Screening Adolescents for Alcohol Use Disorders

You may find the following of interest - see  Screening for underage drinking and Diagnostic and Statistical Manual of Mental Disorders, 5th Edition alcohol use disorder in rural primary care practice - http://findings.org.uk/PHP/dl.php?file=Clark_DB_2.abs&s=eb

One  of the more frequent challenges professionals in counter when interviewing college students in adolescence is obtaining accurate information. Without reliable information, it is difficult if not impossible to accurately screen or assess someone regarding her or his drinking. This article seems to suggest that asking students to less charged question, "how often do you drink" is perhaps more effective when screening for an alcohol use disorder than asking the more invasive, "how many do you have when you drink" or other "amount-based" questions.  In addition, asking students about the number of drinks they have when consuming is not only invasive, it likely results in inaccurate estimates. Either because of poor recall, a lack of familiarity with standard drink sizes and a realization that "a drink" can measure 2, 3, or more "standard servinugs" of alcohol--or both--student estimates regarding how much they drink can result in notoriously inaccurate responses to such questions when asked by screeners.  

There are several key elements involved in conducting an effective screening interview with a young adult or adolescent. First, the relationship is of paramount importance.  Anyone conducting a screening interview like a parent or cop conducting an investigation can expect resistance. Unfortunately, this resistance is then interpreted as denial, which in turn is viewed as suggestive of a problem. Ironically, this resistance says more about the interviewer's ineffective approach than about the adolescent's use.

Next, effective interviewers know that it is as important to identify low-risk as it is important to recognize high-risk when screening for alcohol use disorders (AUD). The referenced article suggests that as useful as a single question about frequency of use is in identifying high-risk of an AUD, it is more effective in identifying low-risk. NOTE: We are talking about determining low-risk for an alcohol use disorder here. It is possible to drink infrequently and have a low-risk of an AUD, yet still drink enough on any single occasion as to be at risk of an untoward incident.

A third element of an effective screening interview is recognize the importance of autonomy when it comes to considering recommendations following the interview. If behavior change appears warranted, the typical adolescent is not likely to respond to directives based on what the interviewer believed the adolescent "should do." Adolescents, like most people faced with a decision about considering behavior change, tend to move towards a change they "want to make" rather than changes they feel "directed to make." 

The referenced abstract--including its link to the entire research article on which it is based--suggests the efficacy of a simple question based on the frequency of one's drinking rather than the quantity. Such an approach to screening will likely reduce the likelihood of what William Miller of "Motivational Interviewing" fame calls "wrestling" with a client and, instead, facilitates what he recommends instead...dancing. What do you think?

Dr. Robert