Screening is useful when a condition is prevalent, when we can screen in a cost-effective manner, when early diagnosis makes a difference, and when we know that acting on that screen will make a difference.
Dr. Susan Curry, the immediate past chairwoman of the U.S. Preventive Services Task Force, told me: “There have simply not been enough studies that assess the effects of screening and behavioral counseling in adolescents to address this issue. In addition, many of the existing studies have been conducted in school settings, and it is unclear if the results would translate to primary care.”
The effects of behavioral counseling on adults are proven enough to show a moderate benefit. The same holds true for pregnant women, although the evidence is a bit less strong. But when it comes to adolescents, the evidence is almost nonexistent.
In a large systematic review, there were two studies (out of 68 total) that addressed how counseling interventions might affect adolescent alcohol use. One was a randomized controlled trial of 119 urban adolescents screened in a medical clinic, published in 2015, that used peer networks and motivational interviewing. Over all, it failed to achieve statistical significance with respect to reducing alcohol use.
The other was a 2017 randomized controlled trial in Switzerland schools (not clinics) of a web-and-text-based peer-network messaging system to reduce single-occasion binge drinking. It decreased the chance of that happening by 5.9 percent in the intervention group. But it had no effect on how much youths drank over all or the estimated peak blood alcohol concentration during binge drinking.
That’s all we’ve got. And before 2015, there was nothing.
“We are calling for additional research in all areas related to screening adolescents for alcohol use and providing counseling interventions to those who need them,” Dr. Curry said. “It is also important to explore whether such interventions could reduce other risky behaviors. In the meantime, we encourage primary care clinicians to use their clinical judgment when deciding whether to screen their adolescent patients for alcohol use.”
There’s disagreement on the definition of unhealthy alcohol use for adults.
For men, risky drinking is more than four drinks on any day or more than 14 drinks in any week, according to the national institute. And for women, it’s more than three drinks on any day or more than seven drinks in any week. (The institute defines a drink as 12 ounces of beer, 5 ounces of wine or 1.5 ounces of spirits.)