Alcohol Screening and Intervention in Youth

Transcription

1 Alcohol Screening and Intervention in Youth By Bruce Peters, DO FACOP, FAAP Pediatrics Internal Med. Addictions NSU COM Dept. of Pediatrics Learning Objectives Facts Surrounding Youth Drinking Recognize child and adolescent alcohol abuse Identify risk and protective factors Understand health provider screening for substance use/abuse & Treatment Options Understand When and How to refer and the resources available

2 I have no disclosures! Disclosures Youth Alcohol Facts The minimum legal drinking age varies dramatically aroundthe world. Most such laws apply only to drinking alcoholic beverages in public locations. The only country with a minimum legal age for consuming alcohol at home is the United Kingdom, which prohibits drinking below the age of six. Although h it is commonly bli believed dthat t the minimum i drinking age in the U.S. is 21, people can legally drink below that age under many different circumstances.

3 When 21 doesn t mean 21 An established religious purpose, when accompanied by a parent, spouse or legal guardian age 21 or older Some States also allow exceptions for educational purposes (e.g., students in culinary schools), religious purposes (e.g., sacramental use of alcoholic beverages), or medical purposes. p In the course of lawful employment by a duly licensed manufacturer, wholesaler or retailer. In private clubs or establishments Where do Youth get the Alcohol?

4 Prevelance of Alcohol Use in the Past Year by Grades (MTF) Lifetime Prevalence of Alcohol Use in 8 th, 10 th, & 12 th Grade

5 Risk Assessment Where Shoud We Screen? Well Child Visits annual examination Acute Care Visits Emergency Departments

6 Who Should We Screen? All youth age Youth who smoke cigarettes Youth with conditions associated with increased risk Depression Anxiety ADD/ADHD Conduct problems Major Risk with Youth Drinking

7 Health Problems that may be alcohol related Accidents or injury Sexually transmitted infections Unintended pregnancy Changes in eating or sleeping patterns Gastrointestinal disturbances Chronic pain Substantial Behavioral Changes that may be alcohol related Increased oppositional behavior Significant mood changes Loss of interest in activities Change of friends A drop in grade point average Large number of unexcused school absences

8 Preparation for Screening in your Practice Educate office staff Decide how screening will be conducted Set reminders taking advantage of EHR and Meaningful Use Prepare for confidential care Prepare for referrals Stock materials for both patients & parents Getting Started Screening

9 STEP 1: Ask two screening questions Do you have any friends who drank beer, wine, or any drink containing alcohol in the past year? How about you have you ever had more than a few sips of beer, wine, or any drink containing alcohol? Does the Patient have Friends who Drink? If NO you go to the next step Praise choice of not drinking and of having no drinking friends. Reinforce healthy choices with praise and encouragement Elicit and affirm reasons to stay alcohol free. Educate Keep rescreening annually If YES, Still Praise Choice of not di drinking Consider probing a little using a neutral tone: When your friends were drinking, you didn t drink? Tell me a little more about that. Reinforce healthy choices Elicit & affirm reasons to stay alcohol free Educate Explore how your patient plans to stay alcohol free when friends drink Advise against riding in a car with a driver who has been drinking or using other drugs Rescreen at next visit

10 Assess Risk 1 Assess Risk 2 Assess patient s age and drinking frequency Factor in friends For elementary and middle school students having friends who drink heightens concerns. For high school students having friends who binge drink heightens concerns.

11 Assess Risk 3 For moderate and highest risk patients: Ask about drinking pattern Ask about problems experienced or risks taken Ask about other substance use Consider using other formal tools to help gauge risk for other substances of abuse Advise and Assist Conduct a brief intervention for the patients who drink based on their risk level Based on our assessment risk chart based on how many DAYS in the past year did the patient drink they will fall either into each of the following categories Lower Risk Moderate Risk Highest Risk

12 Provide brief advice by recommend they stop drinking, discuss brain dev, decision making, and future plans. Notice the good and reinforce any strengths and healthy decisions. Explore and troubleshoot the potential influence of friends who drink or binge drink. Lower Risk Group Moderate Risk Group Does the pt have alcoholrelated problems? related problems? If no, then beefed up advice used for low risk If yes, conduct brief motivational interviewing to elicit a decision and commitment to change Ask if their parent knows Arrange for follow up

13 Highest Risk Group 1 Conduct brief motivational interviewing Ask if parents know Consider referral for further evaluation or treatment Arrange for follow up within a month Highest Risk Group 2 If you observe signs of acute danger, such as drinking and driving, high intake levels per occasion, or use of alcohol with other drugs, take immediate steps to ensure safety! This can include informing the patient s parents, recommend that they take away car keys and driving privileges, and referring the patient for treatment.

14 Do Threats Work?

15 For All Patients Who Drink Collaborate on a personal goal and action plan Advise your patient not to drink and drive or ride in a car with an impaired driver. Plan for a full psychosocial interview or evaluation. At Follow up, Continue Support For patients who DID drink If unable to meet and sustain goals Reassess the risk level Acknowledge that change is difficult Notice the good by: praising honesty and efforts, reinforcing strengths, and supporting any positive change. Relate drinking to associated consequences or problems Identify and address challenges and opportunities in reaching the goal. Reinforce the importance of goals, renegotiate specific next steps as needed. Conduct, complete, or update psychosocial history.

16 At Follow up, Continue Support For patients who DID drink For patients who were able to meet and sustain goals: Reinforce and support continued adherence to recommendations Notice the good, praise progress and reinforce strengths and healthy decisions. Elicit future goals to build on prior ones Conduct, complete, or update the comprehensive psychosocial history. Rescreen at least annually! Psychosocial History=HEEADSSSS Home Education Eating Activities Drugs/Alcohol Abuse Sexual Activity Safety Suicide/Depression Support Network

17 CRAFFT pneumonic has been validated as an appropriate screening tool for substance abuse in adolescents Car driven by yourself or someone using alcohol or drugs Relax use drugs/alcohol to feel better about yourself or to fit in. Alone Ever use drugs/alcohol while alone Forget things thi while using alcohol/drugs l/d Friends do friends/family ever tell you should cut down Trouble ever got into trouble while using alcohol or drugs? Referral Resources

18 Finding Evaluation and Treatment Options For patients with insurance: Contact behavioral health case manager at the insurance company For patients uninsured or underinsured: Contact local health dept. about substance abuse treatment services for adolescents. For older patients who are employed or in college: ask about access to employee assistance or school counseling program that includes substance abuse treatment Other Treatment Options Ask behavioral health practitioners affiliated with your practicefor recommendations Seek local directories of behavioral health services Contact local hospitals and metal health service organizations Call the National Drug and Alcohol Treatment Referral Routing Service ( HELP) or visit the Substance Abuse Treatment Facility Locator Web site at

19 Finding Support Groups Groups specific to your area: Nationwide groups: Alcoholics Anonymous (AA) Support groups for family members, contact Al Anon ( anon.alateen.org) ADDITIONAL RESOURCES 1 National Institute on Alcohol Abuse and Alcoholism (NIAAA) NIH AAP ( Confidential care: Center for Adolescent Health and the Law for help with minor consent laws and policies. Societyfor Adolescent Health and Medicine for sample confidentiality statement, billing guidance, and other clinical care resources.

20 ADDITIONAL RESOURCES 2 Motivational interviewing Treatment locator HELP or ADDITIONAL RESOURCES 3 NIAAA AAP SAMHSA Students Against Destructive Decisions anon.alateen.org National Assoc. for Children of Alcoholicswww.nacoa.org Monitoring the Future

21 In Summary Contact Information Bruce B. Peters, D.O., FACOP, FAAP Director of Medical Education, Bethesda Memorial Hospital Professor, Department of Pediatrics Specialty: Pediatrics, Internal Medicine, & Addiction Medicine Nova Southeastern University College of Osteopathic Medicine 3200 South University Drive Fort Lauderdale, Florida Tel: