Adolescent alcohol abuse: addressing the treatment gap

Teen Alcohol Abuse

Adolescent alcohol abuse has been an ongoing public health problem for many years. While alcohol abuse trends tend to increase and subside over time, recent research continues to show an alarming level of alcohol use. For example, surveys by the National Institute on Drug Abuse (NIDA) show that alcohol use has dropped slightly when compared with previous years, in 2011 almost two thirds (65%) of high school seniors and almost one third (29%) of eighth graders had used alcohol within the past month (Winters, Botzet & Fahnhorst, 2011).

Health Needs Assessment

As of 1988, the purchase of alcohol by youth under the age of 21 is prohibited. Therefore, the Centers for Disease Control (CDC) define underage drinking as consuming alcohol prior to the minimum legal drinking age of 21 years. Further, zero tolerance laws make it illegal in all states for youth under age 21 to drive with any measurable amount of alcohol in their system, that is, with a blood alcohol concentration (BAC) > 0.02 g/dL) (CDC, 2010).

The term substance abuse describes a pattern of substance (drug) use that leads to "significant problems or distress such as failure to attend work/school, substance use in dangerous situations (driving a car), substance-related legal problems, or continued substance use that interferes with friendships and/or family relationships" (Ohio State University, n.d.) Alcohol is the most common legal drug of abuse. Symptoms may include getting intoxicated on a regular basis and believing they need to drink in order to have fun (Ohio State University, n.d.)

There is a significant treatment gap between the number of adolescents who meet the criteria for alcohol abuse and those who receive treatment. According to Sterling, Weisner, Hinman, & Parthasarathy, only 6% to 8% of those who could benefit from alcohol treatment received treatment over the period between 2003 and 2006 (2010). The treatment gap occurs because of a number of factors, including poor health coverage, low motivation by the adolescent or parents, and a lack of specialized adolescent treatment programs (Winters, Botzet & Fahnhorst, 2011).

Demographics. According to the CDC, approximately 25% of young people begin drinking before the age of 13 (Ohio State University, n.d.). The National Survey on Drug Use and Health (NSDUH) reports that in 2010, about 10 million youth aged 12 to 20, 26.3% of this age group, reported that they drank alcohol within the past month. Of these numbers, approximately 6.5 million, or 17%, were binge drinkers, and another 2 million or 5.1% were heavy drinkers. More males than females aged 12 through 20 reported current alcohol use (28.3 versus 24.1%), binge drinking (19.8 versus 14.0%), and heavy drinking (6.7 versus 3.5%) in 2010 survey results (U.S. Department of Health and Human Services (HHS), 2011).

Effects of Alcohol Abuse. Because adult alcohol use is legal, many people do not consider it to be an addictive drug; however, alcohol is one of the most widely used drug substances in the world. Alcohol misuse has various negative impacts on the adolescent's quality of life. Binge drinking and alcohol use among youth is one of the nation's most serious public health problems:

In 2009, 24% of high school students reported episodes of heavy or binge drinking.

In 2009, an estimated 12% or 30.2 million people aged 12 or older reported driving under the influence of alcohol at least once in the past year (NIDA, 2011).

In 2009, 10% of high school students reported driving a vehicle during the previous 30 days when they had been drinking alcohol.

Every year approximately 5,000 people under the age of 21 die as a result of underage drinking. This figure includes about 1,900 deaths from motor vehicle crashes, about 1,600 from homicides, 300 from suicide, and hundreds more form other injuries such as falls, burns, and drowning (HHS, 2007).

Excessive alcohol use can harm the growing brain, and can affect the body in many ways ranging from hangovers to death from alcohol poisoning (HHS, 2007).

Long-term alcohol misuse is associated with liver disease, cancer, cardiovascular disease, and neurological damage, along with psychiatric problems such as depression, anxiety, and antisocial personality disorder (CDC, 2010).

Alcohol misuse is often accompanied by other conditions and risky behaviors, such as delinquency, exposure to human immunodeficiency virus (HIV), poor academic performance as well as suicide (Sterling, Weisner, Hinman, & Parthasarathy, 2010). Societal costs of alcohol misuse include time lost from school or work, increased criminal activity, and increased medical care use. Alcohol misuse has also been linked to unintentional injuries, physical fights, academic and occupational problems and illegal behavior (CDC).

Evaluation Plan

The purpose of the evaluation plan is to learn whether the education, prevention and public policy initiatives undertaken by the project plan are changing the attitudes and behavior of both youth and adults in the community about adolescent alcohol use.

Evaluation Plan Description. 2012 NDSUH survey responses will be analyzed to obtain information on the illegal use of alcohol in the civilian, non-institutionalized population of the U.S. aged 12 years or older. The survey collects data through face-to-face interviews of approximately 67,500 persons each year. The survey reports on alcohol use broken out by persons aged 12 to 20 by three categories: current (past month) use, binge use (five or more drinks on the same occasion on at least 1 day in the past 30 days), and heavy use (five or more drinks on the same occasion on each of 5 or more days in the past 30 days) (HHS, 2011).

Timeline. The report on 2012 state-level estimates is expected to be released in the spring of 2013, with substate estimates expected during the summer of 2013.

Program Resources. This prevention program primarily supplements some existing underage drinking programs and services that are already in place, such as the public and private health care system (Medicaid and health plans), and such programs as Mothers Against Drunk Driving (MADD) and Students Against Drunk Driving (SADD). Where additional resources are required, funding will be obtained through grants. Personnel requirements include a director for each state to coordinate with local and community officials.