Screening Tool Identifies Adolescents Who Have Alcohol and Drug Problems
Researchers at the Brown University Center for Alcohol and Addiction Studies (CAAS) evaluated existing alcohol diagnostic screening tools to develop a quick, low-cost way to identify adolescents who might benefit from alcohol-use interventions.
- Of the three alcohol-use diagnostic screening tools evaluated, AUDIT most reliably identified teenagers fitting criteria for an alcohol-related diagnosis, as specified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
AUDIT is a 10-question screening tool developed to identify problem drinkers in primary care settings.
- Certain DSM-IV criteria appear more appropriate than others for use with adolescents:
- "Drinking more or longer than intended" was the item that best predicted having a diagnosis of alcohol dependence.
- "Use despite psychological or physical consequences" was also a good predictor of alcohol dependence.
- Signs of withdrawal appear to have limited screening value among adolescents.
The Robert Wood Johnson Foundation (RWJF) supported the project with a grant of $46,000.
In 1997, RWJF awarded a grant to CAAS to evaluate existing diagnostic screens for alcohol problems and develop a quick, low-cost method of identifying adolescents who might benefit from alcohol-use intervention. Recent studies had suggested that measures used to identify problem drinking in adults might not be developmentally appropriate for adolescents, and that the screens designed for adolescents were too long to be administered in hospital emergency departments or in routine health care settings.
This study was "piggy-backed" onto an earlier RWJF-funded study to examine a motivational interviewing intervention for teen smokers (ID# 030330). The two projects took place in the same hospital setting, permitting the investigators to draw on the resources already in place and to conduct the study reported here for a relatively small financial investment.
Additional data used in this study were collected under a separate, $1.9 million five-year grant for diagnostic work on teenage drinkers from the National Institute of Alcohol Abuse and Alcoholism (NIAAA). Brown University and Rhode Island Hospital provided in-kind support.
The project examined three adult diagnostic screens for sensitivity, predictive validity, and ease of use comparing them to the "gold standard" of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Researchers also examined the ability of different DSM-IV criteria to predict alcohol problems among study participants. In addition, the study assessed marijuana use and used an instrument known as the Reckless Behavior Questionnaire to assess the degree to which respondents engaged in other risky behaviors.
Researchers recruited a cross section of 415 study participants, ages 13 to 19, over a 26-month period from among adolescents receiving treatment for an injury in the Emergency Department of Rhode Island Hospital, an urban hospital in Providence. Assessments lasted about 45 minutes, and teenage participants received a $15 gift certificate for participating. The study also included 246 parents of participants. Researchers compared the alcohol-screening instruments developed for use with adults to the DSM-IV diagnosis of alcohol abuse or dependence.
Questions included in more than one screen were asked only once. These were the three screening tools assessed:
- CAGE, a four-question screen designed to identify medical patients with alcoholism.
- TWEAK, a five-question screen developed for risk drinking during pregnancy.
- AUDIT, a 10-question screen developed to identify problem drinkers in primary care settings.
- Of the three alcohol-use diagnostic tools, AUDIT most reliably identified teenagers with a current DSM-IV alcohol diagnosis. TWEAK was rated second and CAGE third, possibly because its questions reflected later-occurring patterns of alcohol dependence, such as "attempts to cut down" and "early morning drinking."
- Certain DSM-IV criteria seem more appropriate than others for use with adolescents. The teenagers met the criterion for "drinking more or longer than intended" with relatively high frequenc and this item best predicted having a diagnosis of alcohol dependence. "Use despite psychological or physical consequences" was also a good predictor. Conversely, signs of withdrawal appear to have limited screening value among adolescents.
- The adolescents in the study showed a fairly high prevalence of both drinking and problem drinking. Of the 415 teens surveyed, 261 (63 percent) reported alcohol use in the last year. Among those who drank, 23 percent met the criteria for alcohol dependence and 5 percent met the DSM-IV criteria for alcohol abuse. These figures highlight the need for routine alcohol screening and effective interventions, yet only 4 percent of the teens with an alcohol abuse or dependence diagnosis had received treatment.
- Parental knowledge of drinking problems tended to lag. Parents typically described their teen's use of alcohol and alcohol-related symptoms as less severe than did the teens themselves.
- The study associated alcohol use with reckless behavior. Some 40 percent of the adolescents who engaged in high-risk behaviors, including speeding while driving, unprotected sex, and drug use, reported that alcohol was involved at least some of the time.
- Significant portions of study participants used both alcohol and marijuana. Some 40 percent of study participants had tried both marijuana and alcohol at some point; about one-fourth (24 percent) had used both during the past six months; and about 16 percent met criteria for marijuana abuse or dependence. The marijuana study suggested a number of questions for future research, including the extent to which diagnoses of abuse and dependence predict negative outcomes and/or persistent use and problems among youth.
In September 1998, study findings were presented at an international symposium on addictions, held in England and attended by more than 150 scientists and clinicians from 16 countries.
In October 1998, researchers made two presentations at a national conference, "Adolescents, Alcohol, and Substance Abuse: Reaching Teens Through Brief Interventions," hosted by CAAS and supported by RWJF (ID# 034435).
A November 1998 symposium at the Annual Conference of the Association for Advancement of Behavior Therapy discussed methodological and conceptual issues related to the project. In addition, four articles have been accepted in peer-reviewed journals, and researchers have presented study findings at two other conferences. See the Bibliography for details.
AFTER THE GRANT
A manuscript outlining the key findings of the marijuana prevalence and symptomatology research has been drafted and will be submitted for publication in April 2002. The results of this study are expected to inform further research and grant applications.
GRANT DETAILS & CONTACT INFORMATION
Study of Youth Alcohol Diagnostic Screening Tools
Brown University Center for Alcohol and Addiction Studies (Providence, RI)
Dates: November 1997 to October 1999
Peter M. Monti, Ph.D.
(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)
Barnett NP, Colby SM, Monti PM, Spirito A and Rohsenow DJ. "The Use of Alcohol During Risk-Taking Behavior: An Addition to the Reckless Behavior Questionnaire." Alcoholism: Clinical and Experimental Research, 22(3): 73A, 1998. 40 copies were distributed at the 1998 Annual Meeting of the Research Society on Alcoholism in Hilton Head, S.C.
Chung T, Colby SM, Barnett NP, Rohsenow DJ, Monti PM and Spirito A. "Screening Adolescents for Problematic Alcohol Use in a Hospital Setting: Performance of Brief Alcohol Screens Against DSM-IV Alcohol Diagnoses." Journal of Studies on Alcohol, 61(4): 579587, 2002. Abstract available online.
Chung T, Colby SM, Barnett NP and Monti PM. "Alcohol Use Disorders Identification Test: Factor Structure in an Adolescent Emergency Department Sample." Alcoholism: Clinical and Experimental Research, 26(2): 223231, 2002. Abstract available online.
Chung T, Colby SM, O'Leary TA, Barnett NP and Monti PM. "Screening for Cannabis Use Disorders in an Adolescent Emergency Department Sample." Drug and Alcohol Dependence, 70(2): 177186, 2003. Abstract available online.
D'Amico EJ, Barnett NP, Monti PM, Colby SM, Spirito A and Rohsenow DJ. "Does Alcohol Use Mediate the Association Between Alcohol Evaluations and Alcohol-related Problems in Adolescents?" Psychology of Addictive Behaviors, 16(2): 157160, 2002. Abstract available online.
Spirito A, Barnett NP, Lewander WJ, Colby SM, Rohsenow DJ, Eaton CA and Monti PM. "Risks Associated With Alcohol-Positive Status Among Adolescnets in the Emergency Department: A matched case-control study." Journal of Pediatrics, 139(5): 694699, 2001. Abstract available online.
Presentations and Testimony
Nancy P. Barnett, Suzanne M. Colby, Peter M. Monti, Anthony Spirito and Damaris J. Rohsenow, "The Use of Alcohol During Risk-Taking Behavior: An Addition to the Reckless Behavior Questionnaire," poster presented at the Annual Conference of the Research Society on Alcoholism, June 1998, Hilton Head, S.C.
Suzanne M. Colby, Tammy Chung, Tracy A. O'Leary, Anthony Spirito, Damaris J. Rohsenow and Peter M. Monti, "Alcohol and Marijuana Abuse and Dependence Diagnoses in an Adolescent Sample: Relative Prevalence and Comorbidity," at Addictions '98 Comorbidity Across the Addictions International Symposium, September 1998, Newcastle-Upon-Tyne, England.
Peter M. Monti and Suzanne M. Colby, "Motivational Interviewing in Opportunistic Settings: Reaching Teens Through Brief Interventions," at Adolescents, Alcohol, and Substance Abuse: Reaching Teens Through Brief Interventions, October 1998, Newport, R.I.
Peter M. Monti, chaired symposium entitled "Methodological and Conceptual Issues in the Diagnosis of Adolescent Substance Abuse," at the Annual Convention of the Association for the Advancement of Behavior Therapy, November 1998, Washington, D.C. Two presentations by project staff.
- Tammy Chung, "Screening for Problem Drinking among Adolescents in an Emergency Department Setting."
- Suzanne M. Colby, "Marijuana Abuse and Dependence Symptomatology in an Adolescent Sample: Prevalence and Discriminant Validity of Diagnostic Criteria."
Tammy Chung, Suzanne M. Colby, Anthony Spirito, Nancy P. Barnett, Damaris J. Rohsenow, Peter M. Monti, Robert Woolard and William Lewander, "Performance of Brief Alcohol Screens Among Teens in a Hospital Setting," at the Annual Convention of the American Psychological Association, August 2024, 1999, Boston, Mass.
Report prepared by: Susan Freis
Reviewed by: Karyn Feiden
Reviewed by: Robert Crum
Program Officer: C. Tracy Orleans