Wednesday, April 28, 2010

American Academy of Pediatrics Policy Alcohol

The American Academy of Pediatrics issued a new policy statement in regard to underage drinking which succinctly outlines the risks as well as recommendations. Alcohol use and abuse is very common in adolescents and after nicotine is the drug used more than any other in this age group. The policy highlighted information from the National Longitudinal Alcohol Epidemiologic Study which cites some interesting statistics. Individuals who first use alcohol at 12 years or younger have 40.6% risk of developing alcohol dependence. For those who use first prior to 18 the incidence of alcohol dependence is 16.6% and for those who abstain until 21 the incidence is 10.6% which is about the lifetime risk for the general population. This is very striking.

The policy paper highlights the fact that early alcohol use is associated with greater sexual risk taking, academic difficulties, other substance abuse, criminal or violent behavior, suicide attempts and motor vehicle crashes. Accidents,homicide, and suicide are the three leading factors for death in adolescents so it is probably fair to say that alcohol misuse is the leading cause of adolescent death in the United States. It also points out that because of the immaturity of the brain at this point that there is greater vulnerability to the toxic effects of alcohol.

The policy statement recommends that pediatricians routinely screen for substance use and abuse, that they use a particular well validated tool, the CRAFFT which is a six item questionnaire and that they use motivational interviewing as the best way to address identified problems. Motivational interviewing focuses on empathy, development of discrepancy between patient goals and current behavior, avoiding arguing with the patient and supporting patients to make decisions for themselves. Confrontation is not recommended and is seen as counterproductive.

I am very glad that the American Academy of Pediatrics is highlighting the issue of substance abuse and I hope substance abuse issues become a major part of adolescent health visits.

Thought for the day

Behavioral issues are the leading cause of morbidity and mortality in adolescents but the resources expended here are less than other pediatric illnesses.

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