This article is more than 5 years old. Information may no longer be current.

One question can identify teens at risk for alcohol use disorder

A single question regarding alcohol use frequency during primary care visits can be enough to identify adolescents at risk for alcohol use disorder, according to data published in The Journal of Pediatrics.

According to the researchers, 10% of adolescents aged 15 years and older in rural primary care clinics met the criteria for alcohol use disorder (AUD) set out in the Diagnostic and Statistical Manual of Mental Disorders, 5^th Edition (DSM-5).

“Given the relatively high prevalence of alcohol-related harm among youth, medical organizations recommend routine screening for underage drinking in clinical practice,” Duncan B. Clark, MD, PhD, of the department of psychiatry at the University of Pittsburgh School of Medicine, and colleagues wrote. “However, most adolescents visiting primary care practitioners (PCPs) do not receive alcohol screening and related services, with PCPs citing barriers including time constraints and inadequate training. … Approaches to facilitate screening to identify adolescents with alcohol-related problems are particularly needed for PCPs in rural settings, given higher rates of alcohol use among rural youth.”

To examine the alcohol frequency screening thresholds defined by the National Institute on Alcohol Abuse and Alcoholism Youth Guide when applied to the DSM-5, and to determine alcohol use disorder and use patterns among rural youth, the researchers questioned 1,193 participants aged 12 through 20 years during their primary care outpatient visits. In all, six rural primary care clinics were included.

Participants used a tablet computer to self-report how often they had used alcohol in the past year, the quantity of their use and any DSM-5 alcohol use disorder symptoms. The researchers also determined sensitivity, specificity, positive predictive value and negative predictive value.

According to the researchers, 1.9% of early adolescents, defined as those aged 12 through 14 years, met the DSM-5 criteria for alcohol use disorder in the past year, and reported alcohol use on 3 or more days in the past year yielded a screen with optimal psychometric properties (sensitivity: 89%; specificity: 95%; positive predictive value: 37%; negative predictive value: 100%).

For those aged 15 through 17 years, 9.5% met the alcohol use disorder criteria. Among those middle adolescents, 3 or more days with alcohol use also resulted in optimal screening results (sensitivity: 91%; specificity: 89%; positive predictive value: 50%; negative predictive value: 99%). Among late adolescents aged 18 through 20 years, 10% met the criteria, and alcohol use on 12 or more days in the past year yielded optimal screening results (sensitivity: 92%; specificity: 75%; positive predictive value: 31%; negative predictive value: 99%).

“Adolescent alcohol involvement characteristics were strongly related to age, such that few in the early adolescence group had a significant alcohol involvement history,” Clark and colleagues wrote. “… The present study confirmed that alcohol use frequency demonstrates acceptable psychometric properties as a screen for DSM-5 [alcohol use disorder] among this rural primary care adolescent sample with thresholds and utility similar to those previously reported.” – by Jason Laday

Disclosure: The researchers report no relevant financial disclosures.