Opportunistic screening for alcohol use problems in adolescents attending emergency departments: an evaluation of screening tools.

Sadie Boniface,Eilish Gilvarry,Robert Patton,Dorothy Newbury-Birch,Simon Coulton,Kim Donoghue,Ian Russell,John Strang,Paolo Deluca,Ian Maconochie,Eileen Kaner,Hannah Rose,Ceri J Phillips,Colin Drummond,Ellen Lynch,Paul Mcardle,Thomas Phillips,Ruth Mcgovern,M Fasihul Alam

doi:10.1093/pubmed/fdy049

Abstract

ObjectiveTo estimate and compare the optimal cut-off score of Alcohol Use Disorders Identification Test (AUDIT) and AUDIT-C in identifying at-risk alcohol consumption, heavy episodic alcohol use, ICD-10 alcohol abuse and alcohol dependence in adolescents attending ED in England.DesignOpportunistic cross-sectional survey.Setting10 emergency departments across England.ParticipantsAdolescents (n = 5377) aged between their 10th and 18th birthday who attended emergency departments between December 2012 and May 2013.MeasuresScores on the AUDIT and AUDIT-C. At-risk alcohol consumption and monthly episodic alcohol consumption in the past 3 months were derived using the time-line follow back method. Alcohol abuse and alcohol dependence was assessed in accordance with ICD-10 criteria using the MINI-KID.FindingsAUDIT-C with a score of 3 was more effective for at-risk alcohol use (AUC 0.81; sensitivity 87%, specificity 97%), heavy episodic use (0.84; 76%, 98%) and alcohol abuse (0.98; 91%, 90%). AUDIT with a score of 7 was more effective in identifying alcohol dependence (0.92; 96%, 94%).ConclusionsThe 3-item AUDIT-C is more effective than AUDIT in screening adolescents for at-risk alcohol use, heavy episodic alcohol use and alcohol abuse. AUDIT is more effective than AUDIT-C for the identification of alcohol dependence.

Highlights

The excessive consumption of alcohol is a major global public health issue[1,2] and places a significant burden on international health systems
Using the sample to estimate the prevalence of drinking behaviours in adolescents attending ED, the prevalence of at-risk drinking was 14.8%
A simple short three item self-completed screening instrument, the Alcohol Use Disorders Identification Test (AUDIT)-C, is overall more effective than the longer 10-item AUDIT in identifying adolescents who engage in at-risk of alcohol consumption, monthly heavy episodic alcohol use and fulfil ICD-10 criteria for alcohol abuse

Summary

Introduction

The excessive consumption of alcohol is a major global public health issue[1,2] and places a significant burden on international health systems. While the majority of this burden lies with adult populations, for many the roots of problematic alcohol use lies in adolescence.[3] Adolescence is a critical developmental stage when young people make behavioural and lifestyle choices that have the potential to impact on their health and wellbeing into adulthood. Inappropriate risk-taking is significantly associated with health and social harm during adolescence.[4] Young people are much more vulnerable than adults to the adverse effects of alcohol use due to a range of physical and psychological factors that often interact. Adolescence is a unique period whereby neural proliferation and subsequent ‘pruning’ processes may leave brain structures vulnerable to the effects of alcohol.[5,6]

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Results

Conclusion