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Why pediatricians should screen teens for alcohol use

The five minutes it takes for a physician to screen a teen for alcohol usage may save lives.


As an adolescent medicine physician, I always ask my patients about alcohol usage since it's associated with the leading causes of death and serious injury at this age, including motor-vehicle accidents, suicides, and homicides.

You can imagine my shock when I read a conclusion from the recent U.S. Preventive Services Task Force report about interventions to reduce unhealthy alcohol use in adolescents and adults that said, "… the evidence is insufficient to determine the benefits and harms of screening for unhealthy alcohol use in the primary care setting in adolescents aged 12 to 17 years."

The task force reviews scientific research and makes recommendations that serve as a guide for health-care providers about which screenings and interventions to provide for patients. What happens when the evidence is insufficient and primary-care providers (PCPs) already have limited time with their patients?

PCPs may stop screening teenagers for alcohol use. This is not good on several levels. First of all, the task force based its conclusions on just two studies of adolescents. What's more, their recommendations run counter to those of major professional organizations including the American Academy of Pediatrics, the Society for Adolescent Health and Medicine, the American Society of Addiction Medicine, and the National Institute on Alcohol Abuse.

Screening may identify a dangerous drinking pattern. A teen's typical drinking pattern is often dangerous binge drinking. This is a frenzy of drinking that brings a person's blood alcohol content (BAC) to at least 0.08 as a percentage of total blood volume. It generally equates to about five or more drinks in two hours for males and four or more drinks in two hours for females. A BAC of even 0.06 is associated with impaired reasoning, visual perception, and reaction time. A BAC of 0.20 is associated with loss of consciousness, and a BAC of 0.30 or more may result in death.

Binge drinking is more common than you may think. In 2017, binge drinking was admitted by 17 percent of high school seniors, 10 percent of sophomores, and 4 percent of eighth graders, found a report by Monitoring the Future.

Teens and alcohol don't mix. Alcohol-related car crashes are the leading cause of death for young adults aged 15 to 24 years. Immediate risks include alcohol poisoning, a medical emergency that results from high blood alcohol levels; and risky sexual behaviors, including unprotected sex or sex with multiple partners. These behaviors can result in unintended pregnancy or sexually transmitted diseases.

Over time, excessive alcohol use can lead to high blood pressure, heart disease, stroke, liver disease, digestive problems, learning and memory problems, and mental health problems including depression and anxiety, and cancer including of breast, mouth, and throat.

Screening can identify teens who are likely to have alcohol-use disorder. Positive screening results may lead to a more detailed assessment or a brief intervention to help a patient determine the next course of action.

Screening in the primary-care office can be as simple as three questions. For example, a sequence of questions could go:

  1. How often did you have a drink containing alcohol in the past year?

  2. How many drinks did you have on a typical day when you were drinking in the past year?

  3. How often did you have six or more drinks on one occasion in the past year?

My advice to other PCPs:  Please continue screening teens for alcohol use.  The five minutes it takes to screen may save lives.

My advice to parents: Make sure your teen's PCP is asking about alcohol use. But don't put the onus entirely on the PCP. Alcohol prevention needs to start in the home. Parents have the strongest influence on children and have a major impact on a child's decision to not use alcohol or other drugs. Prevention starts when you start talking with, and listening to, your child.