About This Guide

NIAA created this Guide to help you conduct fast, effective alcohol screens and interventions with your patients, even during brief, acute care visits. The tools, tips, and resources are designed to help you surmount common obstacles to youth alcohol screening in primary care. Typical barriers include insufficient time, unfamiliarity with screening tools, the need to triage competing problems, and uncertainty about how to manage a positive screen (Van Hook et al., 2007).

It's about time - yours and your patients'

In primary care, your time is at a premium. Time is also of the essence for your patients who may be considering, experimenting with, using, abusing, or even becoming dependent on alcohol. With this in mind, we wanted you to have the shortest possible alcohol screening tool with the strongest evidence for predicting current or downstream problems in youth. To reach this goal, NIAAA convened a working group of researchers who conducted primary analyses of multiple databases across multiple years. Their extensive analyses boiled down to two questions per patient, varying slightly by age group.

Two powerful questions open the door

One question is about friends' drinking, and the other is about personal drinking frequency (see page 8). The friends' drinking question is an early warning signal that strongly predicts the patient's future drinking levels (Brown et al., 2010). It also allows you a nonthreatening "side-door" entrance to begin talking about alcohol with younger patients in particular. The personal drinking question zeroes in on frequency, the best predictor of current risk for alcohol-related harm in adolescents who are already drinking (Chung et al., 2012). The researchers examined many other questions, but these two by far had the greatest practicality and predictive strength. If you're going to ask about alcohol, these are the questions to ask. For details about the development of the questions, see page 16 and visit https://www.niaaa.nih.gov/alcohols-effects-health/professional-education-materials/alcohol-screening-and-brief-intervention-youth-practitioners-guide.)

The risk estimator can help you triage

Acute care visits generally don't allow time for anticipatory guidance. Even during well-care visits, you'll need to choose the guidance to offer. The risk estimator (see page 10 and the Pocket Guide) broadly indicates your patient's chances for having alcohol-related problems, based on his or her age and drinking frequency. Coupled with what you already know about your patient, it will help you determine the depth and content of your response.

Positive screens become manageable

This Guide's tools will take much of the mystery out of intervening with your patients who are drinking, allowing you to proceed within a clinical framework of lower, moderate, or highest risk (see page 11). Once you determine that a patient is at lower risk, for example, you'll be able to provide brief advice, quickly and with confidence, and move on. For patients at moderate or highest risk for alcohol-related harm, you will have uncovered perhaps the greatest current threat to their health - and still, you can manage it efficiently. The Guide outlines different levels of intervention with tips for topics to cover. It also presents an overview of brief motivational interviewing, an interactive youth-friendly intervention considered to have the best potential effectiveness for the adolescent population (see page 29). 

In addition, the Guide aims to help clinicians overcome other common barriers to screening: concerns about confidentiality (see page 25), a lack of information about coding for counseling about alcohol use (see page 24), and the challenge of finding adolescent treatment resources for referrals (see page 34).

In short, our goal is to support your efforts to protect you patients from alcohol-related harm. And we want to hear from you. Please send us your comments about this Guide - and suggestions for ways to improve our support for you - by email to NIAAAYouthGuide@mail.nih.gov.