by Lisa Frederiksen
Alcohol use and heavy drinking are common during adolescence and
young adulthood, although the minimum legal drinking age across the
United States is 21 years. Some individuals may start hazardous alcohol
consumption earlier in childhood. The prevalence of problematic
alcohol use continues to escalate into the late adolescent and young adult
age range of 18 to 20 years. Drinking by college-aged students
remains a major issue. Results of recent research that have demonstrated
that brain development continues well into early adulthood1
and that alcohol consumption can interfere with such development2,3
indicate that alcohol use by youth is an even greater pediatric health
concern.
The above is a quote from the American Academy of Pediatrics Committee on Substance Abuse’s, April 12, 2010, “Policy Statement Alcohol Use by Youth and Adolescents: A Pediatric Concern,” published online and available for download. I urge parents, community leaders, policy makers, teachers and school administrators to read this article. It presents the new brain research and study findings as the reasons for Pediatricians to take an ongoing, proactive approach to consulting with their patients about underage drinking. Below are the 16 recommendations Pediatricians and other health care providers who work with children and adolescents are encouraged to do:
1. Become knowledgeable about all aspects of adolescent alcohol, tobacco, and other substance use through participation in training program curricula and/or continuing medical education that provide current best-practices training, including media-literacy training.
2. Obtain a complete family medical and social history at prenatal and health supervision visits to explore potential genetic and family influences regarding alcohol and other substance use.
3. Recognize risk factors for alcohol (as well as other drug) use among youth and be aware of coexisting mental health problems, such as depression, that may occur in this age group.
4. Regularly screen for current alcohol (as well as other drug) use by adolescents and young adults by using nonjudgmental, validated screening methods and appropriate
confidentiality assurances.
5. Assess patients whose screening results are positive for alcohol use to determine the appropriate level of intervention.
6. Use brief intervention techniques in the clinical setting and be familiar with motivational interviewing techniques to work with patients who use alcohol but do not meet criteria for immediate referral. Offer referral to treatment when indicated.
7. Discuss the hazards of alcohol and other substance use with patients as part of anticipatory guidance and patient/parent education at health supervision visits as well as when relevant at acute-problem visits. Anticipatory guidance aligned with key school calendar events, such as proms and graduation, may be especially meaningful.
8. Strongly advise against the use of alcohol, tobacco, and other illicit drugs by youth.
9. Encourage parents to be good role models for healthy life choices and never allow underaged drinking at their home or other property. Empower parents with the realization that their involvement with their adolescents is a powerful deterrent of substance abuse.
10. Be familiar with local resources to which various pediatric-aged patients with alcohol use disorders, their parents, and other family members can be referred for developmentally appropriate treatment.
11. Support adolescents with substance use disorders throughout and after their treatment.
12. Serve as a resource and support for school and other community-based alcohol use prevention programs.
13. Support advocacy efforts to promote appropriate media modeling of alcohol consumption and consequences, including print media, television, film, and the Internet.
14. Support advocacy efforts to promote legislation that reduces alcohol-related morbidity and mortality, such as graduated driver licensing; treatment parity from third-party payers; legal ramifications for parent sponsorship of adolescent drinking; increased alcohol excise taxes; and other prevention and treatment policies recommended in the Surgeon General’s call to action.
15. Support continuation of the age of 21 as the minimum legal drinking age, and support enforcement that decreases access to alcohol for minors.
16. Support further research into prevention, evidence-based screening and identification, brief intervention, and management and treatment of alcohol and other substance use by adolescents.
To better understand what problematic underage drinking is, the following is the CRAFFT Questions suggested for use by Pediatricians.
CRAFFT Questions: A Brief Screening Test of Adolescent Substance Abuse
C Have you ever ridden in a car driven by someone (including yourself) who was “high” or had been using alcohol or drugs?
R Do you ever use alcohol or drugs to relax, feel better about yourself, or fit in?
A Do you ever use alcohol or drugs while you are by yourself, alone?
F Do you ever forget things you did while using alcohol or drugs?
F Do your family or friends ever tell you that you should cut down on your drinking or drug use?
T Have you ever gotten into trouble while you were using alcohol or drugs?
Two or more yes answers suggest a significant problem, abuse, or dependence. The CRAFFT questions were developed with grant support from the Robert Wood Johnson Foundation, the National Institute on Alcohol Abuse and Alcoholism, and the Substance Abuse and Mental Health Services Administration.
Source for all of the above: THE AMERICAN ACADEMY OF PEDIATRICS PEDIATRICS® Volume 125, Number 5, May 2010 1083 Downloaded from www.pediatrics.org on May 11, 2010.
