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.