Editorial Comment:  Accepting the things we cannot change, changing the things we can

The US Preventive Services Task Force (USPSTF, partners and conflicts of interest disclosures: https://www.uspreventiveservicestaskforce.org/Page/Name/about-the-uspstf ) is a non-governmental organization whose statement regarding screening for illicit drug use is linked below. The screening tools under consideration do not include assays identifying the presence of illicit substances in fluids or tissue. The recommendations regarding screening for adults are relatively directive: briefly, the organization recommends that it should be done, for adults. Interestingly, recommendations relating to children and adolescents are not forthcoming, for want of data regarding the risks associated with screening and disclosure. To some, this will seem too cautious, given the vulnerability and sensitivity of that population to use of illicit substances. But the USPSTF’s reputation relies on its objectivity. And a close reading of the source document (https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementDraft/drug-use-in-adolescents-and-adults-including-pregnant-women-screening ), in the section on adolescents aged 12 to 17 years, includes the following suggestive remark on current practice: “About 50% to 86% of pediatricians report routinely screen for substance use and most screen using their clinical impressions rather than a validated screening tool." 

Some weeks ago, at a conference that included U.S. and international high school students and their teachers, one kid stood to ask me a series of questions regarding Destiny.  Or, more specifically, he wanted answers regarding destiny; in this case, of family members whose parents and more remote antecedents suffer or suffered from alcohol addiction, further complicated by a high penetrance of bipolar disorder. After a few minutes of exchange, it was clear that he was speaking of himself; and that his wariness regarding his own future use was more like desperation. His one experience with drinking had been some glasses of wine at dinner in the home of an Italian host, the year before.  But his experience of alcoholism was far more extensive.  He was looking ahead, to children of his own.   16 years old, athletic and tall, he appeared to be in his early 20s, an unlikely candidate for carding.  My responses were of the usual cautionary type: postpone any alcohol until as late as possible, maintain non-drinking friendships, Alateen, ask how much drinking means to you, watch the science with attention to genomics, read Marc Schuckit.  When I was done, and had given him my contact data, he seemed content.  Maturity includes accepting the limits of your teachers.

He reminded me that for millennia, the physician's role was rarely to produce a cure; more often to provide a diagnosis and sometimes a prognosis.

- Bill Haning, MD, DFASAM