Adolescent Drug Screening and Limitations
Adolescent Drug Screening and Limitations
Adolescent Drug Screening and Limitations
I would explain the limitation to drug testing to the patient and her grandmother. Levy et al. (2014) stated that the American Academy of Pediatrics (AAP) noted that blood testing for drugs helps detect alcohol and other drug use within the past two to 12 hours. Blood testing is intrusive and requires special equipment and personnel; these limitations make blood testing rare in primary care settings. Urine drug screening (UDS) is less invasive and allows for a more extended detection period for some substances, and is the more prevalent screening method used in primary care. There are two types of UDS available: qualitative testing for screening and quantitative for confirmation. False-positive and false-negative results are common with UDS, and the AAP advises clinicians to seek verification assistance from the testing laboratory with test result interpretations.
Levy et al. (2014) stated that the AAP strongly recommends protecting the dignity of the adolescent in question and attaining a reasonable balance between the teen’s overall health and the necessity of such testing. Forgoing a drug test and basing clinical decisions on the patient’s health history and physical examination will help establish or preserve a provider-patient relationship. If there is a suspicion of illicit drug use, the clinician can refer the patient for further evaluation by a mental health provider. The AAP cautions against involuntary drug testing in adolescents. If the child is competent, drug testing without her consent is impractical, erodes her trust in health care providers, and testing without her knowledge is unethical.
Guidelines for Adolescent Depression in Primary Care (GLAD-PC)
I would use the Guidelines for Adolescent Depression in Primary Care (GLAD-PC) tool, as recommended by the American Academy of Pediatrics (Zuckerbrot et al., 2018). The guidelines distinguish from mild, moderate, and severe forms of major depressive disorder (MDD).
Five Targeted Questions
Before asking the patient health history questions, I would ask the grandmother to leave the room to provide the patient with privacy and answer the questions more candidly. Prior to administering the GLAD-PC questionnaire to the patient, I would first prompt her by asking questions relating to those included on the scale (one through four):
1. Your grandmother mentioned that you had lost interest in singing in the youth choir; why do you think this has happened?
2. What is the most challenging part of your life right now?
3. How do you feel about your mom’s incarceration?
4. What do you like to do for fun in your spare time?
5. Would you consent to a drug screen? (I would not perform the test without the patient’s consent, and only if both the patient and her grandmother now understood the limitations of drug testing)
After asking these targeted questions, I would ask the patient to complete the GLAD-PC questionnaire and continue gathering information for completing the patient’s health history.
References
Gerlach, J. (2020). Teens of incarcerated parents: A group counseling intervention for high school counselors [PDF]. Journal of School Counseling, 18(16). https://files.eric.ed.gov/fulltext/EJ1254173.pdf
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