circumstance for involuntary testing may occur when there is an existing law or specific court-ordered test that drives the testing. Teens who lack the capacity to make informed judgments about their medical care may be tested for drug abuse with parental permission. These teens would probably be in the early adolescent stage twelve to fourteen years.
Voluntary drug testing is probably a deceptive concept. If a teen declines to participate in the testing, there may be negative consequences. For the older teen who is capable of making competent decisions about his or her medical care, then parental permission is not sufficient in itself to have the teen tested for drug use. The teen must also consent. Competency in adolescents refers to his or her ability to understand the relationship between the drug use, its consequences and testing for the drug in his or her body. Youth who can conceptualize a cause and effect phenomenon may have developed formal operational thinking. Those teens who are abusing drugs, and have developed formal operational thinking would presumably decline to be voluntarily tested since unpleasant consequences may occur if substances are discovered in the testing. As a result, voluntary drug testing of competent teens will probably result in a negative drug test. This may not serve the drug abusing adolescent well, since his or her path to treatment may be blocked by the negative test.
Drug testing furnishes no information on a teen’s drug dependency, whether he or she is an occasional or chronic drug abuser or if there is mental or physical impairment from the drug use. Clandestine drug testing will undermine the teen’s relationship with his or her clinician, his or her sense of autonomy and the youth’s rights for informed consent. A positive drug test may affect a teen’s employment, insurance coverage or personal relationships unless the clinician ensures absolute confidentiality for the results of the testing.
Some communities have involuntary drug testing as a condition for participation in high school sports. The American Academy of Pediatrics Committee on Substance Abuse questions the appropriateness of this type of screening. If the purpose of drug screening is to identify conditions that may be hazardous to the athlete’s health when combined with physical activity that may be justifiable. However, most groups that promote testing of athletes probably are not motivated by this consideration. One could argue that all adolescents in high school should be tested for drugs. The implications of a comprehensive screening program for all adolescents are far reaching and would have significant social, personal, legal and financial costs.
For the teen who is suspected of abusing drugs, the better alternative rather than drug testing is referral to a clinician who is experienced in caring for substance abusing adolescents. This may very well be a psychiatrist, adolescent medicine specialist, psychologist or social worker. Insurance plans vary in the amount of coverage that is afforded for substance abuse treatment. In addition, it is often difficult to find inpatient facilities that deliver appropriate substance abuse services to adolescents.
Related topics:
Academics, alcohol, amphetamines, confidentiality, counseling, intellectual development, marijuana, medical decision-making, party drugs, peer pressure, phencyclidine, prescription drug abuse, risk-taking, steroids, substance abuse
