AAP News •
www.aapnews.org • September 2015 21
by Melissa Jenco • News Content Editor
Pediatricians should ask every adolescent about alcohol use and educate parents about doing the same in
an effort to prevent binge drinking,
according to a new AAP clinical report.
“It takes much less in a kid to get intoxicated, espe-
It is published in the September issue of Pediatrics
cially in the young brain, and the effects can be long
lasting,” said Lorena M. Siqueira, M.D., M.S.P.H.,
FAAP, co-author of the report. “So
just like with any high-risk behav-
ior, if you can delay the onset, it’s
much better than thinking about
dealing with it after the fact.”
The report, Binge Drinking,
from the AAP Committee on
Substance Abuse, discusses the
epidemiology, risk factors and consequences of
binge drinking and offers guidance to pediatricians.
Binge drinking by the numbers
Alcohol is the substance adolescents in the U.S.
abuse most often. Of those who drink, about half
of those ages 12-14 and 72% of those 18-20 drink
heavily, according to the report, which did not specifically look at college binge drinking.
The report uses the National Institute on Alcohol
Abuse and Alcoholism’s (NIAAA’s)
definition of binge drinking, which
is drinking that results in a blood alcohol concentration of 0.08% or higher. That means
about three or more drinks in two hours for girls
ages 9-17 years, according to the report. Boys likely
would reach intoxication levels with three or more
drinks in two hours for those ages 9-13, four or
more drinks for ages 14-15 and five or more drinks
for ages 16-17 years. However, that does not mean
fewer drinks should be considered safe.
Adolescents often don’t realize how much they are
drinking and can become intoxicated with relatively
small amounts, according to Dr. Siqueira.
Adults including parents and other relatives are
the most common source of the alcohol.
The report calls adolescence “a critical risk period
for initiation of alcohol” as areas of the brain that
control impulsivity have not fully
developed. Peer use also can play
a role in teen drinking in addition
to media that make drinking seem
like the norm.
Dr. Siqueira called drinking in
advertising and on TV programs
“pervasive,” saying it is helpful to
talk to youths early before they are
influenced by how the media portray alcohol use.
High school boys are more likely
than girls of the same age to binge
drink, and white high school students are more likely to do so than
other races, according to the report.
Alcoholism typically has both
genetic and environmental roots.
However, those who start drinking
before age 15 are four times more
likely to develop alcohol dependence than those who start after age 20.
Short- and long-term consequences
The list of consequences of adolescent binge
drinking is a long one. In the short term, alcohol
poisoning can lead to coma or death. Binge drinking has been associated with using other substances
at a young age and higher rates of teen pregnancy
and sexually transmitted infections. It also increases
the risk of becoming a victim of unwanted sexual
Alcohol use is associated with vehicle accidents, homicides and suicides,
Those who binge drink may struggle in school, and
some face legal consequences for underage drinking.
In addition, alcohol use may interrupt brain development, resulting in cognitive impairment. Down the
road, they may suffer from liver disease, hypertension,
heart disease, stroke and cancer.
Pediatricians should screen every adolescent for
alcohol use during office visits, according to the report. A tool developed by the NIAAA and Academy
consists of two questions that vary slightly by age
group, but generally ask about drinking by the child
and his or her friends.
Those deemed at low risk for alcohol-related problems are given brief advice while those at moderate
risk are given advice plus motivational interviewing
in which the pediatrician and patient discuss the
benefits of making changes to achieve goals.
“I think it’s a much better approach and learning
how to do it effectively is much better I think than
don’t do this, don’t do that,” Dr. Siqueira said. “Kids
will tune you out.”
For adolescents deemed high risk, consider moti-
vational interviewing and possible referral.
Pediatricians also should educate parents, as 80%
Guidance for pediatricians
of teens called their parents their biggest influence on
drinking. The Substance Abuse and Mental Health
Services Administration’s (SAMHSA’s) “Talk. They
Hear You.” program includes background informa-
tion and talking points (See resources).
• Take part in universal preventive interventions that
address both youths and adults such as launching
adult-oriented media campaigns, increasing community interventions and school-based education
programs, and limiting access to alcohol.
• Educate parents about talking to their children as
early as age 9 about the dangers of drinking.
• Screen every adolescent for alcohol use and intervene with brief advice, motivational interviewing
and/or referral depending on the level of risk.
AAP report: Screen every adolescent for alcohol use
• SAMHSA’s “Talk. They Hear You.” program, 1.usa.gov
• NIAAA’s guide to screening and intervention, 1.usa.
• AAP policy Alcohol Use by Youth and Adolescents: A
Pediatric Concern, bit.ly/1MIhn1i
• Community Preventive Services Task Force, bit.ly/1P1t
Alcohol is the substance adolescents in the U.S. abuse most often. Of
those who drink, about half of those ages 12-14 and 72% of those 18-
20 drink heavily. Dr. Siqueria
Several pediatric programs and observances take
place in September. Following are links to AAP
resources and support. An AAP member ID and
password are required for some links. Find out about
all of the September events by visiting www.aap.org,
HealthyChildren.org and following @AmerAcad
Peds on Twitter.
• Fetal Alcohol Spectrum Disorders (FASD)
Awareness: AAP/Centers for Disease Control
and Prevention FASD program toolkit (http://
• Child Obesity Awareness Month: Visit the
websites for the AAP Institute for Healthy
Childhood Weight ( https://ihcw.aap.org/Pages/
default.aspx) and Section on Obesity (http://bit.
•National Childhood Injury Prevention
Month: Find patient safety handouts at The
Injury Prevention Program website (http://bit.
• Child Passenger Safety Week (Sept. 13-19):
Car seat information and links available on the
Council on Injury, Violence and Poison Prevention webpage ( http://www2.aap.org/sections/