A single question on alcohol use frequency appears to be a good screening tool for DSM-5 alcohol use disorder in adolescents aged 12-17 years who live in rural areas, according to a study published in the Journal of Pediatrics.
“Approaches to facilitate screening to identify adolescents with alcohol-related problems are particularly needed for PCPs [primary care practitioners] in rural settings, given higher rates of alcohol use among rural youth,” said Dr. Duncan B. Clark of the University of Pittsburgh, and his associates.
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This study of 1,193 adolescents aged 12-20 years was conducted from September 1, 2008 through June 3, 2015 and was located in the Pennsylvania Wilds region due to the area having the lowest population density and the most proximal rural area to the two universities conducting the studies. The adolescents were patients at six rural primary care clinics.
A threshold of greater than or equal to 3 days with alcohol use in the past year yielded “optimal psychometric performance” for early and middle adolescence: sensitivity of 91%; specificity of 93%; positive predictive value (PPV) of 44%; and negative predictive value (NPV) of 99%. In early adolescence (ages 12-14 years), 1.9% of 479 adolescents met DSM-5 criteria for alcohol use disorder (AUD) in the previous year, and in middle adolescence (ages 15-17 years), 9.5% of 463 subjects met the DSM-5 criteria for AUD in the previous year, the investigators said. However, late adolescents ages 18-20 years were tested by a threshold of greater than or equal to 12 days with alcohol use in the past year, in which 10% of 251 teens met DSM-5 criteria for AUD.
For routine adolescent alcohol screenings, a brief initial screen for DSM-5 AUD is the recommended approach. “In this study, for example, screening for DSM-5 AUD among adolescents ages 12 through 17 years with a threshold of greater than 3 days with alcohol use in the past year resulted in 99% NPV and 44% PPV. Adolescents reporting fewer than 3 days with alcohol use very rarely meet AUD criteria. Among those adolescents with 3 or more days with alcohol use, 44% had AUD,” Dr. Clark and his associates said.
However, in order to find more efficient statistics on underage drinking, screenings have to be improved. “Most practices are not currently using tablet computers to collect information, and integration of this approach into standard practice presents surmountable cost and logistical challenges,” they said.
Find the full story in the Journal of Pediatrics (doi: 10.1016/j.jpeds.2016.02.047).