How to screen for and treat teen alcohol use

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doi:doi: 10.12788/jfp.0337

Behavioral Health

How to screen for and treat teen alcohol use

J Fam Pract. 2022 January;71(1):31-34 | doi: 10.12788/jfp.0337

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References

1. US Department of Health and Human Services. The Surgeon General’s Call to Action to Prevent and Reduce Underage Drinking. Washington, DC; US Department of Health and Human Services, Office of the Surgeon General. 2007.

2. US Department of Health and Human Services. Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC; US Department of Health and Human Services, Office of the Surgeon General. 2016.

3. Hingson R, White A. New research findings since the 2007 Surgeon General’s Call to Action to Prevent and Reduce Underage Drinking: A review. J Stud Alcohol Drugs Suppl. 2014; 75:158-169.

4. National Institute on Alcohol Abuse and Alcoholism. Underage drinking. National Institute of Health. Accessed December 22, 2021. www.niaaa.nih.gov/publications/brochures-and-fact-sheets/underage-drinking.

5. Hingson R, Zha W, Iannotti R, et al. Physician advice to adolescents about drinking and other health behaviors. Pediatrics. 2013;131:249-257.

6. Schaus JF, Sole ML, McCoy TP, et al. Screening for high-risk drinking in a college student health center: characterizing students based on quantity, frequency, and harms. J Stud Alcohol Drugs Suppl. 2009;16:34-44.

7. National Institute on Alcohol Abuse and Alcoholism. Drinking levels defined. Accessed December 27, 2021. www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking

8. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Arlington, VA; American Psychiatric Association. 2013.

9. Substance Abuse and Mental Health Services Administration. Bringing down binge drinking. Accessed December 27, 2021. www.samhsa.gov/sites/default/files/programs_campaigns/nation_prevention_week/data-binge-drinking.pdf

10. Grant BF, Goldstein RB, Saha TD, et al. Epidemiology of DSM-5 Alcohol Use Disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions III. JAMA Psychiatry. 2015;72:757-766.

11. USPSTF. Screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2018;320:1899-1909.

12. Levy SJ, Williams JF, Committee on Substance Use and Prevention. Substance use screening, brief intervention, and referral to treatment. Pediatrics. 2016;138:e20161211.

13. MacKay AP, Duran CP. Adolescent Health in the United States. National Center for Health Statistics, Centers for Disease Control and Prevention. 2007.

14. Haller DM, Meynard A, Lefebvre D, et al. Effectiveness of training family physicians to deliver a brief intervention to address excessive substance use among young patients: a cluster randomized controlled trial. CMAJ. 2014;186:E263-E272.

15. Borus J, Parhami I, Levy S. Screening, brief intervention, and referral to treatment. Child Adolesc Psychiatric Clin N Am. 2016;25:579-601.

16. Knight J, Roberts T, Gabrielli J, et al. Adolescent alcohol and substance use and abuse. Performing preventive services: A bright futures handbook. Accessed December 22, 2021. American Academy of Pediatrics. https://ocfcpacourts.us/wp-content/uploads/2020/06/Adolescent_Alcohol_and_Substance_Abuse_001005.pdf

17. Dyer ML, Heron J, Hickman M, et al. Alcohol use in late adolescence and early adulthood: the role of generalized anxiety disorder and drinking to cope motives. Drug Alcohol Depend. 2019;204:107480.

18. Blumenthal H, Taylor DJ, Cloutier RM, et al. The links between social anxiety disorder, insomnia symptoms, and alcohol use disorders: findings from a large sample of adolescents in the United States. Behav Ther. 2019;50:50-59.

19. Pedrelli P, Shapero B, Archibald A, et al. Alcohol use and depression during adolescence and young adulthood: a summary and interpretation of mixed findings. Curr Addict Rep. 2016;3:91-97.

20. Davis JP, Dworkin ER, Helton J, et al. Extending poly-victimization theory: differential effects of adolescents’ experiences of victimization on substance use disorder diagnoses upon treatment entry. Child Abuse Negl. 2019; 89:165-177.

21. NIDA. Principles of adolescent substance use disorder treatment: a research-based guide. Accessed December 22, 2021. www.drugabuse.gov/publications/principles-adolescent-substance-use-disorder-treatment-research-based-guide

22. Solhkhah R, Wilens TE, Daly J, et al. Bupropion SR for the treatment of substance-abusing outpatient adolescents with attention-deficit/hyperactivity disorder and mood disorders. J Child Adolesc Psychopharmacol. 2005:15:777-786.

23. Camenga DR, Colon-Rivera HA, Muvvala SB. Medications for maintenance treatment of opioid use disorder in adolescents. J Stud Alcohol Drugs. 2019;80:393-402.

24. American Society of Addiction Medicine. The ASAM clinical practice guideline on alcohol withdrawal management. Accessed December 22, 2021. www.asam.org/quality-care/clinical-guidelines/alcohol-withdrawal-management-guideline

A full and complete biopsychosocial interview with adolescents is a necessity, and should include queries about alcohol, drugs, and other substances. Acknowledgment of use should trigger further investigation into the substance use areas. Interviews may start with open-ended questions about alcohol use at home or at school before moving to more personalized and detailed questioning and use of screening tools.¹⁶

While various screening instruments exist, for the sake of brevity we provide as an example the Screening to Brief Intervention (S2BI) tool. It is an efficient, single-page tool that can help clinicians in their routine care of adolescents to quickly stratify the patient risk of substance use disorder as none/low, moderate, or severe.¹² It can be found here: www.mcpap.com/pdf/S2Bi%20Toolkit.pdf (see page 10).

Studies have demonstrated a strong link between insomnia and anxiety, and again between anxiety and alcohol use disorder.

For all patients, but particularly for adolescents, confidentiality is important, and many specialty societies have created language to address this issue.¹² Discuss confidentiality with both the adolescent patient and the patient’s caregiver simultaneously, with dialogue that includes: (a) the need to speak with adolescents alone during the office visit, (b) the benefits of confidentiality in the physician–patient relationship, and (c) the need to disclose selected information to keep patients safe.¹² Describing the process for required disclosures is essential. Benefits of disclosure include further support for the adolescent patient as well as appropriate parental participation and support for possible referrals.¹²

Treating AUD

Treatment for AUD should be multifaceted. Screen for comorbid mood disorders, such as generalized anxiety,^17,18 social anxiety,¹⁸ and depression,¹⁹ as well as for insomnia.¹⁸ Studies have demonstrated a strong link between insomnia and anxiety, and again between anxiety and AUD.^17-19Finally, screen for adverse childhood events such as trauma, victimization, and abuse.²⁰ Addressing issues discovered in screening allows for more targeted and personalized treatment of AUD.

The National Institute on Drug Abuse categorizes evidence-based treatment into 3 areas: behavioral therapies, family therapies, and medications.²¹

Continue to: Behavioral therapies

References

1. US Department of Health and Human Services. The Surgeon General’s Call to Action to Prevent and Reduce Underage Drinking. Washington, DC; US Department of Health and Human Services, Office of the Surgeon General. 2007.

2. US Department of Health and Human Services. Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC; US Department of Health and Human Services, Office of the Surgeon General. 2016.

3. Hingson R, White A. New research findings since the 2007 Surgeon General’s Call to Action to Prevent and Reduce Underage Drinking: A review. J Stud Alcohol Drugs Suppl. 2014; 75:158-169.

4. National Institute on Alcohol Abuse and Alcoholism. Underage drinking. National Institute of Health. Accessed December 22, 2021. www.niaaa.nih.gov/publications/brochures-and-fact-sheets/underage-drinking.

5. Hingson R, Zha W, Iannotti R, et al. Physician advice to adolescents about drinking and other health behaviors. Pediatrics. 2013;131:249-257.

6. Schaus JF, Sole ML, McCoy TP, et al. Screening for high-risk drinking in a college student health center: characterizing students based on quantity, frequency, and harms. J Stud Alcohol Drugs Suppl. 2009;16:34-44.

7. National Institute on Alcohol Abuse and Alcoholism. Drinking levels defined. Accessed December 27, 2021. www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking

8. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Arlington, VA; American Psychiatric Association. 2013.

9. Substance Abuse and Mental Health Services Administration. Bringing down binge drinking. Accessed December 27, 2021. www.samhsa.gov/sites/default/files/programs_campaigns/nation_prevention_week/data-binge-drinking.pdf

10. Grant BF, Goldstein RB, Saha TD, et al. Epidemiology of DSM-5 Alcohol Use Disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions III. JAMA Psychiatry. 2015;72:757-766.

11. USPSTF. Screening and behavioral counseling interventions to reduce unhealthy alcohol use in adolescents and adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2018;320:1899-1909.

12. Levy SJ, Williams JF, Committee on Substance Use and Prevention. Substance use screening, brief intervention, and referral to treatment. Pediatrics. 2016;138:e20161211.

13. MacKay AP, Duran CP. Adolescent Health in the United States. National Center for Health Statistics, Centers for Disease Control and Prevention. 2007.

14. Haller DM, Meynard A, Lefebvre D, et al. Effectiveness of training family physicians to deliver a brief intervention to address excessive substance use among young patients: a cluster randomized controlled trial. CMAJ. 2014;186:E263-E272.

15. Borus J, Parhami I, Levy S. Screening, brief intervention, and referral to treatment. Child Adolesc Psychiatric Clin N Am. 2016;25:579-601.

16. Knight J, Roberts T, Gabrielli J, et al. Adolescent alcohol and substance use and abuse. Performing preventive services: A bright futures handbook. Accessed December 22, 2021. American Academy of Pediatrics. https://ocfcpacourts.us/wp-content/uploads/2020/06/Adolescent_Alcohol_and_Substance_Abuse_001005.pdf

17. Dyer ML, Heron J, Hickman M, et al. Alcohol use in late adolescence and early adulthood: the role of generalized anxiety disorder and drinking to cope motives. Drug Alcohol Depend. 2019;204:107480.

18. Blumenthal H, Taylor DJ, Cloutier RM, et al. The links between social anxiety disorder, insomnia symptoms, and alcohol use disorders: findings from a large sample of adolescents in the United States. Behav Ther. 2019;50:50-59.

19. Pedrelli P, Shapero B, Archibald A, et al. Alcohol use and depression during adolescence and young adulthood: a summary and interpretation of mixed findings. Curr Addict Rep. 2016;3:91-97.

20. Davis JP, Dworkin ER, Helton J, et al. Extending poly-victimization theory: differential effects of adolescents’ experiences of victimization on substance use disorder diagnoses upon treatment entry. Child Abuse Negl. 2019; 89:165-177.

21. NIDA. Principles of adolescent substance use disorder treatment: a research-based guide. Accessed December 22, 2021. www.drugabuse.gov/publications/principles-adolescent-substance-use-disorder-treatment-research-based-guide

22. Solhkhah R, Wilens TE, Daly J, et al. Bupropion SR for the treatment of substance-abusing outpatient adolescents with attention-deficit/hyperactivity disorder and mood disorders. J Child Adolesc Psychopharmacol. 2005:15:777-786.

23. Camenga DR, Colon-Rivera HA, Muvvala SB. Medications for maintenance treatment of opioid use disorder in adolescents. J Stud Alcohol Drugs. 2019;80:393-402.

24. American Society of Addiction Medicine. The ASAM clinical practice guideline on alcohol withdrawal management. Accessed December 22, 2021. www.asam.org/quality-care/clinical-guidelines/alcohol-withdrawal-management-guideline

How to screen for and treat teen alcohol use

References

Treating AUD

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