Teens’ alcohol risk predicted with 2 quick questions

As a busy pediatrician, you likely find it difficult to find time during rushed office visits to screen patients for issues such as alcohol abuse. But what if you could accurately assess risk for alcohol-related problems with just 2 straightforward questions?

That is now possible with a new tool developed in collaboration with the American Academy of Pediatrics (AAP), the Alcohol Screening and Brief Intervention for Youth: A Practitioner’s Guide.

The tool, available from the National Institute on Alcohol Abuse and Alcoholism (NIAAA), includes 2 questions-one that asks how often the patient uses alcohol and the other that inquires about friends’ drinking habits-that have been shown to have the greatest accuracy in predicting current or future alcohol issues in young people.

“Clinicians who care for young people are well aware of the many harms caused by underage drinking,” noted Sharon Levy, MD, MPH, chair of the AAP’s Committee on Substance Abuse and assistant professor of pediatrics at Harvard Medical School. “The guide takes much of the mystery out of intervening with young patients who are drinking, allowing clinicians to proceed within a clinical framework of low, moderate, or high risk. It will enable pediatricians and other clinicians who care for young people to easily incorporate alcohol screening across the care spectrum, from annual visits to urgent care.”

Underage drinking, especially binge drinking, not only causes short-term academic and social problems but also is associated with even more serious health consequences, such as increased risk for alcohol dependence, disruptions in brain development, injuries, and even death. The risk increases precipitously during the teenaged years, according to NIAAA, with the proportion of youth using alcohol increasing from 7% of 12-year-olds to nearly 70% of 18-year-olds.

Researchers convened by NIAAA to extensively analyze data on underage drinking developed the screening tool. The goal was to develop the shortest possible screen that also had strong predictive accuracy.

Developed by the research group, the question “Do you have any friends who drank beer, wine, or any drink containing alcohol in the past year?” was found to be predictive of future levels of alcohol use. And the question “How about you-in the past year, on how many days have you had more than a few sips of beer, wine, or any drink containing alcohol?” was designed to predict current risk in teenagers who already drink. The questions are slightly adapted based on the patient’s age-elementary, middle, or high school.

The questions can be asked quickly, and pediatricians then can use a youth alcohol risk-estimator chart to assess how likely the patient is to have or develop alcohol problems. The guide also provides information on different levels of intervention, if necessary, and even some tips on how to discuss drinking issues with adolescents.

In urging pediatricians to employ the tool, NIAAA pointed out its several advantages: early detection of risk; an empirical basis; efficiency and versatility, and inclusion of information about friends’ drinking.

Go back to the current issue of the eConsult.