Identifying substance use disorders in primary care contexts is difficult for multiple reasons. Like other psychiatric disorders, substance use disorders are typically not associated with objective physical findings, and laboratory test results alone are not sufficient to make a diagnosis or monitor response to treatment. Furthermore, in contrast to most other psychiatric disorders, patient with substance use disorders often attempt to conceal rather than reveal true patterns of use, both in primary care and specialty settings. Even in acute clinical situations where evidence of a substance use disorder is readily apparent, such as hospitalization for alcohol withdrawal, users may under-report their overall pattern of use, particularly with respect to comorbid illicit substance use [5]. As a result, for each individual identified as needing treatment for a substance use disorder, a large number of other users never come to clinical attention. This is particularly concerning in child and adolescent populations, where there is the greatest potential for a change in an individual’s long-term psychosocial and physical health trajectory as well as for clinical outcomes.
