Resources

  1. Patte, K., Qian, W. &Leatherdale, S. (2017) Binge drinking and academic performance, engagement, aspirations, and expectations: a longitudinal analysis among secondary school students in the COMPASS study. Health Promotion and Chronic Disease Prevention in Canada, Research, Policy and Practice . Vol 37, No 11, November 2017.  https://doi.org/10.24095/hpcdp.37.11.02. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5695901/ 
  2. National Institute on Alcohol Abuse and Alcoholism Fact Sheet Accessed 6/19/18. https://pubs.niaaa.nih.gov/publications/UnderageDrinking/Underage_Fact.pdf 
  3. Draft Recommendation Statement. Unhealthy Alcohol Use in Adolescents and Adults: Screening and Behavioral Counseling Interventions. This opportunity for public comment expires on July 2, 2018 at 8:00 PM EST.  https://www.uspreventiveservicestaskforce.org/Page/Document/draft-recommendation-statement/unhealthy-alcohol-use-in-adolescents-and-adults-screening-and-behavioral-counseling-intervention
  4. SAMHSA’s National Helpline is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders. https://www.samhsa.gov/find-help/national-helpline  


Transcript

Dr. Frank Domino:
Jack is a 17-year-old in your practice who comes in for his college entry physical and immunization update. He and his family have been in your practice since you've been very young. He's the oldest child and first to go to college. During your visit, he answers yes to both alcohol and tobacco use. When you inquire about amounts, he admits to drinking five or more alcoholic beverages a few times a week. How can you assist in decreasing or stopping his alcohol and substance use during today's visit?

Hi, this is Dr. Frank J. Domino, professor and family physician at the University of Massachusetts Medical School. Joining me today is Dr. Jill Terrien, associate professor and director of the Nurse Practitioner Specialties Program at the University of Massachusetts Medical School, graduate School of Nursing. Thanks for coming today, Jill.

Jill Terrien:

Thanks for having me, Frank.

Dr. Frank Domino:

So I think we can all identify with our patient Jack here, not just personally but professionally. Adolescents seems to be using more substances of late and are pretty okay with talking to us about it. How common is alcohol use in this age group? And what is binge drinking?

Jill Terrien:

So, yes Frank, I think we can all identify with this. And you wonder, every time I turn around, it seems like there's a substance I haven't heard about. But alcohol use and abuse is a really big problem in this country. It's actually the number one substance use issue. Even though opioid seem to be talked about most, they are very fatal, alcohol can go on for many years with people, and in families. So it is a problem, and it's pretty common in this age group. And I just wanted... Like you asked me to define binge drinking, it is five or more of a standard drink in one, basically, sitting or one evening, one afternoon. But what is a standard drink? And this is where it can get a little fuzzy with a lot of the alcoholic beverages we have these days. The regular beer, 12-ounce beer is about 5% alcohol. And so you have to look at some of these new beers that might be 7% or 9% alcohol will be a little bit different. Malt liquor, which is about 8-9 ounces is about 7% alcohol, and it's a 5-ounce glass of wine, or it is 1 1/2 ounces of a spirit. So that's a standard drink. So five or more of those in one occasion would equal binge drinking.

Dr. Frank Domino:

Wow, and how common does this start? About what age and when should we start thinking about this?

Jill Terrien:
So, I'm going to talk about the COMPASS study. And this was a Canadian study done in secondary schools, and they basically looked at a cohort of students in the 10th grade, 11th grade, and then the 12th grade. And what they did is, they surveyed them every year to ask about a lot of things, but the outcome of this one was binge drinking, and they found that quite a few of them do it, and it is very concerning. It starts initiation age 13-15, it peaks in the late teens and early 20s. And then what seems to happen is that it tapers off. So for this study, what they were looking at, is how did it affect their school performance? They had seven different outcomes they were looking at, but it was like tardiness to school, missing school, grades in Math, particularly, and then wasn't going to interfere with their education, post-secondary school. And what they found is, yes, all of those indicators showed that they had dips in their grades, the ones that did admit to the binge drinking, even if they had done it once a month or once to twice in the past year.

Dr. Frank Domino:
Wow! So it certainly looks like binge drinking is possibly a risk factor for a variety of long-term life challenges and something even as rare as once or twice over a long period of time can place them at risk. How do we screen teens for binge drinking? And then once we identify it, what do we do about it?

Jill Terrien:

So you think about this study, they screened in the schools. They asked on this, and not that they could identify the cohort or basically say, "Okay this student has a problem, I want to help them." But what they can do, if you think about it, it has to come from many angles. And I think being a primary care provider, you have to ask, and try and prevent at every visit, every contact with that patient. So you're asking them when they're there for their well visit, you're asking them when they're there for their sick visit. And it's not like you're going down this long checklist because you feel like you have to, but because you know that they're at the vulnerable age of risk-taking, and that anything they do with substance use, particularly binge drinking, increases that risk. They're very vulnerable. So it's worth maybe the extra one to two minutes to say, "You know, Jack, how are you doing? Tell me about when you started? This is new information to me, and I want to educate you a little about it. That's my job, and I have a deep interest in making sure that your future is secured, and how I can help get you there."

Dr. Frank Domino:
Would you ask them about how many drinks per week they have or how often they drink five in the course of 24 hours or is that too specific?

Jill Terrien:

No, I think you have to tease out what exactly it is they're doing. What is five? I want to know what the five are? Is it more than five, is it eight? Have they blacked out? A lot of the things you would want to know that you'd say, "Do you remember doing that? Do you ever wake up and not know... Do you drive a car when you've been drinking?" And it's not about... So Jack is 17, so then you're wondering where is he getting this amount of alcohol and... But again, it's not... You're not there to be punitive and rat him out, but to try and make him understand that this is going to affect his future, and it could be for a very long time. You might ask questions about parents and more of the family history about the next generation. Because we do know that there can be a genetic link.

Dr. Frank Domino:
I think that's a really important question is to ask if there's other members of the family that might drink a great deal, and I think your thoughts are perfect. We probably shouldn't be punitive, but we should offer him information that says, "We know that doing this, even once or twice a year, can hurt your potential in post-graduate school and your career options and, of course, your health, safety risks with driving or whatever." Any thoughts about other interventions or other things, are there resources we can offer him that might help him in a non-judgmental way, move forward from this?

Jill Terrien:
Absolutely. So you have to know what your local resources are. Globally in the US, we know that Alcoholics Anonymous is a very supportive group for some people. They do have a teen Alcoholics Anonymous, there is Narcotics Anonymous, there is counseling. Maybe you're going to be referring him to counseling, and basically offering him a menu of options and see what appeals to him, and if you have caught his attention, and he is listening to you, maybe you can stop this habit, hopefully stop it, at least decrease it and make him aware. And he also is smoking while he's using, so he's got tobacco. So you want to kind of couple that with it. Again, the education and the oral health and what that can lead to because that is a substance as well.

Dr. Frank Domino:

I think it's important to tell him that this is a problem and offer him resources, and we'll have available on the landing page, a 24-hour a day, seven-day-a-week national help line that you can offer to your patients so that they can initiate asking for help. Maybe not at today's visit, but on their own terms, especially if something has just happened that scared them. Well, Jo, thank you for reminding us about binge drinking in adolescence, and I really appreciate this studies information about how we can apply it clinically.

Jill Terrien:
Thank you, Frank.

Dr. Frank Domino: 
Practice pointer: Screen early and often for substance use in your teenage population remembering that binge drinking is often initiated by age 13. Join us next time when we discuss the Mediterranean diet study and how it's recently been updated. And for more timely relevant and practical medical education check out PriMed.com. pri-med.com.