Alcohol is the drug most frequently used by teenagers in the United States. Underage drinking has long been an important issue for family physicians who care for these young patients, and many FPs deal with it on a daily basis in their practices. Now, however, the issue has grown even more significant, as so-called binge drinking has emerged as another common problem among teens.
In response to this public health threat, the National Institute on Alcohol Abuse and Alcoholism, or NIAAA, and the American Academy of Pediatrics, or AAP, have developed a resource designed to prevent alcohol-related problems in teens before they start or to detect these problems at an early stage. Still, says one family physician, it's up to clinicians to make a conscious decision to start conversations about alcohol use with their adolescent patients.
- The National Institute on Alcohol Abuse and Alcoholism and the American Academy of Pediatrics have created a quick and effective alcohol screening guide for young people.
- The goal of the guide is to prevent problems with alcohol in teens before they start or to detect these problems at an early stage.
- The guide includes a two-question alcohol screening tool that asks about the patient's and the patient's friends' drinking habits.
- The guide also offers pointers about brief interventions and motivational interviewing.
Numerous studies have shown that underage and binge drinking can have many adverse consequences for teens, including academic problems, injuries, increased risk for alcohol dependence, possible alteration of the function and structure of the brain, and even death. Moreover, even one risky behavior among this age group serves as a marker for other unhealthy behaviors, such as using illicit drugs or having unprotected sex.
"People who start drinking before the age of 15 are much more likely to have alcohol problems later in life than those who begin drinking at age 21 or older," says Pamela Hyde, administrator of HHS' Substance Abuse and Mental Health Services Administration, in an NIAAA news release(www.niaaa.nih.gov) announcing publication of the guide. "By helping clinicians identify underage drinking early, this simple and straightforward tool will help young people avoid behaviors that prevent them from achieving their full potential."
Research also has demonstrated, however, that health care professionals report difficulty broaching this topic with their teenage patients for a number of reasons, including not having enough time during office visits, being unfamiliar with appropriate screening tools and being uncertain about how to manage a positive screen.
A new report(www.samhsa.gov) from the Substance Abuse and Mental Health Services Administration, or SAMHSA, indicates that from 2005 to 2009 (the latest year for which figures are available) there was a sharp increase in the number of ER visits associated with the use of nonalcoholic energy drinks -- from 1,128 visits in 2005 to 13,114 visits in 2009. The highest number of energy drink-related ER visits actually occurred in 2008, with 16,055 visits.
According to the SAMHSA report, 44 percent of these ER visits involved energy drinks combined with other substances, such as alcohol, pharmaceuticals or illicit drugs. The proportion of combined use of energy drinks and other substances was greatest among adults ages 18 to 25 (52 percent).
The report, Emergency Department Visits Involving Energy Drinks, is based on data from SAMHSA's 2005-09 Drug Abuse Warning Network, or DAWN, reports. DAWN is a public health surveillance system that monitors drug-related hospital emergency department visits reported throughout the nation.
Alcohol Screening and Brief Intervention for Youth: A Practitioner's Guide(pubs.niaaa.nih.gov) "introduces a two-question screening tool and an innovative youth alcohol risk estimator to help clinicians overcome time constraints and other common barriers to youth alcohol screening."
Developed primarily through survey research and studies that spanned an eight-year timespan and included 166,000 patients ages 12-18, the alcohol screening tool includes one question about the drinking habits of the patient and a second question about the drinking habits of the patient's friends. The risk assessment chart puts the patient's answers to personal drinking frequency questions in the context of his or her age and whether he or she has friends who drink to determine risk level.
In addition to the two-question screening tool and alcohol risk chart, the new guide provides family physicians with
- information about different levels of intervention,
- tips for alcohol-related topics to cover with young patients and
- an overview of motivational interviewing.
Still, says family physician Daniel Vinson M.D., M.S.P.H., of Columbia, Mo., "The challenge remains: How can we integrate screening and treatment into routine clinical work? We say we don't have time, but I think it's the culture of medical practice."
But that view, he notes, is subject to change. "We can start asking. We can learn skills to make the conversation that follows a positive screen more comfortable and more effective.
"I think it's far more important how we ask teens about drinking and drug use than what we ask."