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Screening for Underage Drinking and Diagnostic and Statistical Manual of Mental Disorders, 5th Edition Alcohol Use Disorder in Rural Primary Care Practice

      Objective

      To examine the National Institute on Alcohol Abuse and Alcoholism Youth Guide alcohol frequency screening thresholds when applied to Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) diagnostic criteria, and to describe alcohol use patterns and alcohol use disorder (AUD) characteristics in rural youth from primary care settings.

      Study design

      Adolescents (n = 1193; ages 12 through 20 years) visiting their primary care practitioner for outpatient visits in six rural primary care clinics were assessed prior to their practitioner visit. A tablet computer collected youth self-report of past-year frequency and quantity of alcohol use and DSM-5 AUD symptoms. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined.

      Results

      For early adolescents (ages 12 through 14 years), 1.9% met DSM-5 criteria for past-year AUD and ≥3 days with alcohol use in the past year yielded a screen for DSM-5 with optimal psychometric properties (sensitivity: 89%; specificity: 95%; PPV: 37%; NPV: 100%). For middle adolescents (ages 15 through 17 years), 9.5% met DSM-5 AUD criteria, and ≥3 past year drinking days showed optimal screening results (sensitivity: 91%; specificity: 89%; PPV: 50%; NPV: 99%). For late adolescents (ages 18 through 20 years), 10.0% met DSM-5 AUD criteria, and ≥12 past year drinking days showed optimal screening results (sensitivity: 92%; specificity: 75%; PPV: 31%; NPV: 99%). The age stratified National Institute on Alcohol Abuse and Alcoholism frequency thresholds also produced effective results.

      Conclusion

      In rural primary care clinics, 10% of youth over age 14 years had a past-year DSM-5 AUD. These at-risk adolescents can be identified with a single question on alcohol use frequency.

      Keywords

      Abbreviations:

      AUD (Alcohol use disorder), CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble), DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition), DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition), FN (False negative), FP (False positive), NIAAA (National Institute on Alcohol Abuse and Alcoholism), NPV (Negative predictive value), PCP (Primary care practitioner), PPV (Positive predictive value), TN (True negative), TP (True positive)
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