1.It's very common for teens to drink, and it may be a part of normal development [1].

2.Alcohol (and other drug) problems are fairly common types of problems during adolescence [2].

3.There are ethnic differences in the prevalence of alcohol use among youth: Native American and Caucasian youth have the highest rates, then African-American and Hispanic youth (males more than females). Asian youth have the lowest rates [3].

4.Boys are more involved than girls, but the gender difference isn't that great (except in Hispanic youth) [3].

5.Alcohol Abuse and Dependence rates are approximately 6% according to school-based diagnostic interviews (ages 12-18) [4].

6.Many of these youth have other problems as well, such as early sexual experiences, smoking, delinquent behaviors, and other drug use (aside: 56% of U.S. 12th graders have used illicit drugs) [3, 5].

7.BOTTOM LINE: Many teens experiment with drinking, so how do we know if we need to do something about it?

1.Early drinking is associated with an increased risk for additional problems.

2.Teens involved with alcohol and other drugs are likely to have other problems too, and may skip emotional and social milestones (e.g., forming a peer group, developing self-discipline, and dating without the influence of intoxicants) [8].

3.Subtle cognitive deficits may appear for some youth (especially memory and spatial problems) [9].

4.KEY POINT: Early alcohol and drug use might set the stage for more severe problems later in life.

1.Red flags: injuries or accidents, family problems (e.g., isolation from family), dropping grades (or truancy), mood swings (due to intoxication and/or withdrawal), change in friends (peers have a major influence during adolescence), and blackouts (e.g., forgetting how one got home) [10].

2.Common problems are the "3Ds" -- driving, dating, & drugs (i.e., accidents, early sexual experiences, and early or heavy drug use). Co-occurring problem behaviors and poor judgment are frequently seen as well [11].

3.Health problems and severe withdrawal are uncommon problems (don't wait for these problems because they are very unlikely in youth). Adult criteria for substance abuse and dependence are not ideal for teens due to developmental differences [12].

4.EXAMPLE: A 15-year-old girl living with her mom and 3 older brothers drinks 9-24 beers per occasion 2-4 times a week. After a weekend of heavy drinking, she experienced hand tremor, nausea, headaches, and insomnia for about 2 days following STOPPING drinking, but she did not experience DTs or seizures. Her grades slipped from mostly Bs, and she was losing interest in track. Her mom noticed new friends at the house including some 17-18 year old boys.

5.Screening Tools: {Slide 6}

1.Most programs are based on adult approaches and don't necessarily address adolescents' needs. Teens with substance use disorders tend to have a broader range of life problems. Treatment may require involvement of multiple life domains, such as school and family [15].

2.Availability: Adolescent-specific treatments are not widely available (especially with managed care).

3.Formats:

4.EXAMPLE: The 15-year-old girl noted earlier benefited most from incorporating HER ideas about her problem and bringing in her brothers, mother, teacher, and best friend to sessions.

5.Pathways to success: There are 3 routes a substance use-disordered teen can take toward achieving a healthy lifestyle [23] {Slide 8}

6.Treatment Outcome (there is limited data, but existing evidence supports the following): [24]

7.Prevention [25]

1.Experimentation with alcohol is common.

2.Heavier drinking can lead to later problems.

3.Change in peers, mild withdrawal, and blackouts are signs of risk.

4.If intervention is needed, treatment is better than no treatment.

5.Optimal intervention involves multiple systems (school, pediatrician, social worker, and family) and collaborating with the adolescent to set concrete goals.

1.Most of what we know about alcohol problems is based on studies of men.

2.Alcohol dependence happens in women too.

3.There are many similarities between male and female alcoholics but also a few differences.

4.EXAMPLE CASE: A 52-year old woman's youngest child moved out. She works part-time for her husband who had a long-standing alcohol problem. She started drinking more when she was out with him, and recently began to drink at home alone in the afternoons.

1.62% of women drink, whereas 83% of men drink. This is a significant difference [26].

2.Women are about half as likely to meet criteria for alcohol abuse or dependence as men are [27].

3.BOTTOM LINE: Alcohol dependence in women is less likely, but still common.

1.Alcohol dependent females are at risk for infections, anemia, STDs, hepatitis, UTIs, reproductive organ problems, liver and brain damage [28].

2.They are also at an increased risk for being victims of violence [28].

3.Women experience the same neurocognitive impairments as men despite having drank heavily for fewer years [29].

4.Female alcoholics have increased rates of STDs. STD clinics should assess drinking.

1.KEY POINT: The effect of alcohol on a developing fetus is a major public health risk for female drinkers.

2.16-35% of pregnant women drink regularly (and 6% used illicit drugs). However, under-reporting of drinking during pregnancy is believed to be common due to stigma [30].

3.4% of pregnant women are frequent drinkers (7 or more drinks per week or 5 or more drinks per occasion) versus 13% of non-pregnant women, suggesting that most frequent-drinking women may cut down during pregnancy (or at least report that they have done so) [31].

4.FAS: occurs in 1.5/1000 births in the U.S. and is diagnosed based on 3 criteria: [32]

5.There is no established safe level of drinking during pregnancy, so abstinence is recommended [31]. Heavier drinking has been associated with risk for more severe fetal alcohol effects, and the risk is especially great for women who achieve high blood alcohol concentrations during the first trimester (quantity may be more impactful than frequency).

6.Concurrent additional risks are more likely in pregnant drinkers (e.g., smoking, low-income, or poor prenatal care) [31].

7.A stigma exists such that some women may avoid treatment and prenatal care for fear that their children might be taken away or they will be charged with child abuse.

1.KEY POINT: Alcohol problems are under-detected in women, especially in pregnant women due to under-reporting.

2.The TWEAK is well-validated on pregnant women [33].

1.There are more barriers for women than for men to get to treatment [34, 35].

2. 1.5 million women are estimated to need treatment; 75% of people in treatment programs are male [37].

3.KEY POINT: It is very cost effective to combine obstetrics or prenatal care with drug treatment. Offering frequent visits and a multidisciplinary approach greatly improves healthy birth rates [31].

4.BOTTOM LINE: Overall, it is harder for women to get to treatment than men. Fewer women do get treatment, although they may need it more than men.

5.Brief intervention for heavy or problem drinking may be effective [38].

1.Possible history of violence or abuse victimization

2.Psychiatric problems

3.If the woman lives with children, she may fear having them taken away.

4.Some studies have suggested better treatment retention in women with more problems (e.g., legal involvement, comorbid psychiatric problems, or childhood sexual abuse) [36].

1.EXAMPLE - detect & treat

2.Alcohol dependence is less common in females than in males, but not altogether uncommon.

3.Women have a greater risk of health problems for the same number years of heavy drinking.

4.There is a risk of continued drinking into pregnancy.

5.Alcohol dependence in women is under-detected and under-treated.

6.Treatment can be effective if barriers are removed and it is combined with healthcare services.