Two-question teen screening tool predicts future alcohol use, drinking problems

Michael G Burke, MD

Adolescents who initially screened as being at highest risk for alcohol problems on a 2-question screen were more likely than their peers to have more drinking days and be at higher risk for alcohol use disorders (AUDs) at 1, 2, and 3 years after the screen, a large study showed. Participants were 12- to 17-year-olds treated for a non–life-threatening injury, illness, or mental health condition in 1 of 16 pediatric emergency departments (EDs).

The questions on the screen, which was developed by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), address if and on how many days the participant had more than a few sips of alcohol and if and how much his or her friends drink. The questions differed slightly for middle school and high school students. Participants numbered 2209 for the initial screen, with somewhat fewer completing each of the successive 3 follow-ups.

Participants who were classified as nondrinkers at baseline had the fewest drinking days at all 3 follow-ups, whereas those who were considered at highest risk for drinking had the most. Further, the screen accurately predicted AUD diagnoses 1 and 2 years after the initial screening but did it somewhat less well for diagnoses 3 years ahead (Linakis JG, et al. Pediatrics. 2019;143[3]:e20182001).

Thoughts from Dr. Burke

So, the 2- question screen suggested by the NIAAA (https://pubs.niaaa.nih.gov/publications/Practitioner/YouthGuide/YouthGuide.pdf) works in screening both for current AUD and for high risk of development of the disorder within a few years. The screen is quick, but, as with every screening tool, you need to be ready with a plan when the response is positive. The SBIRT (screening, brief intervention, referral for treatment) model requires that you know resources for referral in your community. Do your homework before you start.