Screening for Alcohol Use in Adolescents
The US Preventive Services Task Force recommends screening and counseling interventions directed at unhealthy alcohol use by adults, and the National Institute on Alcohol Abuse and Alcoholism as well as the American Academy of Pediatrics recommend alcohol use screening of adolescents. Alcohol is the most commonly abused substance in teens, and much has been published about binge drinking in adolescents, generally referred to as 3-4 drinks over a 2-hour period on any given day. Underage drinking is also associated with the most common causes of adolescent death, including unintentional injuries, homicides, and suicides.
Hingson and colleagues surveyed practitioners to determine the proportion of adolescents who receive screening and counseling for alcohol use. These data were collected as part of the NEXT Generation Health Study, which sampled 10th graders in high schools in the United States in 2010
The students were in multiple school settings (public, private, etc.) across 9 US Census divisions. Recruitment was by school, and 58% of the schools that were approached participated. The average age of respondents was 16.2 years, and 55% were girls. The demographics were 42% white, 34% Hispanic, and 18% black, with small percentages of other racial or ethnic groups.
Students were asked whether they had a check-up with a physician in the last year and whether they were asked at that visit about their use of alcohol, smoking, or drugs, and degree of exercise. Students were also asked whether, during the healthcare visit, they were advised about the risks associated with unhealthy behaviors and received advice to stop drinking. Students were also asked to complete a recall of alcohol consumption in the preceding 30 days. They were asked how many times they got drunk and how many times they had 5 or more drinks (boys) or 4 or more drinks (girls) on any occasion during the previous month. Other questions pertained to frequency of other drug use, cigarette smoking, and the number of days in the previous week that they exercised for at least 60 minutes.
The students’ responses to the survey are summarized in the table below
Table. Student Responses to Survey
|Survey Question||“Yes” Response|
|Had at least 1 drink in past 30 days||36%|
|Binge drinking at least once in past 30 days||28%|
|Drunk at least once in past 30 days||23%|
|Drank ≥ 6 times in past 30 days||11%|
|Binge drinking ≥ 6 times in past 30 days||5%|
|Drunk ≥ 6 times in past 30 days||7%|
|Cigarette smoking in past 30 days||19%|
|Marijuana smoking in past year||25%|
|Other drug use in past year||13%|
|Had health visit with physician in past year||82%|
|Asked about cigarette smoking at visit||57%|
|Asked about exercise habits at visit||72%|
|Asked about alcohol consumption at visit||54%|
|Advised by physician about health risks of drinking||40%|
|Counseled by physician to reduce or stop drinking||17%|
|Asked about marijuana or other drug use at visit||55%|
A correlation was found between physicians asking about drinking and subsequent provision of counseling to reduce or stop drinking, suggesting that asking the question leads to further discussion with students who are frequent drinkers, binge drinkers, or who are often drunk. However, students who reported drinking at least 6 times within 30 days were more likely to be advised about alcohol-related risks (odds ratio, 1.8; 95% confidence interval, 1.1-3.0
Despite the high frequency of physician visits, only half of 12- to 15-year-old adolescents were asked about drinking. Fewer than half were counseled about the effects of drinking. Those with higher frequencies of drinking, binge drinking, or frequent episodes of being drunk were more likely to have been asked about alcohol consumption and to have been counseled about it.
I reviewed this study not to point out how infrequently providers screen for alcohol and other substances of abuse but to remind us all how commonly 10th graders drink alcohol, use drugs, and smoke tobacco. Even when problem drinking behaviors were identified, adolescents were advised about the risks or urged to stop drinking much less often than similar advice was given to students who smoked or used drugs frequently. The National Institute on Alcohol Abuse and Alcoholism provides a useful resource for clinicians who would like to increase their level of knowledge and comfort in screening and counseling adolescents in office settings.