Screening for Adolescent Alcohol Use in the Emergency Department: What Does It Tell Us About Cannabis, Tobacco, and Other Drug Use?

Abstract

Background: The pediatric emergency department (PED) represents an opportune time for alcohol and drug screening. The National Institute of Alcohol Abuse and Alcoholism (NIAAA) recommends a two-question alcohol screen for adolescents as a predictor of alcohol and drug misuse. Objective: A multi-site PED study was conducted to determine the association between the NIAAA two-question alcohol screen and adolescent cannabis use disorders (CUD), cigarette smoking, and lifetime use of other drugs. Methods: Participants included 12–17-year olds (n = 4834) treated in one of 16 participating PEDs. An assessment battery, including the NIAAA two-question screen and other measures of alcohol, tobacco and drug use, was self-administered on a tablet computer. Results: A diagnosis of CUD, lifetime tobacco use or lifetime drug use was predicted by any self-reported alcohol use in the past year, which indicates a classification of moderate risk for middle school ages and low risk for high school ages on the NIAAA two-question screen. Drinking was most strongly predictive of a CUD, somewhat weaker for lifetime tobacco use, and weakest for lifetime drug use. This same pattern held for high school and middle school students and was stronger for high school students over middle school students for all three categories. This association was also found across gender, ethnicity and race. The association was strongest for CUD for high school students, sensitivity 81.7% (95% CI, 77.0, 86.5) and specificity 70.4% (95% CI, 68.6, 72.1). Conclusions/Importance: A single question about past year alcohol use can provide valuable information about other substance use, particularly marijuana.

Keywords:

• Alcohol screening
• adolescent
• tobacco
• marijuana
• other drugs
• pediatric emergency department

Acknowledgments

The authors wish to acknowledge the Pediatric Emergency Care Applied Research Network (PECARN) and the participating PECARN sites including: Baylor College of Medicine/Texas Children’s Hospital; Boston Children's Hospital; The Children's Hospital of Philadelphia; Children's National Medical Center; Cincinnati Children's Hospital Medical Center; Columbia University/Children’s Hospital of New York-Presbyterian; Hasbro Children’s Hospital; Lurie Children's Hospital of Chicago; Medical College of Wisconsin; Nationwide Children's Hospital; Nemours/Alfred I. duPont Hospital for Children; St. Louis Children’s Hospital/Washington University; University of California, Davis Children’s Hospital – Colorado; University of Michigan, University of Pittsburgh/Children's Hospital of Pittsburgh of UPMC. Our efforts would not have been possible without the commitment of the investigators and research coordinators from these sites. We also thank the PECARN Steering Committee members: R. Stanley (chair), B. Bonsu, C. Macias, D. Brousseau, D. Jaffe, D. Nelson, E. Alpern, E. Powell, J. Chamberlain, J. Bennett, J. M. Dean, L. Bajaj, L. Nigrovic, N. Kuppermann, P. Dayan, P. Mahajan, R. Ruddy and R. Hickey. A special thanks to the staff at the Data Coordinating Center including: H. Gramse, S. Zuspan, J. Wang, J. M. Dean, M. Ringwood and T. Simmons for their dedication and assistance throughout the study. Lastly, the authors wish to thank the participants and their parents for participating in this study.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

All phases of this study were supported in part by NIAAA 1R01AA021900 to A Spirito and JG Linakis. This project is supported in part by the Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB), Emergency Medical Services for Children (EMSC) Network Development Demonstration Program under cooperative agreement number U03MC00008, and is partially support by MCHB cooperative agreements: U03MC00001, U03MC00003, U03MC00006, U03MC00007, U03MC22684, and U03MC22685. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.