Health Provider Checklist for Adolescent and Young Adult Males

Substance Use Disorders

Key Points

  • Adolescent/young adult males have higher substance abuse rates than females, and boys under 17 drink more heavily than any other population group.
  • Massachusetts primary care providers who see adolescents found that less than half of respondents reported using a validated adolescent screening tool. The majority of respondents used ineffective screening practices for adolescent substance use. In 2011, 21.5% of adolescent males engaged in prescription drug use.
  • A recent study found that adolescents preferred paper forms and computerized questionnaires over interviews with physicians or nurses.
  • Another international trial found that a computer-facilitated system for screening, feedback, and provider brief advice for primary care can increase adolescent receipt of substance use screening across a variety of practice settings, and shows promise for reducing adolescents’ use of alcohol and cannabis.

Questions to ask young male patients about Substance Use Disorders

Overview

Nearly half of American high school students now smoke, drink or use other drugs. A new study reveals that 90 percent of Americans who are addicted to tobacco, alcohol or other substances started smoking, drinking or using drugs before they were 18 years old.1  The same study found that health care professionals are not screening enough for teen substance abuse.

The study also found that one-quarter of Americans who began using any addictive substance before age 18 are addicted, compared with one in 25 Americans who started using an addictive substance when they were 21 or older.2

Individuals with adolescent and young adult-onset SUD had increased odds of developing a secondary mood disorder. This indicates that adolescents and young adults with SUD should be closely monitored for both positive and negative mood symptoms. SUD treatment and aftercare offer opportunities for the early identification of secondary mood disorders.3

Adolescent Males

Alcohol. Adolescent/young adult males have higher substance abuse rates than females, and boys under 17 drink more heavily than any other population group. Among high school males, 39.5% report any alcohol use in the past 30 days, and 23.8% report consuming more than 5 drinks.4

iIllicit Drugs. In 2011, among 9th through 12th grade students, males were more likely than females to  use ecstacy, heroin, methamphetamines, hallucinogenic drugs, steroid pills or illegal needle injected drugs.  Males were also more likely to be offered, sold or given an illegal drug on school property. Drug use is common, with 25.9% reporting marijuana use in the past 30 days, 10.5% inhalant use, 9.8% ecstasy use.5

Prescription Drugs. In 2011, 21.5% of adolescent males engaged in prescription drug use (such as oxycodone, hydrocodone, benzodiazepines, etc).6

Early substance use (before age 13 years) is common in males (23.3% of males reporting early alcohol use and 10.4% early marijuana use), with risk factors including low supervision and parental monitoring.7   Higher rates of substance use have been reported among sexual minority youth. (as cited in 8)

College Age Males

Compared to college females, in 2011 college males were:

  • One and a half times more likely to use amphetamines and cocaine
  • Nearly twice as likely to use hallucinogens
  • Twenty five percent more likely to use any illicit drug9

Professional guidelines recommend annual screening, brief intervention, and referral to treatment (SBIRT) as part of health maintenance for all adolescents, but reported screening rates have been low and no report has documented the techniques being used.10

Despite this, a recent study of Massachusetts primary care providers who see adolescents found that less than half of respondents reported using a validated adolescent screening tool. The majority of respondents used ineffective screening practices for adolescent substance use.11

Another recent study found that adolescents preferred paper forms and computerized questionnaires over interviews with physicians or nurses. The CRAFFT was the best studied instrument for screening for alcohol/drug use and related problems, and is the only tool with data to support its use in medical settings. Other screening instruments require more testing/evaluation in more representative samples of adolescents in primary care settings. Long term follow-up data to establish the efficacy of SBIRT in adolescence are not available. Innovative computerized approaches to screening for substance use in this population have recently been proposed. Although promising, they require further evaluation.12

Another international trial found that a computer-facilitated system for screening, feedback, and provider brief advice for primary care can increase adolescent receipt of substance use screening across a variety of practice settings, and shows promise for reducing adolescents’ use of alcohol and cannabis.13


1 National Center on Addiction and Substance Abuse (CASA) at Columbia University. New CASA Report Finds Adolescent Substance Use at Epidemic Levels . 2011.

2 Ibid

4 Bell, David L. Breland , David A. and Ott, Mary A.  Adolescent and Young Adult Male Health: A Review Pediatric. 2013.

5 Centers for Disease Control and Prevention. Youth Risk Behavior Surveillance System, Health Risk Behaviors by Sex. 2011.

6 Ibid

8 Bell, David L. Breland , David A. and Ott, Mary A.  Adolescent and Young Adult Male Health: A Review Pediatric. 2013.

10 Harris SK, Herr-Zaya K, Weinstein Z, Whelton K, Perfas F Jr, Castro-Donlan C, Straus J, Schoneman K, Botticelli M, Levy S. Results of a statewide survey of adolescent substance use screening rates and practices in primary care. 2012.

11 Ibid