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Pediatricians play key role in routine anticipatory guidance on teen alcohol use :

June 24, 2019

Much-needed attention is being paid to the impact of opioid, cannabis and nicotine use among youths in communities throughout the U.S. However, alcohol remains the most widely used substance by teens and has a significant impact on their morbidity and mortality.

To address the problem, the AAP has updated a 2010 policy statement and published a new technical report, both titled Alcohol Use by Youth. The documents, from the Committee on Substance Use and Prevention, are available at https://pediatrics.aappublications.org/content/early/2019/06/20/peds.2019-1356 and https://pediatrics.aappublications.org/content/early/2019/06/20/peds.2019-1357 and will be published in the July issue of Pediatrics.

Dangers of alcohol use

Adults may minimize alcohol use by teens as typical behavior, but it can have negative effects on adolescents’ physical and mental health.

While rates of alcohol use among U.S. youths have declined over the past few decades, 59% of adolescents reported consuming alcohol by 12th grade, and 43% said they had been drunk at least once, according to the 2018 Monitoring the Future study.

Neurodevelopment continues into young adulthood, and the adolescent brain is vulnerable to the negative impacts of alcohol exposure. The younger a person is at first use of alcohol, the greater the likelihood of having an alcohol use disorder later in life.

Furthermore, alcohol use while dealing with anxiety, depression or other mental health impairments increases the risk for suicidal behavior and suicide attempts. This is of particular concern considering the increasing rates of suicide among youths today. Use of alcohol while driving also increases the risk of motor vehicle crashes, which remain the leading cause of death for adolescents.

Family history of alcohol use disorders and environmental influences impact the risk of underage drinking. Social media expose youths to frequent marketing of alcohol products, many of which are produced with flavorings that appeal to young people. There are even how-to videos for making powdered alcohol.

Pediatricians should continue to screen for alcohol use as part of routine care and be aware that classification of substance use disorders shifted with publication of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) in 2013. This impacts the language describing use and the diagnosis of disorders. Any identified use should lead to assessment and consideration of treatment within the pediatric practice or referral to treatment in the community. The policy statement includes a list of resources.

Recommendations for pediatricians

  • Send a clear, consistent message against the use of alcohol by those under age 21 years.
  • Provide anticipatory guidance to youths on alcohol use as part of routine care as outlined in Bright Futures: Guidelines for Health Supervision of Infants, Children and Adolescents.
  • Implement SBIRT (screening, brief intervention and referral to treatment) in everyday practice and screen for alcohol use.
  • Educate families about the hazards of alcohol use in youths and how parents’ alcohol use and disapproval of alcohol use by their children affect youths’ decision to use alcohol.
  • Encourage parents who have an alcohol use disorder to seek evaluation and treatment.
    • Support continued funding and improved availability of substance use treatment services for adolescents and young adults.

Policy recommendations

  • Continue to uphold age requirements of at least 21 years to purchase alcohol products.
  • Uphold state laws that require graduated driver licensing.
  • Advocate for continued research on the impact of alcohol exposure on the developing brain.
  • Support continued taxation of alcohol products.
  • Support state legislation to ban the sale and distribution of powdered alcohol.
  • Develop and review policy related to marketing of alcohol products on social media platforms.
  • Continue to support school and community programming in screening and prevention efforts related to alcohol use by youths.

Dr. Quigley is the lead author of the policy statement and a member of the AAP Committee on Substance Use and Prevention.

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