112 THE REFERENCE MANUAL OF PEDIATRIC DENTISTRY ORAL HEALTH POLICIES: SUBSTANCE MISUSE IN ADOLESCENTS Purpose e American Academy of Pediatric Dentistry (AAPD) recognizes that substance misuse in adolescents is a significant health, social, and familial issue in the United States. e increasing prevalence of substance misuse among adolescents obligates dental personnel to identify behaviors characteristic of active use, recognize clinical signs and symptoms of active use or withdrawal, modify dental treatment accordingly, and facilitate referral to medical providers or behavioral addiction specialists. is policy addresses the harmful effects of alcohol and drug misuse in the adolescent and the dental provider’s role in recognition, initiation of appropriate interventions, and referrals. Methods is policy, developed by the Council on Clinical Affairs and adopted in 2016 1 , is based upon a review of current dental and medical literature, including a literature review through the PubMed ® /MEDLINE database using the terms: adolescent substance abuse, adolescent substance misuse, substance use in adolescents, alcohol use in adolescents, illicit drug and alcohol use in teenagers, adolescent alcohol and/or drug abuse, and prescription drug use/misuse in teenagers; fields: all; limits: within the last five years, humans, English, birth through age 18. e search resulted in 741 papers that were reviewed by abstract and title. Papers for review were chosen from this list and from the references within selected articles. Websites and documents from select healthcare and public policy organiza- tions, as well as governmental agencies, also were reviewed. Definitions Adolescence: “11 to 21 years of age, dividing the group into early (ages 11-14 years), middle (ages 15-17 years), and late (ages 18-21 years) adolescence.” 2 Binge or heavy episodic drinking: “pattern of drinking alcohol that brings blood alcohol concentration (BAC) to 0.08 percent – or 0.08 grams of alcohol per deciliter – or higher. For a typical adult, this pattern of excessive alcohol use corresponds to consuming four or more drinks (female), or five or more drinks (male) in about two hours. Research shows that fewer drinks in the same timeframe result in the same BAC in youth; only three drinks for girls, and three to five drinks for boys, depending on their age and size”. 3 Substance misuse: “used to distinguish improper or unhealthy use from use of a medication as prescribed or alcohol in moderation. ese include the repeated use of drugs to produce pleasure, alleviate stress, and/or alter or avoid reality. It also includes using prescription drugs in ways other than prescribed or using someone else’s prescription”. 4 Substance use disorder (SUD): “a cluster of cognitive, be- havioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance-related problems”. 5 Withdrawal syndrome: “the development of a substance-specific maladaptive behavioral change, usually with uncomfortable physiological and cognitive consequences, that is the result of a cessation of, or reduction in, heavy and prolonged sub- stance use”. 6 Background Many physical, social, and behavioral changes occur during the adolescent years. e developing adolescent may encounter difficulties and pressures without effective coping skills or maturity. Unfortunately, some teenagers do not have familial, peer, or other support systems to provide help and guidance in adjusting to changes or with decision making. As a result, they may turn to alcohol or drugs to seek comfort and reduce the stresses associated with this erratic time in their lives. 7 Substances misused by adolescents include alcohol, in- halants, opiates, amphetamines, cocaine, marijuana, barbiturates, benzodiazepines, hallucinogens, and anabolic steroids. 8 In a 2019 survey of eighth, tenth, and twelfth grade students, trends revealed alcohol use at 7.9, 18.4, and 29.3 percent respectively in the previous 30 days, reflecting a five-year decreasing trend in comparison to survey results from 2014. 9 Prevalence of binge drinking in the past 30 days demonstrated a five-year decline, reported at 3.8, 8.5, and 14.4 percent. 9 Use of any illicit drug was reported to be 8.5 percent for eighth graders, 19.8 percent for tenth graders, and 23.7 percent for twelfth graders. 9 Findings from the 2019 Monitoring the Future (MTF) survey demonstrate the strong desire for vaping in adoles- cence, as seen in the increased prevalence of marijuana use as well as nicotine vaping. 9 Past-month marijuana vaping among twelfth graders nearly doubled in a single year from 7.5 to 14 percent. 9 Marijuana was the most commonly used illicit ABBREVIATIONS AAPD: American Academy Pediatric Dentistry. COVID-19: Corona- virus disease 2019. ENDS: Electronic nicotine delivery systems. MTF: Monitoring the Future. SUD: Substance use disorder. Latest Revision 2021 Policy on Substance Misuse in Adolescent Patients How to Cite: American Academy of Pediatric Dentistry. Policy on substance misuse in adolescent patients. The Reference Manual of Pediatric Dentistry. Chicago, Ill.: American Academy of Pediatric Dentistry; 2022:112-6.
Policy on Substance Misuse in Adolescent Patients
Jul 09, 2023
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