1. The National Institute of Alcohol Abuse and Alcoholism (NIAAA) 2-question screen showed high predictive validity in identifying adolescents at risk for developing alcohol use disorders (AUDs).
Study Rundown: Employment of early screening, brief intervention, and referral to treatment (SBIRT) is a well-known and effective strategy among adolescents to prevent future AUDs and their sequelae. The NIAAA supports the use of a previously validated, 2-question screen to identify adolescents who use alcohol and are at risk of having concurrent AUD, however its effectiveness at predicting future alcohol problems is unknown. In this study, investigators conducted 1, 2, and 3-year follow-up visits with a subset of participants who completed the baseline screen to determine the tool’s ability to accurately predict future AUDs in adolescents. Results showed there were significantly more AUDs in baseline, lower-risk drinkers compared to nondrinkers at all 3 follow-up visits, as well as more AUDs in baseline highest-risk drinkers compared to moderate-risk drinkers at years 1 and 2. Overall, the best specificity and sensitivity for predicting AUDs was achieved when using cutoffs of lower-risk and high-risk. This study was conducted primarily at urban medical centers therefore results may not be representative of pediatric populations in suburban and rural parts of the United States. Results of this study suggest emergency medicine physicians can use the 2-question NIAAA screen to identify youth at risk of developing future AUDs and who would most benefit from interventions to reduce alcohol use and prevent development of future alcohol related health problems.
Relevant reading: Substance use screening, brief intervention and referral to treatment
In-depth [follow-up survey]: Investigators randomly selected 2209 of the original 4834 baseline study participants to complete 1, 2, and 3 year follow-up surveys to determine the validity of the NIAAA screen in predicting future AUDs based on original risk categorization. Of the 2209 participants invited to participate in follow-ups, 1611 (73%) completed a 1-year follow-up, 1591 (72%) completed a 2-year follow-up, and 1377 (62%) completed a 3-year follow-up. Participants in the follow-up subset were significantly more likely to be female (p=.009) and white and Asian American (p<.001). Results showed participants originally characterized as lower-risk drinkers were significantly more likely to have an AUD diagnosis, as defined by the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, compared to nondrinkers at all 3 follow up visits (p=.0002 at 1-year, p<.001 at 2-year, and p=.0005 at 3-years). Similarly, highest-risk drinkers were more likely than moderate-risk drinkers to have an AUD at 1-year and 2-year (p<.0001 and p=.0088 respectively) but not at the 3-year follow-up (p=.0758). No difference was seen when comparing lower-risk to moderate-risk drinkers. The sensitivity and specificity were highest for all 3 follow-ups when using lower-risk versus higher-risk as a cutoff for predicting AUD development (86.2% and 78.1% respectively at 1-year, 75.6% and 79.2% respectively at 2-years, and 60.0% and 80.0% respectively at 3-years).
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