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Adolescent Alcohol Misuse – Searching for a solution   Back Bookmark and Share
Adolescent Alcohol Misuse Searching for a solution
Author : M ONeill, H Fadl, L Keavney

Sir Alcohol misuse permeates western society. While few adolescents become addicted to alcohol in their teenage years, eighty per cent experiment. Subsequently a significant number enter a stage of regular use or binge drinking. In Ireland, weekly drinking occurs in 1%, 6% and 12% of eleven, thirteen and fifteen year old females; and in males aged eleven, thirteen and fifteen years of age it is 7%, 8% and 28%1. Adolescents enter the problem use stage of alcohol when they come in contact with the health services as a consequence of their excessive drinking. Doctors, while committed to the prevention of alcohol abuse by adolescents feel uncomfortable and inadequately prepared to address this issue2,3. This study was undertaken to

  1. address the interaction of young adolescents at the problem stage of alcohol with hospital services and
  2. to review strategies to address their needs.

Method
A retrospective chart review was undertaken in Mayo General Hospital on all patients admitted in the year 2000 with a diagnosis of acute alcohol intoxication under sixteen years of age. Data extracted from the chart included:

  1. the type and location of alcohol ingestion,
  2. the triggering event, if documented,
  3. the mode of access medical services,
  4. the medical assessment treatment. The literature was reviewed for effective preventive strategies.

Results
Fifty- six patients, twenty two female and thirty four males were included. The mean age for girls was 14.2 years, range 13-15. The mean age for boys was 13.8, range 8-15 years. Thirty patients (53%) ingested spirits, nineteen patients (33%) ingested a combination of beer and spirits and seven patients (13%) ingested beer only.

The intoxicated adolescents were found at various locations, twenty six (47%) on the street or roadside, fourteen (25%) at a disco, nine (16%) at home, four (7%) at school or at a social gathering and three (5%) at a party in a neighbouring house.

Twelve (22%) patients had a major life event as a specific reason to trigger the episode of intoxication, for four it was family disruption, for three it was a death in the family, for two it related to their parental alcohol addiction, for two it was a suicidal attempt and for one it was related to conclusion of his examinations. Twenty four (42%) of patients accessed the emergency department unaccompanied via ambulance, twelve (22%) with their friends, eleven (20%) with their parents, and nine (16%) with Garda.

Seven (12%) arrived before 10.00pm, six (11%) between 10.00 and 12.00 mid-night, twenty six (46%) between 12.00am and 2.00am, 16 (28%) between 2.00am and 4.00am and one (2%) after 4.00am.

The mean alcohol level on admission was 215mg% (range 115-339), the average duration of hospital stay was 1.5 days (range of 1-5). Twenty patients (35%) were referred for further therapeutic intervention to other health professionals, but only eight attended the appointment.

Eight (14%) patients had a previous episode of intoxication the previous year. Thirty-seven (66%) parents were in attendance within six hours of the admission of their child to hospital. Seventeen (30%) patients admitted had an associated head injury, seventeen (30%) patients were found comatosed outdoors and alone. Two of the female patients admitted were pregnant.

The literature suggest that brief intervention strategies are effective in dealing with adolescent intoxication but prevention should be the goal.

Discussion
Dealing with the young intoxicated adolescent is difficult, given that most present on weekends, late at night and has short lengths of stay. To have more impact doctors and nurses need to be aware of and use Brief Intervention Strategies (B.I.S.).4

An example of a B.I.S. is the six part strategy summarised by the FRAMES mnemonic; Feedback, Responsibility, Advice, Menu, Empathy and Self Efficacy; this provides a structured approach to deal with the adolescent admitted to hospital. The co morbidity associated with alcohol misuse, for example seventeen (30%) patients were found comatosed, outdoors and alone, seventeen (30%) had associated head injuries, must be highlighted and the potential consequences outlined.

Thirty three per cent of parents did not visit their child for twelve hours after admission. For the vast majority this was related to anger directed to their son/daughter for being admitted in an intoxicated state. Such anger is understandable in the acute phase, however counselling parents with regard to the negative effects of being angry on an ongoing basis is essential, as the adolescent may see the parents response to their drinking as the problem as opposed to the actual drinking itself. Twenty five per cent of adolescents obtain alcohol at home, a fact that parents should be made aware of, and take steps to prevent it from recurring. We are unable to explain 12 patients (60%) failed to attend the initial post discharge appointments that were made to address their alcohol misuse.

Can alcohol misuse by adolescent be prevented? Given the current research base, persons at high risk of alcohol misuse can be identified. The Strengthening Family Programme (SFP) shows promise as an effective preventative intervention5. The number needed to treat (NNT) in the SFP over 4 years for three alcohol initiation behaviours (alcohol use, alcohol use without permission, and first drunkenness) was 9 (for all three behaviours). This programme has been tested in areas with a high percentage of economically stressed families in the United States and has both a youth and parent component. The youth content includes modules on :

  1. having goals and dreams.
  2. dealing with stress,
  3. handling peer pressure, and
  4. reaching out to others.
The parent programme content includes:
  1. supporting goals and dreams,
  2. appreciating family members,
  3. understanding family values,
  4. building family communications, and
  5. reaching goals.

Alcohol misuse amongst adolescents needs to be tackled as part of a comprehensive national Programme with specific goals and objectives.

A strategy to deal with adolescent alcohol misuse should include the following:

  1. A Sensible approach to alcohol use. In this programme abstinence and moderation are presented as both equal and viable options to reduce alcohol abuse.
  2. The misuse of alcohol, not alcohol itself, is recognised as the source of the drinking problem.
  3. Advertising be restricted to tombstone advertisements where only inherent qualities of the product can be displayed thus removing the myths that advertising has suggested or inferred are related to alcohol. Alcohol in advertisements is linked by children and adolescents to highly valued personable attributes such as sociability, elegance, physical attractiveness and with desirable outcomes such as success, relaxation and adventure6.
  4. A formalised educational module for all schools be developed pertaining to alcohol use and misuse with educationally appropriate material. In this programme the consequences and impact of being drunk are explained. Safety issues, for example the importance of not abandoning a drunk friend who is comatose, (given that a quarter of the patients in this study were abandoned by their friends once contact had been made with the ambulance services) are stressed. Such programmes would impart knowledge of what is acceptable and unacceptable drinking behaviour.
   
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