Brief screening during doctor visit can dramatically reduce teenage drinking

by Tripp Underwood on May 10, 2012

By reviewing a computer based screening on patient alcohol use, doctors can help reduce underage drinking according to a new study

Can a doctor really persuade a teenager not to use alcohol or drugs with a two or three minute intervention? The answer is “yes,” according to a new study in the journal Pediatrics.

Conducted by Sion Harris, PhD, CPH and her team at Boston Children’s Hospital’s Center for Adolescent Substance Abuse Research (CeASAR), the study demonstrates that a small effort on the part of patients and primary care physicians can go a long way in combating underage drinking.

“In just a few minutes we can make a significant impact in reducing teenage alcohol use,” says Harris. “By streamlining the alcohol screening process for clinicians and patients alike we can make the process easier and more efficient for everyone, which will yield more positive results.”

Teens in Harris’s study completed a five-minute computer-based survey, known as the CRAFFT, which asks six simple questions about alcohol and drug use. After the screening users are assigned a “score” and risk level based on their answers. They’re then directed to 10 illustrated pages of stories and science-based evidence about the serious health effects of alcohol and drug use.

The teen’s physician receives the results as well, and a list of talking points on the medical problems caused by alcohol and drugs, which the doctor uses to prompt a two to three minute discussion with the patient. The final point has the doctor inform the patient that it would be best for their developing brain to not use alcohol or drugs at all.

Three months after screening, teenagers in Harris’s study were almost 50 percent less likely to drink compared to teenagers who didn’t complete the program. Interestingly, they were also 25 percent less likely to drink one year later. Harris’s findings also suggest that patients in the study found their doctor visit more satisfying and were more likely to heed their doctor’s advice.

John Knight, MD

The CRAFFT screening was originally developed by John R. Knight, MD, senior author of the study and director of CeASAR.

“We designed the CRAFFT specifically for teenagers,” says Knight. “It’s meant to be brief, easy to administer and simple to score.”

Each ‘yes’ answer scores one point. Data shows that a total of two or higher indicates with 80 percent accuracy that the patient has a substance abuse disorder.

The American Academy of Pediatrics already recommends that doctors screen all of their adolescent patients for substance use and provide brief counseling as a part of routine care. But in the modern age, when pediatric visits are often under 30 minutes, many doctors say they don’t have time to screen for substance abuse because their patients have more pressing health issues that need to be addressed. To counteract this problem, researchers monitored the effectiveness of having patients take the CRAFFT test electronically before visits.

By completing the screening prior to the visit, the doctor is given more time to interpret results and discuss them with patients. The patient is also primed for the doctor’s advice because he is already aware of the personal risk. That heightened awareness, combined with the immediate counseling from a doctor, seems to have a noticeable affect on many young patients.

“Our research has found that teens view pediatricians as trustworthy sources of health information, and a doctor’s recommendation not to use has a powerful impact on teen behavior,” Knight says. “This is the first study to show that a primary care doctor’s advice can impact teen substance use.”

Are you concerned about drug and alcohol use in your home? Ask your child’s pediatrician about CRAFFT screening, or contact Dr. Knight and his team at the Center for Adolescent Substance Abuse Research at 617-355-2727, CeASAR@childrens.harvard.edu

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