Alcohol Problems and High School Students

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Alcohol Problems andHigh School Students

• Dan Hungerford, DrPH
• Epidemiologist
• National Center for Injury Prevention and Control
• Centers for Disease Control and Prevention

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Prevention Strategies
Universal a total population Selective a
high-risk subpopulation Indicated high-risk
individuals
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Types of Drinkers
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Alcohol Dependent
Risky Harmful
25
Low- Risk Abstaining
71
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How do we identify and help high-risk individuals?
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Proxies for Alcohol Problems

• Alcohol dependence symptoms
• Alcohol-related Harm
• Hazardous Drinking

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Alcohol Dependence Symptoms

• Inability to stop drinking
• Tolerance
• Morning drinking
• Amnesia
• Shakiness
• Salience

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Drinking-related Harm
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Recommended Drinking Limits
NIAAA, Helping Patients Who Drink Too Much
A Clinicians Guide, 2005
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Diagnosable Alcohol Use Disordersby Drinking
Pattern
NIAAA, Helping Patients Who Drink Too Much
A Clinicians Guide, 2005
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Binge Drinking, Current Drinkers
Naimi et al, JAMA, 2003
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Prevalence of Alcohol Dependence among Binge
Drinkers
Dependent 8
Non-dependent 92
New Mexico, BRFSS, 2002
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Binge Drinking Harm

• Unintentional injuries (Anda, JAMA,
  1988)
• Violence (Rossow, Addiction, 1996)
• Meningitis (Imrey, Am J Epidemiol,
  1996)
• Sexually transmitted diseases (Lauchli, AEP,
  1996)
• Myocardial infarction (Rehm, Am J
  Epidemiol, 2001)
• SIDS (Iyasu, JAMA, 2002)
• Unintended Pregnancy (Naimi, Pediatrics,
  2003)
• Impaired driving (Naimi, JAMA, 2003)

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Screening CRAFFT

• Have you even ridden in a Car driven by someone
  (including yourself) who was high or had been
  using alcohol or drugs?
• Do you ever use alcohol or drugs to Relax, feel
  better about yourself, or fit in?
• Do you ever use alcohol or drugs while you are by
  yourself Alone.
• Do you ever Forget things you did while using
  drugs or alcohol
• Do your Family or Friends ever tell you that you
  should cut down on your drinking or drug use?
• Have you even gotten into Trouble while you were
  using alcohol or drugs?

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Screening, Brief Intervention, andReferral to
Treatment (SBIRT)
S ? case finding everyone risk
factors BI onsite 5 to 30 minutes drink less or
stop R as needed facilitated T prevalence
offsite build motivation
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What is a brief intervention?

• Present screening results
• Identify risks discuss consequences
• Provide medical advice
• Solicit patient commitment
• Goal reduced drinking or abstinence
• Give advice and encouragement
• Refer to specialized treatment?