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2-question screen predicts adolescent risk for alcohol use disorder
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A two-question screening tool accurately predicted a diagnosis of alcohol use disorder in adolescents, according to research published in Pediatrics.
“The early identification of adolescents who are at high risk may be an important step in preventing the escalation of adolescent alcohol use and misuse and the eventual development of adolescent alcohol use disorders (AUDs) and their sequelae,” James G. Linakis, PhD, MD, the associate director of pediatric emergency medicine at Hasbro Children’s Hospital and Rhode Island Hospital and professor of emergency medicine and pediatrics at the Albert Medical School of Brown University, and colleagues wrote.
The researchers validated the screening tool at 16 pediatric EDs between May 2013 to June 2015. A total of 4,834 participants aged 12 to 17 years who were being treated for non-life-threatening injuries, illnesses or mental health conditions were included in the analysis. The patients completed the National Institute on Alcohol Abuse and Alcoholism (NIAAA) two-question screen on a computer tablet. They also provided information about substance use and risk behaviors, and completed an interview based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) to determine alcohol-use diagnoses.
The two questions differed slightly for middle school and high school students, and were used to categorize the students as nondrinkers, low risk, moderate risk or high risk.
Middle school students were asked, “Do you have any friends who drank beer, wine or any alcohol in the past year?” followed by the question, “How about you? In the past year, on how many days have you had more than a few sips of beer, wine, or any drink containing alcohol?”
High school students were first asked, “In the past year, on how many days have you had more than a few sips of beer, wine, or any drink containing alcohol?” They were then asked, “If your friends drink, how many drinks do they drink on an occasion?”
The researchers reported that the differences in AUDs between baseline NIAAA screen nondrinkers and low-risk drinkers were statistically significant at 1 year (P = .0002), 2 years (P < .0001) and 3 years (P = .0005). The differences in AUDs between moderate drinkers and high-risk drinkers were also significant at 1 year (P = .0001) and 2 years (P = .0088), but not at 3 years.
They used “lower risk” and higher as a cutoff for the prediction of a DSM-5 diagnosis to reach the best combined score for sensitivity (86.2% at 1 year, 75.6% at 2 years, and 60% at 3 years) and specificity (78.1% at 1 year, 79.2% at 2 years, and 80% at 3 years).
“The NIAAA two-question screen provides clinicians with a first step in identifying teens with an alcohol use disorder,” Linakis told Infectious Diseases in Children. “It is important to point out that a positive screen — which is likely to occur in only a small minority of patients — does not mean that the teen definitely has or will definitely develop an alcohol use disorder. Therefore, additional screening will be necessary, and how clinicians should conduct that further screening remains to be determined.”
Other attempts have been made to simplify screening for AUDs in teens. For example, a single-question screen was developed to identify alcohol use in adolescents during primary care visits. The screen had a sensitivity of 89%, a specificity of 95%, a positive predictive value of 37% and a negative predictive value of 100%.
The findings from the NIAAA’s two-question screen “beg the question” of whether EDs should screen all adolescents for alcohol use, according to Scott E. Hadland, MD, MPH, MS, assistant professor of pediatrics at Boston Medical Center and Boston University School of Medicine, and colleagues.
“The [AAP] recommends universal substance use screening, brief intervention and referral to treatment for adolescents presenting to primary care, and increasingly schools are also adopting screening, brief intervention, and referral to treatment,” they wrote in an accompanying editorial. “Conducting universal screening in [EDs] would offer an additional setting in which to identify high-risk adolescents, including the highest risk individuals who might not seek primary care or attend school.” – by Bruce Thiel
Disclosures: The researchers report no relevant financial disclosures.
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