Clinical Briefs

Am Fam Physician. 2002 Feb 1;65(3):513-517.

AAP Statement on Alcohol Use and Abuse

The Committee on Substance Abuse of the American Academy of Pediatrics (AAP) has issued a statement on alcohol use and abuse by children and adolescents. The statement discusses the attitudes, perceptions, influence, and contributing factors, outlines the role of physicians, and provides recommendations for identifying alcohol use and abuse by young persons. The AAP statement appears in the July 2001 issue of Pediatrics.

According to the committee, approximately 9.5 million persons between 12 and 20 years of age reported drinking at least one drink in the previous month, with as many as one half of them reporting that they binge drink and 20 percent reporting that they drink heavily (five or more drinks on the same occasion at least five different days). The percentage of children as young as nine years experimenting with alcohol is increasing.

Experimenting with drinking by teenagers is considered by many to be normal behavior. However, what often may be overlooked is their lack of experience with alcohol, which may cause them to become intoxicated easier than adults. In susceptible adolescents, progression to abuse of alcohol may have a much shorter course than in adults. Adolescents' immaturity and inability to recognize the cognitive or psychosocial effects of long-term alcohol abuse adds to the danger of alcohol use in this population.

Abuse of alcohol should be suspected in adolescents whose tolerance to alcohol intake increases, who try unsuccessfully to decrease or stop alcohol intake, who experience alcohol-related blackouts, and who continue alcohol consumption despite adverse consequences. While several questionnaires are available as screening tools, the AAP includes the CRAFFT questionnaire as part of the committee's statement (see the accompanying table). The AAP policy statement, “Indications for Management and Referral of Patients Involved in Substance Abuse” and the manual, Substance Abuse: A Guide for Health Professionals, are available from the AAP; the “Adolescent Crosswalk” is available from the American Society of Addiction Medicine.

CRAFFT—Questions to Identify Adolescents with Alcohol Abuse Problems*

C

Have you ever ridden in a Car driven by someone (including yourself) who was “high” or had been using alcohol or drugs?

R

Do you ever use alcohol or drugs to Relax, feel better about yourself, or fit in?

A

Do you ever use alcohol or drugs while you are by yourself or Alone?

F

Do you ever Forget things you did while using alcohol or drugs?

F

Do your family or Friends ever tell you that you should cut down on your drinking or drug use?

T

Have you ever gotten into Trouble while you were using alcohol or drugs?


*—Two or more “yes” answers suggest that the adolescent has a serious problem with alcohol abuse.

Adapted with permission from The Committee on Substance Abuse. Alcohol use and abuse: a pediatric concern. Pediatrics 2001;1:185–9.

CRAFFT—Questions to Identify Adolescents with Alcohol Abuse Problems*

View Table

CRAFFT—Questions to Identify Adolescents with Alcohol Abuse Problems*

C

Have you ever ridden in a Car driven by someone (including yourself) who was “high” or had been using alcohol or drugs?

R

Do you ever use alcohol or drugs to Relax, feel better about yourself, or fit in?

A

Do you ever use alcohol or drugs while you are by yourself or Alone?

F

Do you ever Forget things you did while using alcohol or drugs?

F

Do your family or Friends ever tell you that you should cut down on your drinking or drug use?

T

Have you ever gotten into Trouble while you were using alcohol or drugs?


*—Two or more “yes” answers suggest that the adolescent has a serious problem with alcohol abuse.

Adapted with permission from The Committee on Substance Abuse. Alcohol use and abuse: a pediatric concern. Pediatrics 2001;1:185–9.

Some of the major AAP recommendations are listed below:

  • Physicians should discuss alcohol and other drug use with their patients, particularly if risk factors are present (e.g., family history of alcoholism).

  • Physicians should assess their patients' current use of alcohol use in a nonjudgmental manner.

  • Physicians should be able to recognize warning signs of alcohol use or abuse.

  • Physicians should use prenatal and preventive child health care visits to discuss attitudes and family history regarding alcohol use and the effect of role modeling on children.

  • Physicians are encouraged to participate in school, community, and state efforts to promote alcohol-abuse prevention programs.

  • Legislative efforts at the federal and state levels should be continued to mandate a maximum legal blood alcohol level of 0.02 percent for persons younger than 21 years, with appropriate penalties for those who exceed the legal level.

AAP Report on Mercury in the Environment

The Committee on Environmental Health of the American Academy of Pediatrics (AAP) has issued a technical report on mercury toxicity in children that provides current information on the three forms of mercury (elemental, inorganic, and organic) and reviews the sources, toxicity, treatment, and prevention of mercury poisoning. The report appears in the July 1, 2001 issue of Pediatrics.

Although the United States no longer allows the sale of many mercury products and inorganic mercury has been banned, one primary source of contamination is through consumption of fish. According to the AAP report, the U.S. Food and Drug Administration (FDA) set an advisory limit of 1 ppm (1 μg per g) of methyl-mercury in fish and in March 2001, recommended that pregnant women and women of childbearing age avoid eating shark, mackerel, swordfish, and tilefish. Children and breastfeeding mothers should limit intake of shark, swordfish, and other fish that contain more than 1 ppm of mercury to no more than 7 oz per week (about one serving). The FDA recommends that for other types of fish including tuna, children and pregnant women limit their intake to less than 12 oz per week. State advisories on fish intake are available from the Environmental Protection Agency Web site at www.epa.gov/OST/fish/.

The report concludes that all forms of mercury are considered toxic to fetuses and children, and exposure to pregnant women and the general population should be as limited as possible. Physicians should eliminate mercury-containing devices from their offices and encourage parents and caretakers to remove mercury thermometers from the home. Physicians should be aware of folk and cultural practices that may result in mercury exposure. Currently, the FDA is reviewing use of mercury in biologic and pharmaceutical products.

Call for Papers for Family Practice Research Presentations

A call for papers has been issued by the American Academy of Family Physicians (AAFP) for possible presentation at the 2002 Scientific Assembly occurring October 16–20, 2002 in San Diego. Applications must be submitted by April 12, 2002. Membership in the AAFP is not a prerequisite for submission.

Applications may be submitted in two different categories. Category I is for original research relevant to family practice; Category II includes case studies and literature reviews. Each category has six author classifications: family physicians and fellows primarily in academic medicine, family physicians primarily in clinical practice, family practice residents, medical students, international attendees, and others. The international attendee classification is open to anyone outside the United States who conducted clinical or educational research relevant to family medicine.

Up to six first-place winners in Category I and one first place winner in Category II will each receive a cash award of $1,000. Up to six runners-up in Category I and one runner-up in Category II will receive $250 cash awards. All awards are given at the discretion of the Subcommittee on Family Practice Research Presentations. Application forms may be obtained by visiting the AAFP Web site at http://www.aafp.org/assembly/abstract or from Carrie Vickers, Scientific Program Department, AAFP, 11400 Tomahawk Creek Pkwy., Leawood, KS 66211; telephone: 800-274-2237, ext. 6568.

Pocket Guide for Care of HIV/AIDS Patients

The National Resource Center (NRC) of the AIDS Education and Training Centers, supported by the HIV/AIDS Bureau of the Health Resources and Services Administration (HRSA), offers The Pocket Guide to HIV/AIDS Treatment. The guide includes pertinent information on antiretroviral drugs and treatment. Information contained in drug-related tables follows guidelines from the U.S. Department of Health and Human Services.

The guide can be ordered through the HRSA Information Center at http://www.ask.hrsa.gov or via telephone: 888-ASK-HRSA. The guide can also be downloaded and printed by accessing www.aids-ed.org/e_nrc.html#pocketguide. Updates are available from the NRC's Web site: www.aids-ed.org.


Copyright © 2002 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.

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