|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.
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
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.
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
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.