Alcohol is the number 1 substance of abuse for adolescents, used more than tobacco or drugs.1-3 In 2007 and again in 2016, the Surgeon General of the United States issued reports to highlight this important topic,1,2 noting that early and repeated exposure to alcohol during this crucial time of brain development increases the risk for future problems, including addiction.2
Adolescent alcohol use is often underestimated by parents and physicians, including misjudging how much, how often, and how young children are when they begin to drink.1 Boys and girls tend to start drinking at similar ages (13.9 and 14.4 years, respectively),3 but as girls age, they tend to drink more and binge more.4 In 2019, 1 in 4 adolescents reported drinking and more than 4 million reported at least 1 episode of binge drinking in the prior month.4 These numbers have further ramifications: early drinking is associated with alcohol dependence, relapse, use of other substances, risky sexual behaviors, injurious behaviors, suicide, motor vehicle accidents, and dating violence.4-6
Diagnosing alcohol use disorder
The range of alcohol use includes consumption, bingeing, abuse, and dependence.7,8 Consumption is defined as the drinking of alcoholic beverages. Bingeing is the consumption of more than 5 drinks for men or 4 drinks for women in 2 hours, according to the National Institute on Alcohol Abuse and Alcoholism.7 However, the criterion is slightly different for the Substance Abuse and Mental Health Services Administration, which broadens the timeframe to “on the same occasion.”9 While previously known as separate disorders, alcohol abuse (or misuse) and alcohol dependence are now diagnostically classified together as alcohol use disorders (AUDs), per the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5).8 AUD is further stratified as mild, moderate, or severe, depending on the number of criteria that are met by the patient (TABLE).8,10
Alcohol screening
Currently, the US Preventive Services Task Force (USPSTF) does not recommend screening adolescents ages 12 to 17 for AUD, and has instead issued an “I” statement (insufficient evidence).11 While the USPSTF recognizes the potential burdens of adolescent alcohol use, the potential harms of screening include “stigma, anxiety, labeling, discrimination, privacy concerns, and interference with the patient–clinician relationship.”11 The USPSTF also notes that it “did not find any evidence that specifically examined the harms of screening for alcohol use in adolescents.”11
This is at odds with recommendations from the American Academy of Pediatrics (AAP), which in 2011 released a policy statement advocating screening, brief intervention, and referral to treatment for adolescent substance use.12 In the United States, even though 83% of adolescents see a physician at least once each year,12,13 alcohol misuse screening still varies, occurring in the range of 50% to 86% of office visits.12 When screening does occur, it is often based on clinical impression only.12 Studies have shown that when a screening tool is not used, up to two-thirds of substance use disorders may be missed.12-15
Continue to: A full and complete biopsychosocial interview