Health care professionals are not screening enough for teen substance abuse, according to a new report that finds nine out of 10 Americans who meet the medical criteria for addiction start using addictive substances before age 18.

The report, Adolescent Substance Use: America’s #1 Public Health Problem, finds that one in four Americans who began using any addictive substance before 18 are addicted, compared with one in 25 Americans who started using at age 21 or older. The report was released by The National Center on Addiction and Substance Abuse (CASA) at Columbia University in New York.

The CASA report found that 10 million high school students –75 percent of the total — have used addictive substances including tobacco, alcohol, marijuana or cocaine; 20 percent of them meet the medical criteria for addiction.

Although three-quarters of teens have used tobacco, alcohol or other drugs, the use of teen-focused substance abuse screening is not typically part of routine health care practice, the report notes. Of teens who smoke, only 21.4 percent said a health professional told them to stop smoking, even though studies have shown that interventions by health care professionals can have a major impact on student smokers.

“Addiction is a disease affecting one in eight adolescents and causing more than 70 other diseases requiring hospitalization, yet only six percent of teens who need treatment get it,” said Susan E. Foster, Vice President and Director of the Division of Policy Research and Analysis at CASA, who was the principal investigator and director of the study. “It is critical for doctors to counsel their adolescent patients and their families about the health risks of teen substance use, be sure teens are screened for signs of trouble using available and easy-to-use tools, and intervene to prevent or treat the disease as they would for any other health condition.”

The CASA report recommends the following steps health care professionals should take to tackle teen substance abuse:

• Routinely discuss the dangers of adolescent substance use with patients and their parents.
• Conduct routine substance use screenings of adolescent patients in primary care.
• Screen teen patients who seek urgent or emergency medical care  for substance use and substance use disorders, especially those who have injuries from accidents or violent incidents, mental health problems or who show other potential signs of substance use.
• Conduct brief interventions using established protocols—short counseling sessions directed at changing a teen’s attitudes and behavior related to substance abuse.
• Treat or refer to specialty care. For adolescents, it is critical that the treatment provided be tailored to their age and circumstances, and that it addresses any co-occurring conditions such as anxiety or depression, ADHD or conduct disorders.
• Expand treatment capacity in the medical system.
• Require education and training in addiction services.
• Press government and private health care insurers to reimburse for adolescent substance use prevention and treatment.

Emergency departments (ED) can play an important role in teen screening, the report notes.  About eight percent of substance-related ED visits are made by adolescents. Health care providers who treat teens with emotional or behavioral disorders can also play a critical role in identifying substance use problems, since substance use frequently occurs along with such disorders, the study notes.

Primary care providers say that they don’t screen for substance abuse in adolescents for a variety of reasons. The number one reason was a lack of time, followed by lack of training in how to manage a positive screen, the need to triage competing problems, parents who do not allow their teens privacy for confidential discussions and unfamiliarity with available screening tools.

Health care practitioners not only don’t screen teens for signs of substance abuse, most do not have a plan in place for engaging teenage patients in interventions or treatment services, according to the report. Only 6.4 percent of high school students who meet clinical criteria for a substance use disorder involving alcohol, controlled prescription drugs or illicit drugs received formal treatment in the past year, CASA found.

The report states that 6.1 million high school students — 46 percent — currently use addictive substances; one in three of them meet the medical criteria for addiction. Alcohol is by far the most popular substance of choice, the report found; 72.5 of students report having drunk alcohol, compared with 46.3 percent for cigarettes, 36.8 percent for marijuana and 14.8 percent for misuse of controlled prescription drugs.

The study included online surveys of 1,000 high school students, 1,000 parents of high school students and 500 school personnel; in-depth analyses of seven national data sets; interviews with 50 leading experts in a broad range of fields; five focus groups with students, parents and school personnel; and a review of 2,000 scientific articles and reports.