Teen alcohol use interferes with brain development

In addition, adolescent females who drink alcohol have a greater risk of benign breast disease than do their non-drinking counterparts, according to new research.

By — Posted May 10, 2010

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New evidence showing that alcohol use among youths affects this population more strongly than previously believed has led the American Academy of Pediatrics to urge physicians be more aggressive in discussing substance abuse with their patients.

The AAP posted an updated policy statement on alcohol use by youth and adolescents on the Pediatrics website April 12. The main differences from the last policy, issued in 2001, are updated information on the effects of alcohol on youth neurodevelopment and new recommendations for physicians to prevent and reduce underage drinking.

The 2010 statement indicates that the brain's frontal lobes, essential for functions such as emotional regulation, planning and organization, continue to develop through adolescence and young adulthood. At this stage, the brain is more vulnerable to the toxic and addictive actions of alcohol and other drugs.

"We know alcohol is toxic to the brain itself. Now we also know it interferes with the [brain's] development," said the policy's lead author Patricia Kokotailo, MD, MPH, a member of the AAP's Committee on Substance Abuse.

"We're realizing that alcohol really has a lot of effects on young people, and they're long-lasting ones," said Dr. Kokotailo, a professor of pediatrics and associate dean for faculty development and faculty affairs at the University of Wisconsin School of Medicine and Public Health.

The Committee on Substance Abuse recommends that physicians discuss the hazards of alcohol and other drugs with patients during medical visits, preferably without parents in the room. Dr. Kokotailo said adolescents need time alone with their physicians to talk about difficult issues.

"You don't want to promote that there are secrets going on. But everyone needs time [alone] with the doctor," she said.

When Indianapolis pediatrician Margaret Blythe, MD, meets with her adolescent patients one-on-one, she often spends the time answering their questions about drinking and drug use. Sometimes she follows up on the visits with an e-mail that offers additional information. For example, when a 16-year-old patient said she drinks vodka because it doesn't have calories, Dr. Blythe e-mailed the teenager the liquor's caloric information. A one fluid-ounce shot of vodka has 73 calories.

"You have to educate [adolescents]. Find things that are important to them and point out that [drinking alcohol] may not be in line with their goals for themselves," Dr. Blythe said.

The AAP also encourages doctors to screen adolescents annually for alcohol and other drugs using surveys such as the six-question CRAFFT screening tool. The questions focus on whether substance abuse has caused a teen to get in trouble, whether a teen uses alone, and whether a teen uses to boost self-esteem.

For youths who do use alcohol, the AAP suggests that doctors use motivational interviewing, a technique that helps patients attain the desire and confidence to make necessary behavioral changes. Patients with problematic use of alcohol or a substance abuse disorder should be referred for treatment.

Most commonly used drug

Alcohol is the most commonly used and abused drug among youth in the U.S., according to the Centers for Disease Control and Prevention.

Nearly three-quarters of students (72%) consumed alcohol by the end of high school, according to the 2008 Monitoring the Future study, which is funded by the National Institute on Drug Abuse. Each year, the study surveys a total of about 50,000 students in eighth, 10th, and 12th grades. In 2008, 55% of 12th graders and 18% of eighth-graders reported having been drunk at least once.

A study posted online April 12 in Pediatrics found that adolescent females who drink alcohol have a greater risk of benign breast disease than do their counterparts who do not drink.

Researchers examined data on 6,899 girls age 9 to 15 who were enrolled in the Growing up Today Study. They followed the participants from 1996 to 2007. They found females who drank six to seven days a week were 5.5 times more likely to have benign breast disease than were those who didn't drink, or who had less than one drink a week. Participants who reported drinking three to five days a week had three times the risk.

"It's clear that pediatricians and adolescent medical clinics need to pay more attention to alcohol intake in their populations," said study investigator Graham Colditz, MD, DrPh, professor of epidemiology and public health at Washington University School of Medicine in St. Louis.

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More screening sought

The American Academy of Pediatrics has published an updated policy statement on alcohol use by youth and adolescents. The AAP recommends that physicians take the following steps to help prevent and reduce underage drinking:

  • Become knowledgeable about adolescent alcohol, tobacco and other substance use through training programs or continuing medical education.
  • Obtain a complete family medical and social history at prenatal and child wellness visits to explore potential genetic and family influences regarding alcohol and other substance use.
  • Recognize risk factors for adolescent alcohol use and be aware of mental health problems that might occur in this age group.
  • Use validated methods to screen regularly for alcohol and other drug use.
  • Assess patients whose screening results are positive for alcohol use to determine the appropriate level of intervention.
  • Use brief intervention and motivational interviewing techniques to work with patients who use alcohol but do not meet criteria for immediate referral.
  • Discuss the hazards of alcohol and other substance use with patients.
  • Strongly advise teen patients against the use of alcohol, tobacco and other illicit drugs.
  • Encourage parents to be good role models for healthy life choices.
  • Be familiar with local resources to which young patients can be referred for treatment.
  • Support continuation of 21 as the minimum legal drinking age.
  • Support further research into prevention, evidence-based screening and identification, brief intervention, and management and treatment of alcohol and other substance use by adolescents.

Source: American Academy of Pediatrics, "Policy Statement Alcohol Use by Youth and Adolescents: A Pediatric Concern," Pediatrics, published online April 12 (link)

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External links

"Policy Statement: Alcohol Use by Youth and Adolescents: A Pediatric Concern," Pediatrics, published online April 12 (link)

"Prospective Study of Adolescent Alcohol Consumption and Risk of Benign Breast Disease in Young Women," abstract, Pediatrics, published online April 12 (link)

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