Lesson Learned "medical school"


Going back to medical school curriculum, learning what can help our adolescent students who are using and misusing substances of abuse, is eye opening. Basics still apply to the all-important physician-patient relationship. But to a Doctor who is also a member of the Board of Education, the day-to-day scene can be confusing. Over eight years ago I was surprised to quickly learn that my member role on the Board of Education would include being a judge for our students who have numerous school infractions related to substance use and abuse. Safety first for all applies to managing a school system.

Recently I scouted 55 references, attempting to get a handle on how I can comprehend what is happening and how I can help parents and grandparents and our school community understand and help, too. The scientific approach is to take all variables and reduce them to a common denominator.

Medicine is practiced using these basic steps of the scientific method: 1) make an observation that describes a problem, 2) create a hypothesis, 3) test the hypothesis, and 4) draw conclusions and refine the hypothesis.

A bottom line questionnaire that appeals to me is called “CRAFFT.” Things can be problematic if even 1 item is positive. So, in roughly 74 seconds on paper, or 49 seconds via computer, valuable screening can take place:

During the PAST 12 MONTHS, did you:

1. Drink any alcohol (more than a few sips)? (Do not count sips of alcohol taken during family or religious events.)

2. Smoke any marijuana or hashish?

3. Use anything else to get high? (“Anything else” includes illegal drugs, over-the-counter and
prescription drugs, and things that you sniff or “huff.”)
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If any “yes” responses, then ask all 6 CRAFFT questions:

1. Have you ever ridden in a CAR driven by someone (including yourself) who was “high” or had been using alcohol or drugs?

2. Do you ever use alcohol or drugs to RELAX, feel better about yourself, or fit in?

3. Do you ever use alcohol or drugs while you are by yourself, or ALONE?

4. Do you ever FORGET things you did while using alcohol or drugs?

5. Do your FAMILY or FRIENDS ever tell you that you should cut down on your drinking or drug use?

6. Have you ever gotten into TROUBLE while you were using alcohol or drugs?

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Both the American Academy of Pediatrics, of which Araceli, my Physician wife, is a long-term member, and the American Academy of Family Physicians, of which I am a long-term member, endorse the CRAFFT screen as a valuable diagnostic screening tool.

Of course respecting patient confidentiality is very important for a therapeutic relationship. The “Split-Visit” model works best with parents and adolescent beginning together. This is important for the BOE judge role as well as the parental safety role. But then having the parents leave, so confidentiality can be nurtured and maintained, is vital for creating an atmosphere of therapeutic change.

The “Split-Visit” model must be explained so parents’ expectations and boundaries are clarified, and so an adolescent dealing with substance use and abuse can have a bridge to health and vitality. Early identification is ideal, using screening and interventions to prevent or reduce substance abuse in children or adolescents.

There are many other lessons to learn, but this is a good start.

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