|Your knowledge of your patients development and your continuing rapport with them are probably your most powerful tools in preventing and diagnosing substance use, abuse and dependence. Since alcohol and other drugs are not used in vacuo, your knowledge of individual children, how they are getting along with their families, their teachers, and their peers is invaluable.
Be on the lookout for behavioral signals. Behavioral changes or problems that have developed since a childs last visit are often evident after even brief interviews with the patient and parent. Usually, children who are involved with alcohol and other drugs send out behavioral signals and frequently such changes or problems will emerge during the routine questioning you undertake as part of your examination.
Using Opportunities to Discuss Substance Abuse
The amount of time you can spend with any patient is very limited, but even that required for a routine physical examination can be used to explore possible substance use and encourage a drug-free lifestyle. The routine chest examination provides an excellent opportunity to ask about cigarette smoking and marijuana use. Since the youngster may believe that you can detect use of these substances by your chest auscultation, he or she will usually respond openly to direct, but nonjudgmental inquiry. Routinely asking about alcohol use in the childs school and among his or her peers readily leads to questions about personal use. This questioning is likely to be non-threatening to your patient in the context of your concern for his or her overall health and well being.
Patient Reactions to Your Questions
An important clue to more serious involvement with substance abuse is marked defensiveness about the essence of alcohol or other drug use or any kind of emotional response to your routine questions. If this reaction occurs, it provides a further basis for inquiry, indicating the patient that the topic seems to be a sensitive one and making the patient aware that you wonder why.
Why is the Patient Using Drugs?
The drug use may be the patients way of self-medicating anxiety or dealing with problems in living or a lack of self-esteem. But even though drugs may temporarily alleviate some of these feelings, substance abuse is destructive to emotional maturation and other aspects of growth and development. Thus, objective confirmation can sometimes be a relief to all concerned, making it easier for both the youngster and the parent(s) to acknowledge that a problem requiring their attention exists.
How to Respond to Isolated or Minimal Use
If use has, in fact, been relatively isolated, the child may find evidence in your concern reassuring of adult love, especially if the use is not moralistically condemned, but treated as a potential health hazard. Avoiding a moralistic stance without in any way condoning use is important.