Screening for Underage Drinking
Screening for underage drinking – how do pediatricians do it and what can we learn from their approach?
NIAAA’s Practioner’s Guide for Screening for Underage Drinking
NIAAA (National Institute on Alcohol Abuse and Alcoholism) has developed a two-question screening tool to help pediatricians broach the often difficult subject of drinking with their patients. And, while it is for pediatricians, the PDF is well work the read for parents, teachers and others who work with young people. Quoting from pages 1-2 of the guide, Alcohol Screening and Brief Intervention for Youth: A Practitioner’s Guide:
Why screen for underage drinking?
It’s common: Alcohol is by far the drug of choice among youth. It’s often the first one tried, and it’s used by the most kids (Johnston et al., 2010). Over the course of adolescence, the proportion of kids who drank in the previous year rises tenfold, from 7 percent of 12-year-olds to nearly 70 percent of 18-year-olds (NIAAA, 2011). Dangerous binge drinking is common and increases with age as well: About 1 in 14 eighth graders, 1 in 6 tenth graders, and 1 in 4 twelfth graders report having five or more drinks in a row in the past 2 weeks (Johnston et al., 2011). Chances are, your practice has its share of youth at risk.
It’s risky: In the short term, adolescent drinking too often results in unintentional injuries and death; suicidality; aggression and victimization; infections and pregnancies from unplanned, unprotected sex; and academic and social problems (Brown et al., 2008). In the long term, drinking in adolescence is associated with increased risk for alcohol dependence later in life (Hingson et al., 2006; Grant & Dawson, 1997). In addition, heavy drinking in adolescence may result in long-lasting functional and structural changes in the brain (Squeglia et al., 2009).
It often goes undetected: Most adolescents visit a primary care practitioner every year or two (O’Connor et al., 1999), and many are willing to discuss alcohol use when they are assured of confidentiality (Ford et al., 1997). However, the majority of clinicians do not follow professional guidelines to screen all of their adolescent patients for alcohol use, often citing a lack of confidence in their alcohol management skills as a barrier (Millstein & Marcell, 2003). To offer support in this area, this Guide includes an overview of a promising, teen-friendly approach to promoting positive change in young drinkers (see page 29).
It’s a marker for other unhealthy behaviors: When adolescents screen positive for one risky behavior—whether drinking, smoking tobacco, using illicit drugs, or having unprotected sex—it’s generally a good marker for the others (Biglan et al., 2004). For many kids, drinking alcohol is the first risky behavior tried. So the quick alcohol screen in this Guide can alert you to patients who may need attention for other risky behaviors as well.
Click here to download the PDF, Alcohol Screening and Brief Intervention for Youth: A Practitioner’s Guide
Why Screening for Underage Drinking is Critical
Routine screening for underage drinking is critical because addiction is a developmental disease that most often begins in adolescence. Early substance abuse while the brain is developing is one of the key risk factors for developing addiction. For more on the adolescent brain and adolescent addiction, check out The Addiction Project.
Lisa Frederiksen
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