AAP Clinical Report on Binge Drinking in Adolescents

National Recovery Month

Pediatricians should talk to kids about the dangers of drinking alcohol starting when the children are as young as 9 years old, a new clinical report from the American Academy of Pediatrics recommends.

Initiating this discussion at such an early age is “absolutely” a “very reasonable” approach, says addictive behavior expert Harris Stratyner, PhD, regional vice president, Caron Treatment Centers, New York City, who trains pediatric residents and fellows in this area.

“That’s the age when kids are becoming aware of what alcohol is,” said Dr Stratyner, who had no role in preparing the new report. “And that’s when the brain starts to formulate and understand that something can be enjoyable, but it can still be deleterious to your health.”

But if the child comes from a family of heavy alcohol users, the conversation should start even earlier. “If the child is exposed at age 7, then that’s a good time to sit them down and talk to them about addiction,” said Dr Stratyner.

If adults do not broach the subject at that early stage, in today’s world, where children see advertisements for alcohol just about everywhere they turn, “you’re going to see kids around the age of 12 start to drink and smoke pot as gateway drugs.”

The new clinical report on binge drinking was published online August 31 and appears in the September issue of Pediatrics.

In-Office Screening

According to the surveys cited in the report, 21% of young people have had more than a sip of alcohol before the age of 13, and 79% have done so by the 12th grade. The proportion who drink heavily is higher among youth who drink than among adult drinkers.

The report also advises pediatricians to screen every adolescent for alcohol use. “Just using one’s clinical impression can underestimate substance use and therefore structured screening instruments are recommended,” write the authors, co-led by Lorena Siqueira, MD, Miami Children’s Hospital.”When time does not permit, alcohol-only screening tools may be a reasonable approach.”

A screening tool developed by the National Institute on Alcohol Abuse and Alcoholism in collaboration with the American Academy of Pediatrics can quickly identify youth at risk for alcohol- related problems, say the authors. It includes only two questions ― one on alcohol use among friends, and the other on use among the patients themselves. The questions are changed slightly depending on the age of the child.

Pediatricians should not only ask whether youngsters ever drink alcohol but also tell these kids why that question is important, said Dr. Statyner. “They need to say that alcohol affects your liver and the liver is an organ in your body that cleans your blood before it goes through your brain.”

This, he said, “raises consciousness” so that kids will think about the consequences of excess drinking. “At 9 years old, you have to raise consciousness so that at 16 years or 17 years, you don’t have binge drinkers” on college campuses.

The report defines binge drinking as the pattern of drinking that brings a person’s blood alcohol concentration (BAC) to 0.08% or greater. In adults, binge drinking refers to the consumption of five or more alcoholic drinks in a row by men, and four or more by women, during a 2-hour period.

Because youth typically weigh less than adults, they are likely to reach a BAC much higher than 0.08% with five drinks in a 2-hour period.

Binge drinking is a common problem. In a 2013 report, 22.9% of Americans aged 12 years and older reported binge drinking in the 30 days before the survey. It revealed that 0.8% of 12- to 13- year-olds and 4.5% of 14- to 15-year-olds reported binge drinking.

Dr Stratyner sees a growing rate of such drinking in his practice. “I’m seeing a lot more binge drinking on weekends among college students,” he said. “I think youngsters are under more pressure, and pressure to self-medicate. They see alcohol as being legal and safe.”

Certain personality characteristics might increase the risk for underage drinking, including sensation seeking, low inhibitory control, and impulsivity, according to the report. Hormonal changes during puberty may affect sensitivity to alcohol, making adolescents less sensitive to the effects of intoxication.

Underage drinkers (those younger than 21 years, which is the legal drinking age in all states) typically obtain alcohol from adults, including from parents, siblings, and other relatives. They drink most often at home or at the home of others.

Costly Habit

Binge drinking among kids is costly. According to a 2006 study, underage drinking was responsible for a median of $361.4 million in economic costs, including healthcare expenditures, lost productivity, court costs, property damage from vehicle crashes and fires, and special education for those with fetal alcohol spectrum.

Adolescents who binge drink are more likely to exhibit poor judgment, such as driving while drunk. Alcohol use is involved in each of the major causes of mortality in adolescents ― accidents, suicides, and homicides ― says the report. In the United States, 50% of all head injuries in adolescents are associated with alcohol consumption.

The developing adolescent brain is more vulnerable to alcohol-induced brain damage and cognitive impairment than the adult brain, says the report.

Binge drinking may result in a “blackout” or losing memory of events that occurred while drinking. During a blackout, drinkers are disinhibited and may engage in risky behaviors, such as having unprotected sex, which increases risk for pregnancy.

Research shows that binge drinking is more harmful to the fetus than more continuous drinking patterns, even if the overall amount of alcohol consumed is less.