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

Behavioral therapies can include group therapy, cognitive behavioral therapy (CBT), motivational enhancement therapy, 12-Step facilitation, and contingency management, in which small rewards or incentives are given for participation in treatment to reinforce positive behaviors.²¹

Family-based therapies, such as brief strategic family therapy, functional family therapy, and multisystem therapy recognize that adolescents exist in systems of families in communities, and that the patient’s success in treatment may be supported by these relationships.²¹

Some medications may achieve modest benefit for treatment of adolescents with AUD. Naltrexone, acamprosate, and disulfiram have all been used successfully to treat AUD in adults²¹; some physicians may choose to use these medications “off label” in adolescents. Bupropion has been used successfully in the treatment of nicotine use disorder,²¹ and a small study in 2005 showed some success with bupropion in treating adolescents with attention-deficit/hyperactivity disorder, comorbid depression, and substance use disorder.²² Naltrexone has also been studied in adolescents with opioid use disorder, although these were not large studies.²³

Adolescents with serious, sustained issues with AUD may require more in-depth treatments such as an intensive outpatient program, a partial hospitalization program, or a residential treatment program.¹⁵ The least-restrictive environment is preferable.¹⁵Families are generally included as part of the treatment and recovery process in those settings.²¹ Some patients may require detoxification prior to referral to residential treatment settings; the American Society of Addiction Medicine has published a comprehensive guideline on alcohol withdrawal.²⁴

THE CASE

Paul’s family physician diagnosed his condition as AUD and referred him for CBT with a psychologist, who treated him for both the AUD and an underlying depressive disorder that was later identified. CBT focused on cognitive restructuring of depressive thoughts as well as support for continued abstinence from alcohol. The patient, with family support, declined antidepressant medication.

After 6 months of treatment, Paul and his parents were pleased with his progress. His grades improved to the point that he was permitted to play soccer again, and he was seriously looking at his future college options.

CORRESPONDENCE
Scott A. Fields, PhD, 3200 MacCorkle Avenue Southeast, 5th Floor, Robert C. Byrd Clinical Teaching Center, Department of Family Medicine, Charleston, WV 25304; sfields@hsc.wvu.edu

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

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