Presentations
- Alcohol and nicotine use, including vaping
- Intoxication and overdose
- Misuse of prescription drugs
- Polysubstance use
- Problematic substance use
- Withdrawal syndromes:
- acute agitation
- cravings
- insomnia
- seizures
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a developmentally comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
- consider the impact of illness and disease on growth and the bidirectional impact on education, peers, and family relationships
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
- identify educational / vocational pathways
Conditions
- Alcohol use disorder
- Cannabis hyperemesis syndrome
- Cannabis use disorder
- Common disorders which are amplified or unmasked by substance use, such as:
- attention deficit hyperactivity disorder (ADHD)
- bipolar affective disorders
- conduct disorder
- depression and anxiety
- psychotic disorders
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- recognise the clinical presentation
- identify relevant epidemiology, prevalence, pathophysiology, and clinical science
- take a developmentally comprehensive clinical history
- conduct an appropriate examination
- establish a differential diagnosis
- plan and arrange appropriate investigations
- consider the impact of illness and disease on patients and their quality of life when developing a management plan
- consider the impact of illness and disease on growth and the bidirectional impact on education, peers, and family relationships
Manage
- provide evidence-based management
- prescribe therapies tailored to patients’ needs and conditions
- recognise potential complications of disease and its management, and initiate preventative strategies
- involve multidisciplinary teams
Consider other factors
- identify individual and social factors and the impact of these on diagnosis and management
- identify educational / vocational pathways
- Adverse childhood events associated with adolescent substance use
- Common mental illness and neurodevelopmental comorbidities associated with adolescent substance use
- Higher prevalence of substance use and behavioural addictions among minority populations, and the social determinants of health that contribute to this inequity
- Natural history of substance use in adolescents, and the long-term effects of this into adulthood
- Neurobiology of addiction, and the key neurotransmitters and neurocircuitry pathways involved
- Pharmacokinetics and pharmacodynamics of addictive substances, such as alcohol, cannabinoids, and nicotine
- Physiology of tolerance and withdrawal
- Primary, secondary, and tertiary prevention strategies for young people who use substances
- Public health burden of substance use in young people, including emergency service utilisation, school or vocational disengagement, and crime
- Spectrum of substance use, and that substance use and substance use disorders exist on a continuum of severity
- Trends in substance use by young people, such as:
- alcohol
- illicit substances
- prescription drugs
- tobacco and vapes
- Appropriate use and interpretation of drug testing, such as urine drug screening
- Blood tests to identify complications of substance use, such as blood-borne viruses
- Home, Education / employment, Eating / exercise, Activities, Drugs and alcohol, Sexuality, Suicide and depression, Safety (HEEADSSS) framework to screen for drug and alcohol use
- Targeted physical exams to assess for complications arising from substance use, including:
- abdominal, such as:
- cardiac, such as:
- endocarditis
- hypertension / cardiomyopathy
- neurology, such as:
- respiratory, such as:
- skin, such as:
- Validated alcohol and other drugs (AOD) instruments to assess for various parameters of substance use, such as:
- Alcohol, Smoking and Substance Involvement Screening Test – youth (ASSIST-Y)
- Alcohol Use Disorders Identification Test (AUDIT)
- Australian Treatment Outcomes Profile (ATOP)
- Car, Relax, Alone, Forget, Friends, Trouble (CRAFFT)
- Basic principles of motivational interviewing
- Brief interventions (ask, assess, advise, assist, arrange):
- behavioural
- pharmacotherapies
- psychological modalities
- Comorbidity of mental illness and substance use, and the importance of addressing both as dual diagnoses
- Concepts of trauma-informed care
- Critical importance of early intervention, opportunistic screening, and prevention in adolescent substance use
- Harm minimisation and commonly available strategies
- Impact of adolescent substance use on families, and interventions to support them
- Multidisciplinary approach, avoiding stigmatising language and adhering to principles of confidentiality
- Referral to specialist addiction services
- Risk factors for ongoing substance use problems, such as:
- blood-borne viruses
- development of substance use disorder
- mental health crisis
- overdose and death
- sexually transmitted infections
- unplanned pregnancies
- Specific considerations needed for the following groups:
- Aboriginal and Torres Strait Islander peoples and Māori adolescents
- adolescents whose parents have a mental illness or substance misuse
- adolescents with a disability
- homeless young people
- LGBTQIA+ adolescents
- neurodiverse young people
- refugee and asylum seeker families
- socioeconomically disadvantaged young people
- victims of physical and/or sexual abuse
- young people in custody or out-of-home care
