Drugs and Drinking

There is no one "right" way to approach the topic, but the following tactics can be helpful:

•Start with a generalized conversation and open-ended questions: eg, "Many of my teenage patients tell me their friends sometimes try drugs and alcohol. What kinds of things have your friends talked about trying?"

•As the adolescent answers, start bringing the conversation closer to home. "It must be a challenge for you to be at a party where your friends are drinking and getting drunk. How do you deal with it when they offer you (or pressure you with) something to drink?"

•Congratulate the teen who continually insists that he has never indulged in any of these substances for making good, mature decisions for his health.

•If the teen admits to trying various substances, be careful not to sound judgmental. Explore the benefits (and consequences) the teen gets from the substance use, how it makes him feel the next day, how often he is using the substance.

•When you identify a substance use problem, encourage a follow-up appointment. Let the teen know that you can see why he is attracted to the substance, but that you have concerns for his safety.

•Suspected habitual substance use by a teenager who will not follow up with you constitutes a safety issue that requires breaking confidentiality.