Introduction
1 in 3 children starts drinking by the end of 8th grade
...and of them, half report having been drunk.
With this Guide, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) introduces a simple, quick, empirically derived tool for identifying youth at risk for alcohol-related problems. If you manage the health and well-being of children and adolescents ages 9-18 years, this Guide is for you. It has been produced in collaboration with clinical researchers and health practitioners such as yourself.
Why choose this tool?
It can detect risk early: In contrast to other screens that focus on established alcohol problems, this early detection tool aims to help you prevent alcohol-related problems in your patients before they start or address them at an early stage.
It's empirically based: The screening questions and risk scale, developed through primary survey research, are powerful predictors of current and future negative consequences of alcohol use.
It's fast and versatile: The screen consists of just two questions that you can incorporate easily into patient interviews or pre-visit screening tools across the care spectrum, from annual exams to urgent care.
It's the first tool to include friends' drinking: The "friends" question will help you identify patients at earlier stages of alcohol involvement and target advice to include the important risk factor of friends' drinking.
Why screen for underage drinking?
It's common: Alcohol is by far the drug of choice among youth. It's often the first one tried, and it's used by the most kids (Johnston et al., 2010). Over the course of adolescence, the proportion of kids who drank in the previous years rises tenfold, from 7% of 12-year-olds to nearly 70% of 18-year-olds (NIAAA, 2011). Dangerous binge drinking is common and increases with age as well: About 1 in 14 eighth graders, 1 in 6 tenth graders, and 1 in 4 twelfth graders report having five or more drinks in a row in the past 2 weeks (Johnston et al., 2011). Chances are, your practice has its share of youth at risk.
It's risky: In the short term, adolescent drinking too often results in unintentional injuries and death; suicidality; aggression and victimization; infections and pregnancies from unplanned, unprotected sex; and academic and social problems (Brown et al., 2008). In the long term, drinking in adolescence is associated with increased risk for alcohol dependence later in life (Hingson et al., 2006; Grant & Dawson, 1997). In addition, heavy drinking in adolescence may result in long-lasting functional and structural changes in the brain (Squeglia et al., 2009).
It's a marker for other unhealthy behaviors: When adolescents screen positive for one risky behaviors - whether drinking, smoking tobacco, using illicit drugs, or having unprotected sex - it's generally a good marker for the others (Biglan et al., 2004). For many kids, drinking alcohol is the first risky behavior tried. So the quick alcohol screen in this Guide can alert you to patients who may need attention for other risky behaviors as well.
It often goes undetected: Most adolescents visit a primary care practitioner every year or two (O'Connor et al., 1999), and many are willing to discuss alcohol use when they are assured of confidentiality (Ford et al., 1997). However, the majority of clinicians do not follow professional guidelines to screen all of their adolescent patients for alcohol use, often citing a lack of confidence in their alcohol management skills as a barrier (Millstein & Marcell, 2003). To offer support in this area, this Guide includes an overview of a promising, teen-friendly approach to promoting change in young drinkers (see page 29).
As a trusted health care provider, you are in a prime position to identify drinking-related risks and problems in your patients and to intervene. Our hope is that the brevity, ease of use, and predictive strength of this new tool will enable you to detect alcohol risks and prevent harm at the earliest possible stage. With this Guide, you have what you need to begin.