Massachusetts Medical Society's Physician Focus

November 2012

Youth Substance Abuse: Treatment


  • By the time of high-school graduation, 80 percent of students will have tried alcohol; 40 percent, marijuana; and 9 percent, prescription drugs.

  • Parents should look for ways to discuss substance abuse with their children, such as news articles about car accidents involving teens and alcohol.

  • One of the best sources of alcohol for kids is the parent’s liquor cabinet; for prescription drugs, the home medicine cabinet.

  • The primary care physician can play an important role in identifying and intervening in substance abuse by adolescents.

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“Substance abuse by kids is fairly common,” says Sharon Levy, M.D., M.P.H., Director of the Adolescent Substance Abuse Program at Boston Children’s Hospital, “that’s one of the things that makes it so difficult.”

Dr. Levy, who specializes in adolescent substance abuse and development and behavioral pediatrics, shares her knowledge and experience as the featured guest on the November edition of Physician Focus. She continues the conversation begun in July’s Physician Focus program with her colleague John Knight, M.D., Director of the Center for Adolescent Substance Abuse Research at Boston Children’s Hospital. Hosting this edition is Mavis Jaworski, M.D., a primary care physician in Beverly, Mass.

The numbers show just how serious this problem is: By the time of high-school graduation, eight in ten teens have reported using alcohol, four in ten smoking marijuana, and almost one in ten taking prescription drugs for nonmedical reasons.

And because “addiction is a disease of secrets and substance abuse is a behavior of secrets,” she says, “it can be hard for parents to discover substance abuse by their children.”

Dr. Levy’s ASAP program at Boston Children’s Hospital is the only substance abuse program located within a department of pediatrics, a unique arrangement that allows her and her associates to see a wide range of substance abuse problems and disorders. The program offers assessment, individual counseling and education, monitoring, drug testing, and treatment recommendations for substance abuse by adolescents.

“The truth is,” Dr. Levy says, “is that kids growing up in the United States are going to be exposed to tobacco, alcohol, marijuana and other substances, and the best thing a parent can do is to talk openly with their kids about it.” She suggests parents look for reasons to discuss the topic, such as news stories about car accidents involving teens and alcohol.

She cautions parents to look for changes in behavior – irritability, withdrawal from social situations, changes in mood, declining school performance, or loss of interest – that might indicate substance abuse. “For a parent who is noticing changes,” Dr. Levy advises, “I would encourage them to bring their child in for an evaluation.”

“The primary care physician is a great place to start,” she says, “and can play a big role in identifying and intervening in substance abuse by adolescents. Take your concerns to your doctor, describe them in detail, tell him or her why you’re worried, and what you’ve noticed. Physicians are trained more and more these days to address substance abuse problems.” If the situation warrants, she says a referral can be made to a specialist.

One of the most important things Dr. Levy has learned is how to communicate with kids about difficult topics. “That’s something that I try to teach parents who come to our program.”

Even as the child is coping with substance abuse and treatment, Dr. Levy urges parents to look at the positive. “Remember all the good things about your child,” she says, “as you try to rebuild the relationship while you’re working on behavior.”

Watch the accompanying program for the full discussion, including conversation on the definitions of addiction, dependence, and withdrawal; the importance of screening tools; and what parents can do if they’re concerned about the cost of treatment.

MMS/Richard Gulla

Adolescent Substance Abuse Program at Boston Children's Hospital

American Academy of Pediatrics

NIDA For Teens

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"Youth Substance Abuse: Treatment" PSA

From left: Mavis Jaworski, M.D.;
Sharon Levy, M.D., M.P.H.
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