TABLE 1

Substance Use Spectrum and Goals for Office Intervention

StageDescriptionOffice Intervention Goals
AbstinenceThe time before an individual has ever used drugs or alcohol (more than a few sips)Prevent or delay initiation of substance use through positive reinforcement and patient/parent education
ExperimentationThe first 1–2 times that a substance is used and the adolescent wants to know how intoxication from using a certain drug(s) feelsPromote patient strengths; encourage abstinence and cessation through brief, clear medical advice and educational counseling
Limited useUse together with ≥1 friends in relatively low-risk situations and without related problems; typically, use occurs at predictable times such as on weekendsPromote patient strengths; further encourage cessation through brief, clear medical advice and educational counseling
Problematic useUse in a high-risk situation, such as when driving or babysitting; use associated with a problem such as a fight, arrest, or school suspension; or use for emotional regulation such as to relieve stress or depressionAs stated above, plus initiate office visits or referral for brief intervention to enhance motivation to make behavioral changes; provide close patient follow-up; consider breaking confidentiality
AbuseDrug use associated with recurrent problems or that interferes with functioning, as defined in the DSM-IV-TRContinue as stated above, plus enhance motivation to make behavioral changes by exploring ambivalence and triggering preparation for action; monitor closely for progression to alcohol and other drug addiction; refer for comprehensive assessment and treatment; consider breaking confidentiality
Addiction (dependence)Loss of control or compulsive drug use, as defined in the DSM-IV-TR as “dependence”As stated above, plus enhance motivation to accept referral to subspecialty treatment if necessary; consider breaking confidentiality; encourage parental involvement whenever possible
  • DSM-IV-TR indicates Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision.