Objective: To determine the prevalence of substance use among adolescents with juvenile rheumatoid arthritis and to assess available opportunities for physicians to identify those at high risk by describing the adolescents' sources and frequency of health care contacts.

Methods: Mail survey of 52 adolescents aged 12-17 years (mean age 13.9 years, 86% female, 86% Caucasian) regarding use of substances (alcohol, tobacco, marijuana and other illicit substances), use of prescription medications, and frequency and source of health care contacts.

Results: Medication was prescribed by a physician for 69% of the teens in the preceding six months; 32.7% were prescribed methotrexate. Alcohol use was reported by 30.7% of adolescents, including 23.5% of those for whom methotrexate was prescribed. Among alcohol users, 62.5% were classified as experimenters and 37.5% as frequent users. Fifteen percent reported tobacco use in the last year, and 13.4% reported other illicit substance use in their lifetime, although most use was experimental. No adolescent reported marijuana use. The mean age of initiation was 13.6 years for alcohol and 12.7 years for tobacco. Seventy five percent had two or more pediatric rheumatology visits in the preceding year, while 61.4% had two or more visits with other specialists or primary care physicians. Only 34.6% ever sought care without a parent initiating it and only 26.9% were ever interviewed alone by a pediatric rheumatologist.

Conclusion: Many adolescents with juvenile rheumatoid arthritis used substances, especially alcohol. Despite their increased risk for hepatotoxicity, adolescents who were prescribed methotrexate used alcohol at similar rates. Rheumatologists and primary care physicians who see adolescents with juvenile rheumatoid arthritis should routinely screen them for substance use, especially those teens for whom methotrexate may be prescribed. Interviewing adolescents without parents present improves confidentiality and may increase the utility of substance use screening.