ALCOHOL SCREENING
 

AND BRIEF INTERVENTION
 
FOR YOUTH 

A PRACTITIONER’S GUIDE
 

1 in 3 children starts drinking by the end of 8th grade
 

· 
 

1 in 3 children starts drinking by the end of 8th grade 

... and of them, half report having been drunk. 

Johnston, L. D., O’Malley, P. M., Bachman, J. G., & Schulenberg, J. E. (2011). Monitoring the Future national survey results on 

adolescent drug use: Overview of key findings, 2010. Ann Arbor: Institute for Social Research, The University of Michigan, 77 pp. 
CONTENTS 

Introduction ................................................................................................................. 1
 

About This Guide ........................................................................................................ 3 


Before You Begin........................................................................................................ 5
 

Alcohol Screening and Brief Intervention for Youth Ages 9–18: 


Four Steps at a Glance .............................................................................................. 7
 

For All Patients: 

Step 1: Ask the Two Screening Questions.................................................. 8
 

Step 2: Guide Patients Who Do Not Drink ................................................. 9


 or Assess Risk in Patients Who Do Drink .........................................10
 

For Patients Who Drink: 

Step 3: Advise and Assist................................................................................11
 

Step 4: At Followup, Continue Support....................................................12
 

Appendix 

Frequently Asked Questions ................................................................................14
 

Clinician Support Materials...................................................................................25
 

References...................................................................................................................35
 

Additional Resources ..............................................................................................38
 

INTRODUCTION 

With this Guide, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) introduces a 

simple, quick, empirically derived tool for identifying youth at risk for alcohol-related problems. 

If you manage the health and well-being of children and adolescents ages 9–18 years, this Guide 

is for you. It has been produced in collaboration with the American Academy of Pediatrics, 

clinical researchers, and health practitioners such as yourself. 

Why choose this tool? 

It can detect risk early: In contrast to other screens that focus on established alcohol problems, 

this early detection tool aims to help you prevent alcohol-related problems in your patients before 

they start or address them at an early stage. 

It’s empirically based: The screening questions and risk scale, developed through primary survey 

research, are powerful predictors of current and future negative consequences of alcohol use. 

It’s fast and versatile: The screen consists of just two questions that you can incorporate easily 

into patient interviews or pre-visit screening tools across the care spectrum, from annual exams to 

urgent care. 

It’s the first tool to include friends’ drinking: The “friends” question will help you identify 

patients at earlier stages of alcohol involvement and target advice to include the important risk 

factor of friends’ drinking. 

Why screen for underage drinking? 

It’s common: Alcohol is by far the drug of choice among youth. It’s often the first one tried, and 

it’s used by the most kids (Johnston et al., 2010). Over the course of adolescence, the proportion 

of kids who drank in the previous year rises tenfold, from 7 percent of 12-year-olds to nearly 

70 percent of 18-year-olds (NIAAA, 2011). Dangerous binge drinking is common and increases 

with age as well: About 1 in 14 eighth graders, 1 in 6 tenth graders, and 1 in 4 twelfth graders 

report having five or more drinks in a row in the past 2 weeks (Johnston et al., 2011). Chances 

are, your practice has its share of youth at risk. 

It’s risky: In the short term, adolescent drinking too often results in unintentional injuries and 

death; suicidality; aggression and victimization; infections and pregnancies from unplanned, 

unprotected sex; and academic and social problems (Brown et al., 2008). In the long term, 

drinking in adolescence is associated with increased risk for alcohol dependence later in life 

(Hingson et al., 2006; Grant & Dawson, 1997). In addition, heavy drinking in adolescence may 

result in long-lasting functional and structural changes in the brain (Squeglia et al., 2009). 

www.niaaa.nih.gov/YouthGuide 1 
 

It’s a marker for other unhealthy behaviors: When adolescents screen positive for one risky 

behavior—whether drinking, smoking tobacco, using illicit drugs, or having unprotected sex—it’s 

generally a good marker for the others (Biglan et al., 2004). For many kids, drinking alcohol is 

the first risky behavior tried. So the quick alcohol screen in this Guide can alert you to patients 

who may need attention for other risky behaviors as well. 

It often goes undetected: Most adolescents visit a primary care practitioner every year or two 

(O’Connor et al., 1999), and many are willing to discuss alcohol use when they are assured of 

confidentiality (Ford et al., 1997). However, the majority of clinicians do not follow professional 

guidelines to screen all of their adolescent patients for alcohol use, often citing a lack of 

confidence in their alcohol management skills as a barrier (Millstein & Marcell, 2003). To offer 

support in this area, this Guide includes an overview of a promising, teen-friendly approach 

to promoting positive change in young drinkers (see page 29). 

As a trusted health care provider, you are in a prime position to identify drinking-related risks 

and problems in your patients and to intervene. Our hope is that the brevity, ease of use, and 

predictive strength of this new tool will enable you to detect alcohol risks and prevent harm at the 

earliest possible stage. With this Guide, you have what you need to begin. 

2 | Alcohol Screening and Brief Intervention for Youth | A Practitioner’s Guide 
 

ABOUT THIS GUIDE 

NIAAA created this Guide to help you conduct fast, effective alcohol screens and interventions 

with your patients, even during brief, acute care visits. The tools, tips, and resources are designed 

to help you surmount common obstacles to youth alcohol screening in primary care. Typical 

barriers include insufficient time, unfamiliarity with screening tools, the need to triage competing 

problems, and uncertainty about how to manage a positive screen (Van Hook et al., 2007). 

It’s about time—yours and your patients’ 

In primary care, your time is at a premium. Time is also of the essence for your patients who may 

be considering, experimenting with, using, abusing, or even becoming dependent on alcohol. 

With this in mind, we wanted you to have the shortest possible alcohol screening tool with the 

strongest evidence for predicting current or downstream problems in youth. To reach this goal, 

NIAAA convened a working group of researchers who conducted primary analyses of multiple 

databases across multiple years. Their extensive analyses boiled down to two questions per 

patient, varying slightly by age group. 

Two powerful questions open the door 

One question is about friends’ drinking, and the other is about personal drinking frequency 

(see page 8). The friends’ drinking question is an early warning signal that strongly predicts the 

patient’s future drinking levels (Brown et al., 2010). It also allows you a nonthreatening “sidedoor” entrance to begin talking about alcohol with younger patients in particular. The personal 

drinking question zeroes in on frequency, the best predictor of current risk for alcohol-related 

harm in adolescents who are already drinking (Chung et al., in press). The researchers examined 

many other questions, but these two by far had the greatest practicality and predictive strength. 

If you’re going to ask about alcohol, these are the questions to ask. (For details about the 

development of the questions, see page 16 and visit www.niaaa.nih.gov/YouthGuide.) 

The risk estimator can help you triage 

Acute care visits generally don’t allow time for anticipatory guidance. Even during well-care 

visits, you’ll need to choose the guidance to offer. The risk estimator (see page 10 and the Pocket 

Guide) broadly indicates your patient’s chances for having alcohol-related problems, based on 

his or her age and drinking frequency. Coupled with what you already know about your patient, it 

will help you determine the depth and content of your response. 

3 
 

Positive screens become manageable 

This Guide’s tools will take much of the mystery out of intervening with your patients who are 

drinking, allowing you to proceed within a clinical framework of lower, moderate, or highest 

risk (see page 11). Once you determine that a patient is at lower risk, for example, you’ll be able 

to provide brief advice, quickly and with confidence, and move on. For patients at moderate 

or highest risk for alcohol-related harm, you will have uncovered perhaps the greatest current 

threat to their health—and still, you can manage it efficiently. The Guide outlines different levels 

of intervention with tips for topics to cover. It also presents an overview of brief motivational 

interviewing, an interactive, youth-friendly intervention considered to have the best potential 

effectiveness for the adolescent population (see page 29). 

In addition, the Guide aims to help clinicians overcome other common barriers to screening: 

concerns about confidentiality (see page 25), a lack of information about coding for counseling 

about alcohol use (see page 24), and the challenge of finding adolescent treatment resources for 

referrals (see page 34). 

In short, our goal is to support your efforts to protect your patients from alcohol-related harm. 

And we want to hear from you. Please send us your comments about this Guide—and suggestions 

for ways to improve our support for you—by email to NIAAAYouthGuide@mail.nih.gov. 

4 | Alcohol Screening and Brief Intervention for Youth | A Practitioner’s Guide 
 

BEFORE YOU BEGIN 

Decide on a screening method 

The screening questions can be used at any time, alone or along with other tools, as part of a 

clinical interview. Some practices may prefer to incorporate the questions into written self-report 

questionnaires or computer screening that patients complete before seeing the clinician. You 

will need to protect patient privacy, of course, whether you ask the questions in person or by 

other means. 

Think about opportunities and clinical indications for screening 

• As part of an annual examination 

• As part of an acute care visit 

• In the emergency department or urgent care center 

• When seeing patients who: 

– you have not seen in a while 

– are likely to drink, such as youth who smoke cigarettes 

–	 have conditions associated with increased risk for substance abuse, such as: 

- depression - ADD/ADHD

5 

 - anxiety - conduct problems 

– have health problems that might be alcohol related, such as: 

- accidents or injury - changes in eating or sleeping patterns 

- sexually transmitted - gastrointestinal disturbances 

infections or unintended - chronic pain 

pregnancy 

– show substantial behavioral changes, such as: 

- increased oppositional - change of friends 

behavior - a drop in grade point average 

- significant mood changes - large number of unexcused

- loss of interest in activities school absences 
 

Set up your practice to simplify the process 

• Educate office staff: Ensure that staff members understand the importance of universal 

alcohol screening for youth. Identify a lead “champion” to establish, monitor, and evaluate 

office screening procedures. 

• Decide how screening will be conducted: If a clinical assistant will screen instead of the 

physician, or if a print or computerized tool is used, work out record-keeping to facilitate 

followup in the exam room. Commit to screening at every possible visit. 

• Set reminders: If available, use electronic medical records to cue for screening and 

followup. 

• Prepare for confidential care: Establish procedures for providing confidential care. 

Become familiar with your State laws on a minor’s ability to consent to substance use 

treatment (see page 25). 

• Prepare for referrals: Generate a list of, and build a rapport with, local adolescent alcohol 

treatment resources (see page 34); keep copies of the list in exam rooms. 

• Stock materials: Keep copies of the Pocket Guide (provided) in exam rooms. Provide 

educational materials for parents (see page 38). 

6 | Alcohol Screening and Brief Intervention for Youth | A Practitioner’s Guide 
www.niaaa.nih.gov/YouthGuide 7 

Alcohol Screening and Brief Intervention for Youth Ages 9–18 

FOUR STEPS AT A GLANCE 

Refer to the following pages for detailed steps. 

  

  

Screening 

complete for 

patients who 

do not drink 

•  Ask about alcohol use and any related 

    consequences or problems. 

•  Review the patient’s goal(s) related to alcohol 

and his or her plans to accomplish them. 

•  Offer support and encouragement. 

•  Complete a full psychosocial interview, if not 

    done at the previous visit. 

STEP 4: AT FOLLOWUP, CONTINUE SUPPORT 

STEP 3: ADVISE AND ASSIST 

LOWER RISK 

•  Provide brief advice to stop drinking. 

MODERATE RISK 

•  Provide brief advice or, if problems are present,

    conduct brief motivational inter viewing. 

•  Arrange for followup, ideally within a month. 

HIGHEST RISK 

•  Conduct brief motivational inter viewing. 

•  Consider referral to treatment. 

•  Arrange for followup within a month. 

STEP 2: GUIDE PATIENT 

•  Reinforce healthy choices. 

If friends drink: 

•  Explore your patient’s views about this. 

•  Ask about his or her plans to stay alcohol free. 

•  Rescreen at next visit. 

If friends don’t drink: 

•  Praise the choice of nondrinking friends. 

•  Elicit and affirm reasons for staying alcohol free. 

•  Rescreen next year. 

STEP 2: ASSESS RISK 

For patients who DO NOT drink alcohol For patients who DO drink alcohol 

STEP 1: ASK THE TWO AGE-SPECIFIC SCREENING QUESTIONS 

NO YES 

• One about friends’ drinking 

• One about patient’s drinking frequency 

• Identify  Lower ,  Moderate , or Highest risk 

    level using the age­specific risk char t on page 10. 

•  Use what you already know about your 

    patient, and ask more questions as needed. 

Does the 

patient drink? 
 

For All Patients ... 

STEP 1: ASK THE TWO SCREENING QUESTIONS 

Research indicates that the two age-specific screening questions (about friends’ and patient’s 

drinking) are powerful predictors of current and future alcohol problems in youth. Fit them into 

your office practice in whatever way works best for you, whether by adding them to a pre-visit 

screening tool or weaving them into your clinical interview. In either case, take steps to protect 

patient privacy and, if at all possible, conduct an in-person alcohol screen when you are alone 

with your patient. See page 25 for more information about confidentiality. 

Guidelines for asking the screening questions: (1) For elementary and middle school patients, 

start with the friends question, a less threatening, side-door opener to the topic of drinking. 

(2) Because transitions to middle or high school increase risk, choose the question set that aligns 

with a patient’s school level, as opposed to age, for patients aged 11 or 14. (3) Exclude alcohol 

use for religious purposes. 

8 | Alcohol Screening and Brief Intervention for Youth | A Practitioner’s Guide 

Friends: Any drinking? 

“Do you have any friends 

who drank beer, wine, or 

any drink containing alcohol 

in the past year?” 

ANY drinking by friends 

heightens concern. 

Elementary School 

(ages 9–11) 

Ask the friends 

question first.

Friends: Any drinking? 

“Do you have any friends 

who drank beer, wine, or 

any drink containing alcohol 

in the past year?” 

ANY drinking by friends 

heightens concern. 

Middle School 

(ages 11–14) 

Ask the friends 

question first.

High School 

(ages 14 –18) 

Ask the patient 

question first.

Patient: How many days? 

“In the past year, on how many 

days have you had more than a 

few sips of beer, wine, or any 

drink containing alcohol?” 

Lower, Moderate , or Highest Risk 

(see chart on page 10) 

Patient: Any drinking? 

“How about you—have you ever 

had more than a few sips of 

beer, wine, or any drink 

containing alcohol?” 

ANY drinking: 

Highest Risk 

Patient: How many days? 

“How about you—in the past year, 

on how many days have you had 

more than a few sips of beer, wine, 

or any drink containing alcohol?” 

ANY drinking:
 

Moderate or Highest Risk
 

(see chart on page 10) 

Friends: How much? 

“If your friends drink, 


how many drinks do they
 

usually drink on an occasion?”
 

Binge drinking by friends 

heightens concern. 

(3 to 5+ drinks; see page 15) 

GO TO STEP 2: GUIDE GO TO STEP 2: ASSESS RISK 

NO Does the YES 

patient drink? 
www.niaaa.nih.gov/YouthGuide 9 

For Patients Who Do Not Drink ... 

STEP 2: GUIDE PATIENT 

For patients who DO NOT drink ... 

  

  

 

  

  

 

  

  

• Explore how your patient plans to stay 

 alcohol free when friends drink: Ask patients 

    for their ideas on handling situations where they 

    may feel pressure to drink. You can let them 

    know that often the best response to a drink 

    offer is a simple “No, thanks“; that, if pressured, 

    an effective response is “I don’t want to”; and 

    that they don’t have to give a reason.   

• Advise against riding in a car with a driver 

who has been drinking or using other drugs. 

• Rescreen at next visit. 

•  Rescreen next year at the latest. 

• Reinforce healthy choices with praise and encouragement: “You’ve made a smart 

 decision not to use alcohol.” 

• Elicit and affirm reasons to stay alcohol free: “So, what led you to the decision to stay 

 away from alcohol?” If friends drink , add, “... especially when your friends have chosen to

 drink?” Possible followup: “Those are great reasons and show you really care about yourself 

 and your future.” 

• Educate: If your patient is open to input, you may want to help him or her understand, 

    for example, that (1) alcohol can affect brain development, which continues into a person’s

    twenties; and (2) drinking at an early age increases the risk for serious alcohol problems 

    later in life. 

Screening 

complete for 

nondrinkers 

NO Do friends YES 

drink? 

     

  

Neither patient nor patient’s friends drink 

• Praise choices of not drinking and of 

    having nondrinking friends. 

Patient does not drink, but friends do 

• Praise choice of not drinking. 

• Consider probing a little using a neutral 

    tone: “When your friends were drinking, you 

    didn’t drink. Tell me a little more about that.” 

    If the patient admits to drink ing, go to Step 2 

    for Patients Who Do Drink; other wise, 

    continue below. 
10 | Alcohol Screening and Brief Intervention for Youth | A Practitioner’s Guide 

For Patients Who Do Drink ... 

STEP 2: ASSESS RISK 

For patients who DO drink ... 

For a broad indicator of your patient’s level of risk, start with the chart below, which provides empirically 

derived population-based estimates. Then factor in what you know about friends’ drinking and other risk 

factors, ask more questions as needed, and apply your clinical judgment to gauge the level of risk. 

On how many DAYS in the past year did your patient drink? 

 

 

1–5 days 6–11 days 12–23 days 24–51 days 52+ days 

≤11 Highest risk 

12–15 Tx: Brief motivational interviewing +

possible referral 

16 

17 Lower risk Moderate risk 

18 Tx: Brief advice Tx: Brief advice or 

motivational interviewing 

Estimated risk levels by age and frequency in the past year 

Age 

In the chart, see where your patient’s age and drinking frequency intersect: If your patient responds to 

the screening question with a per-month or per-week frequency, convert the answer to days per year to see 

where the drinking falls on the risk chart. As an example, a 15-year-old who reports drinking about twice a 

month, or 24 days in the past year, is at “highest risk” for adverse consequences. (This chart is also in the 

Pocket Guide; see page 19 for tips on remembering the risk level cut points.) 

Factor in friends: 

• For elementary and middle school students: Having friends who drink heightens concern. Because 

having more drinking friends means more risk, ask how many friends drink, if your patient didn’t 

offer this detail when answering the screening question. 

• For high school students: Having friends who binge drink heightens concern. Recent research 

estimates that binge drinking levels for youth start at 3 to 5 drinks, depending on age and gender 

(see page 15). 

Include what you already know about the patient’s physical and psychosocial development in your risk 

evaluation, along with other relevant factors such as the level of family support, drinking and smoking 

habits of parents and siblings, school functioning, or trouble with authority figures. 

For moderate and highest risk patients: 

• Ask about their drinking pattern: “How much do you usually have? What’s the most you’ve had at any 

one time?” If the patient reports bingeing (see page 15), ask: “How often do you drink that much?” 

• Ask about problems experienced or risks taken: “Some people your age who drink have school 

problems like lower grades or missed classes. Some do things and feel bad about them later, like 

damaging or stealing property, getting into fights, getting sexually involved, or driving or riding in a 

car driven by someone who has been drinking. Others get injured, have memory blackouts, or pass out. 

What not-so-good things related to drinking, if any, have you experienced?” 

• Ask about other substance use (“Have you used anything else to get high in the past year?”) 

and consider using other formal tools to help gauge risk (see page 32). The majority of your lower 

risk patients will not have used illicit drugs (NIAAA, 2011), but ask them, too, about past-year use, 

time permitting. 

GO TO STEP 3 

After you assess risk ... 
www.niaaa.nih.gov/YouthGuide

For Patients Who Do Drink ... 

STEP 3: ADVISE AND ASSIST 

For patients who DO drink ... 

In this step, conduct a brief intervention for your patients who drink, based on the risk levels 

identified during Step 2. See the appendix for additional information on confidentiality 

(page 25) and conducting brief motivational interviewing (page 29). 

Lower Risk 

•	 Provide	brief	advice: “I 

recommend that you stop 

drinking, and now is the 

best time. Your brain is still 

developing, and alcohol can 

affect that. Alcohol can also 

keep you from making good 

decisions and make you do 

things you’ll regret later. I 

would hate to see alcohol 

interfere with your future.” 

• Notice	the	good:	Reinforce 

any strengths and healthy 

decisions. 

• Explore	and	troubleshoot	the 

potential influence of friends 

who drink or binge drink. 

Moderate Risk 

•	 Does	the	patient	have	

alcohol-related	problems?	

– 	 	If	no,	provide	beefed-up	

brief	advice:	 Start with 

the brief advice for Lower 

Risk patients (at left) and 

add your concern about the 

frequency of drinking. 

– If	yes,	conduct	brief	

motivational	interviewing

to elicit a decision and 

commitment to change 

(see page 29). 

•	 Ask	if	parents	know:	See 

suggestions for Highest Risk 

patients (at right). 

•	 Arrange	for	followup, ideally 

within a month. 

Highest Risk 

• Conduct	brief	motivational	

interviewing to elicit a 

decision and commitment 

to change, whether or not 

you plan to refer (see page 29). 

• Ask	if	parents	know: If so, 

ask patient permission to 

share recommendations 

with them. If not, take into 

account the patient’s age, the 

degree of acute risk posed, 

and other circumstances, 

and consider breaking 

confidentiality to engage 

parent(s) in follow-through. 

•	 Consider	referral	for	further	

evaluation	or	treatment	

based on your estimate of 

severity (see page 23). 

•	 Arrange	for	followup within 

a month. 

If	you	observe	signs	of	acute	

danger,	such	as	drinking	

and	driving,	high	intake	

levels	per	occasion,	or	use	

of	alcohol	with	other	drugs,	

take	immediate	steps	to	

ensure	safety	(see	page	21).

				FOR ALL PATIENTS WHO DRINK

•	 Collaborate on a personal goal and action plan for your 

patient. Refer to page 31 for sample abstinence, cutting back, 

and contingency plans. For some patients, the goal will be 

accepting a referral to specialized treatment. 

•	 Advise your patient not to drink and drive or ride in a car

with an impaired driver.

•	 Plan a full psychosocial interview for the next visit if needed. 

11 

GO TO STEP 4 

After intervention ... 
 

For Patients Who Did Drink ... 

STEP 4: AT FOLLOWUP, CONTINUE SUPPORT 

For patients who DID drink ... 

It may be uncommon for patients to return for an alcohol-specific followup. Still, when patients with 

whom you’ve conducted an alcohol intervention return for any reason, you’ll have an opportunity 

to strengthen the effects of the previous visit. Start by asking about current alcohol use and any 

associated problems. Then review the patient’s goal(s) and assess whether he or she was able to meet 

and sustain them. 

12 | Alcohol Screening and Brief Intervention for Youth | A Practitioner’s Guide 

 

NO YES 

Was patient 

able to meet and 

sustain goal(s)? 

Patient was able to 

meet and sustain goal(s): 

Patient was not able to 

meet and sustain goal(s): 

• Reassess the risk level (see Step 2 for 

drinkers). 

• Acknowledge that change is difficult;

 that it’s normal not to succeed on the 

 first try; and that reaching a goal is a 

learning process.

• Notice the good by:

 − praising honesty and efforts.

 − reinforcing strengths.

 − supporting any positive change. 

• Relate drinking to associated 

 consequences or problems to

 enhance motivation. 

• Identify and address challenges and 

 opportunities in reaching the goal.

• If the following measures are not 

already under way, consider:

 − engaging the parents.

 − referring the patient for further 

evaluation.
­

• Reinforce the importance of the 

goal(s) and plan and renegotiate

 specific steps, as needed.

• Conduct, complete, or update the 

 comprehensive psychosocial interview. 

• Reinforce and support continued

 adherence to recommendations.

• Notice the good: Praise progress and 

 reinforce strengths and healthy decisions. 

• Elicit future goal(s) to build on prior ones.

• Conduct, complete, or update the 

 comprehensive psychosocial interview. 

• Rescreen at least annually.
APPENDIX 

Frequently Asked Questions 

About underage drinking patterns................................................................14
 

About screening....................................................................................................16
 

About guiding patients who do not drink and their parents...............18
 

About risk assessment ........................................................................................19
 

About intervention ..............................................................................................22
 

About office procedures ....................................................................................24
 

Clinician Support Materials 

Confidentiality .......................................................................................................25
 

Brief motivational interviewing.......................................................................29
 

Additional workup resources ...........................................................................32
 

Referral resources .................................................................................................34
 

References...................................................................................................................35
 

Additional Resources ..............................................................................................38
 
 

Frequently Asked Questions

FREQUENTLY ASKED QUESTIONS 

About underage drinking patterns 

At	what	age	do	kids	start	drinking?		

The average age at first drink is about 14, according to national surveys of 12- to 20-year-olds 

(Chen et al., 2011). The more we can help kids delay when they begin drinking, the better, as 

the younger the age of drinking onset, the greater the chance for alcohol dependence later in life 

(Hingson et al., 2006; Grant & Dawson, 1997). 

Do	boys	and	girls	differ	in	drinking	patterns?	

Up to about 10th grade, the percentage of boys and girls who drink is about the same. By 12th 

grade, however, boys surpass girls, not only in terms of any use, but also in binge drinking and 

having been drunk in the past month (Johnston et al., 2010). 

How	many	kids	in	my	practice	are	likely	to	screen	positive	for	past-year	drinking?		

As your patients get older, you’re likely to see a dramatic climb in the number who drink. 

Although there will be regional and local variations, national surveys show that across 

adolescence, we can expect a tenfold rise in any past-year drinking (the measure that correlates 

with this Guide’s screening questions) (NIAAA, 2011): 

Past-year drinking 

(more than one or two sips) is reported by: 

1 in 15 12-year-olds 

1 in 4 14-year-olds 

1 in 2 16-year-olds 

2 in 3 18-year-olds 

How	much	do	kids	drink?	

As kids get older, more drink and more drink heavily. In fact, you may find that dangerous binge 

drinking is quite common among your patients. National estimates for youth binge drinking 

currently use the binge definition for adult males, that is, five or more drinks per occasion. By 

that definition, among youth who drink, about half of those ages 12 to 15 and two-thirds of those 

ages 16 to 20 binge drank in the past 30 days (SAMHSA, 2010). These are likely underestimates, 

however, because the definition of binge drinking for most youth should be fewer drinks than for 

full-grown adult males (see next question). 

14 | Alcohol Screening and Brief Intervention for Youth | A Practitioner’s Guide 
15 

Frequently Asked Questions

www.niaaa.nih.gov/YouthGuide

	 	 	 	 	 	 	 	 	 		

	 	 	 	 	 	 	 	

	 	 	 	 	 			

	 	 	 	 	 	 	 	 		

Having five or more drinks on at least one occasion
 

in the past 30 days is reported by about:
 

Half of 12- to 15-year-olds who drink
 

Two-thirds of 16- to 20-year-olds who drink
 

What’s a “child-sized” or “teen-sized” binge?
 

Compared with adults, children and teens are likely to have higher blood alcohol concentrations 

after drinking similar amounts of alcohol. Because we ethically cannot conduct clinical studies 

of youth drinking, we rely on mathematically derived estimates of blood alcohol levels for youth. 

Extrapolating from what is known about alcohol metabolism in adults, a recent study accounted 

for differences between adults and kids in body composition and alcohol elimination to estimate 

blood alcohol and binge levels for youth. The study concluded that binge drinking for youth 

should be defined as follows (Donovan, 2009): 

Estimated binge drinking levels for youth

Boys Girls

3 drinks 

4 drinks Ages 9–17 

Ages 9–13 

Ages 14–15 3 drinks 

Ages 16+ 5 drinks 

(See also the FAQ on page 20 on estimating your patient’s quantity of drinking.) 

What kinds of alcohol are kids drinking these days?

All kinds: beer, malt liquor, liquor, wine, and “flavored alcohol beverages.” Generally similar to 

beer in percent alcohol, flavored alcohol beverages include wine coolers and sweetened maltbased drinks that often derive their alcohol content from spirits. Although we don’t yet have a 

comprehensive, nationwide study on youth beverage choices, a few limited studies show that hard 

liquor is gaining on or overtaking beer and flavored alcohol beverages in popularity with youth 

and that wine is less preferred (Siegel et al., 2011; Johnston et al., 2010; CDC, 2007). 

Young people are also drinking alcohol mixed with caffeine, either in premixed drinks or by 

adding liquor to energy drinks. With this dangerous combination, drinkers may feel somewhat 

less drunk than if they’d had alcohol alone, but they are just as impaired in motor coordination 

and visual reaction time (Ferreira et al., 2006). They are more likely to drink heavily, to be injured 

or taken advantage of sexually, and to ride with an intoxicated driver (O’Brien et al., 2008). 
 

Frequently Asked Questions

About screening 

How	effective	are	these	screening	questions?

The new screening questions were empirically derived through analyses of data from (1) an 8-year 

span (2000–2007) of a nationally representative survey, which included more than 166,000 youth 

ages 12 to 18 (Chung et al., in press) and (2) multiple longitudinal studies that collected information 

about young people as they grew up (Brown et al., 2010). While the two recommended questions 

have not yet been clinically tested, the analyses indicate that they are very effective predictors of 

adverse alcohol outcomes, both current and future. In addition, the questions are consistent with 

accepted standards of care in which youth are queried about friends’ activities and personal health 

choices. (See also “What’s the basis for the risk level estimates?” on page 19.) 

Is	alcohol	screening	and	brief	intervention	effective	for	youth?

The evidence is clear that brief interventions are effective for adults. In fact, in 2004, the U.S. 

Preventive Services Task Force “recommended screening and behavioral counseling interventions 

to reduce alcohol misuse by adults” (USPSTF, 2004). At that time, the evidence was inconclusive 

about the effectiveness of alcohol brief interventions for adolescents. 

Since then, however, evidence has been accumulating on the effectiveness of brief interventions 

for adolescents (Jensen et al., 2011; Tripodi et al., 2010; Walton et al., 2010). In addition, in its 

policy statement “Alcohol Use by Youth and Adolescents: A Pediatric Concern,” the American 

Academy of Pediatrics recommends that clinicians who work with children and adolescents 

regularly screen for current alcohol use and use brief intervention techniques during office visits 

(AAP, 2010). (See also “Brief Motivational Interviewing,” page 29.) 

Why	are	we	asking	about	past-year	drinking	instead	of	past-month	drinking,	when	we	

know	kids	have	bad	memories?

All queries about past alcohol use are fallible in one way or another. Even so, responses to these 

queries can provide us with useful information about how children and adolescents are drinking. 

While data relating to past-month drinking may be more precise, data on past-year use helps to 

identify more youth who drink, since drinking by young people is often sporadic. When asked if 

they have had a drink in the past month, many youths may be able to answer “no” even though 

they have had alcohol at other times during the year. Additionally, research shows that responses 

on past-year use are predictive of alcohol-related problems (Chung et al., in press). We ask children 

about their past-year use not because we know their answers are completely accurate, but because 

their responses can help predict symptoms and problems. 

16 | Alcohol Screening and Brief Intervention for Youth | A Practitioner’s Guide 
17 

Frequently Asked Questions

www.niaaa.nih.gov/YouthGuide

 

If	I	ask	my	patients	how	many	times	they	drank	in	the	past	year,	might	this	suggest	to	

them	that	I	expect	them	to	drink?	

You can weave this Guide’s screening questions into clinical interviews with your patients as 

you see fit. If you are concerned that kids may get the message that drinking is normative if you 

lead with a question about drinking frequency, then you might lead with a prescreener along 

the lines of “In the past year, have you had more than a few sips of beer, wine, or any drink 

containing alcohol?” For those who say yes, you can then ask, “On about how many days did you 

drink?” With a prescreening question, however, you may run the risk of getting a false “no” and 

bringing the screening to a stop. Use your sense of the individual patient’s likelihood of alcohol 

involvement and your professional judgment to decide when to lead with a prescreener. In any 

case, if you praise a “no” response, patients will get the message that you don’t find drinking at 

their age acceptable. 

What	can	I	do	to	encourage	my	patients	to	give	honest	and	accurate	answers	when	I	ask	

the	screening	questions?

Establishing good rapport with patients is more of an art than a science. Below are suggestions 

for ways to encourage accurate responses and promote productive, trusting relationships: 

•		 Build in alone time: Build in time during the visit for parents to leave the room so you can 

be alone with your patient to discuss potentially sensitive issues such as alcohol. 

•		 Explain your confidentiality policy: Make sure your patient understands that unless he or 

she is danger, your conversation will remain between the two of you. You can discuss your 

confidentiality policy with parents and children together—both need to be familiar with it. 

•		 Be on their side: Explain to your patients that you are not singling them out, but that you 

talk to all of your adolescent patients about alcohol use and other health risks. Your purpose 

is to keep all of your patients healthy and to offer good medical advice—not to get anyone in 

trouble. 

How	do	I	prioritize	screening	for	alcohol	in	relation	to	other	risk	behaviors	such	as	

unprotected	sex,	smoking,	and	use	of	other	drugs?

Alcohol use is an excellent place to start screening for risky health behaviors for two main 

reasons. First, talking with your patients about alcohol has the potential to save lives. Drinking is 

associated with three top causes of death among adolescents, the first being unintentional injury, 

usually by car crashes, followed by homicide and suicide (CDC, 2008). 

Second, starting with questions about drinking can help you determine whether asking questions 

about other risk behaviors is a high priority. Alcohol is the drug used by the greatest number of 

adolescents (Johnston et al., 2010), and for many young people it is also the first substance they 

try. Youth who don’t use alcohol are unlikely to use any other substances, whereas youth who are 

heavily involved with alcohol are at increased risk for using other substances and for other risktaking behaviors (NIAAA, 2011; Biglan et al., 2004). 
 

Frequently Asked Questions

	 	 	 	 	 	 	 	 	 	 	 	 	 	

	 	 	 	

Why	should	I	bother	screening	kids	that	I’m	almost	positive	aren’t	drinking	alcohol?

Talking about alcohol—with all of your patients—shows them that you care about their health 

and are concerned about the risks. You may be surprised to discover how widespread alcohol 

use really is among adolescents. Despite your best instincts, you will find that even “good kids” 

drink—and that their alcohol use can cause problems. Discussing alcohol with every adolescent 

who walks through your door helps make sure no one falls through the cracks. 

For kids who are not drinking, this conversation offers you the opportunity to praise and 

encourage the smart and healthy choices they are making. We know that positive reinforcement 

works and this is a great opportunity to use it. In addition, research indicates that youth hold more 

positive perceptions of health care providers who bring up sensitive topics such as substance use, 

suggesting that young people may expect this standard of care (Brown & Wissow, 2009). 

About guiding patients who do not drink and their parents 

For younger patients who have not started to drink, what anticipatory guidance should I

provide to patients and parents?

For patients who are not drinking: Be sure to praise them for making the decision not to 

drink. Recommend that they get involved in activities that build on their strengths, choose friends 

who also make good choices, and avoid situations where alcohol or other drugs are 

easily available. 

For their parents: Parents may wonder if allowing their children to drink with them in the 

home will help protect them from alcohol problems later in life. You can let them know that 

most studies indicate that the opposite is the case (McMorris et al., 2011; NIAAA, 2010) and 

that a permissive home environment can increase the odds for teen alcohol problems. Research 

suggests that parents who don’t want their kids to drink do have an important influence over 

their kids’ alcohol decisions, even through high school and the transition to college (Abar et al., 

2009; Walls et al., 2009; Wood et al., 2004). Suggest that parents set clear expectations, such as 

making a house rule of no underage drinking, with equally clear and consistent consequences. 

Offer resources for learning about underage drinking (see page 38), and encourage parents to 

discuss the realities and consequences with their kids. Remind them that they can find many 

“teachable moments” about alcohol risks in the news and entertainment media. (See page 22 for 

handling a situation in which parents themselves have alcohol problems.) 

What	parent	educational	materials	or	parenting	Web	sites	can	I	suggest	to	families?

See Additional Resources at the end of this Guide on page 38. 

18 | Alcohol Screening and Brief Intervention for Youth | A Practitioner’s Guide 
19 

Frequently Asked Questions

www.niaaa.nih.gov/YouthGuide

About risk assessment 

What’s	the	basis	for	the	risk	level	estimates?

The risk level estimates in this Guide—and the screening question on drinking frequency—come 

from analyses of national survey data on alcohol use by more than 166,000 youth ages 12 to 18 

(Chung et al., in press). Researchers looked for connections between drinking pattern variables and 

concurrent symptoms of an alcohol use disorder (AUD), whether alcohol abuse or dependence, as 

defined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, published 

by the American Psychiatric Association. 

Consistently, they found that the number of drinking days in the past year predicted the presence 

of AUD symptoms more accurately than the quantity of alcohol consumed or the frequency of 

binge drinking. It’s important to note your patients do not need to be completely accurate when 

estimating past-year drinking, because the reported frequency predicts the presence of AUD 

symptoms. 

Among	my	patients	who drink,	what	proportion	will	be	in	the	“lower,”“moderate,” and	

“highest”	risk	categories?

National data provide the big picture, which will vary somewhat by region. At ages 12 to 15 years, 

any drinking is considered at least “moderate” risk, and half of drinkers in this age group drink 

frequently enough to be in the “highest risk” category. At ages 16 to 18, about one-third of 

drinkers are at “lower risk,” one-fifth at “moderate risk,” and just under half are at “highest” risk 

(NIAAA, 2011). 

Approximate distribution of young drinkers at		

lower , moderate , and highest risk levels

Ages 12–15 

Ages 16–18 





How	can	I	remember	the	cut	points	for	the	different	risk	levels?	

When you’re getting started, you can use the Pocket Guide (enclosed), which contains the risk 

estimator chart. Over time, you will get a feel for the risk cut points for the different ages and the 

correlated intervention levels. To facilitate that process, you might focus first on the “highest risk” 

cut points, which identify the kids who need the most attention and possibly a referral. 

Highest risk past-year drinking begins at:

Age 11: 1 day 

Ages 12–15: 6 days (about every other month) 

Age 16: 12 days (about monthly) 

Age 17: 24 days (about twice monthly) 

Age 18: 52 days (about weekly) 
 

Frequently Asked Questions

Once those become familiar, you can round out the picture with the cut points for “moderate risk”: 

	 	 	

 

 

Moderate risk past-year drinking begins at:

Ages 12–15: 1 day 

Ages 16–17: 6 days (about every other month) 

Age 18: 12 days (about monthly) 

Again, these risk levels and cut points are not absolutes, but instead indicators to help you gauge 

the extent of your professional response. 

As	part	of	the	risk	assessment,	how	can	my	patient	and	I	estimate	drink	quantities?	

That can be a challenge. Some youth drinking choices are easier to quantify (shots, cans, bottles, 

and beer from a keg served in 16-ounce plastic cups), whereas others are inventive, built for speed, 

and harder to measure (such as gelatin shots and beer chugged from funnels called beer bongs). 

Fortunately, with this Guide, you don’t need precise quantity estimates to gauge your patient’s 

risk because the number of drinking days in the past year is a powerful predictor of risk on 

its own. Still, for moderate and highest risk drinkers, you will want to ask about quantity of 

drinking to round out your risk assessment. 

For some perspective, the tables below provide information about “standard drink” sizes 

and the approximate number of standard drinks in common containers for beverages 

with different amounts of alcohol by volume (or alc/vol). (For more information, visit 

www.RethinkingDrinking.niaaa.nih.gov.) 

What	counts	as	a	drink?

Many people are surprised to learn what counts as a drink. In the United States, a “standard” 

drink is any drink that contains about 0.6 fluid ounce or 14 grams of “pure” alcohol. Although the 

drinks below are different sizes, each contains approximately the same amount of alcohol 

and counts as a single standard drink. 

12	fl	oz		

of regular	beer

8–9	fl	oz		

of malt	liquor	

(shown in a 12-oz glass) 

5	fl	oz		

of table	wine

1.5-fl	oz	shot		

of 80-proof	spirits

(“hard liquor”— whiskey, gin, 

rum, vodka, tequila, etc.) 

about 

5%	alcohol	

about 

7%	alcohol

about 

12%	alcohol

exactly 

40%	alcohol

The percentage of “pure” alcohol, expressed here as alcohol by volume (alc/vol), varies by beverage. 

20 | Alcohol Screening and Brief Intervention for Youth | A Practitioner’s Guide 
21 

Frequently Asked Questions

www.niaaa.nih.gov/YouthGuide

How	 	 	 	 	 	 many drinks are in common containers?

Below is the approximate number of standard drinks in different-sized containers of: 

regular beer malt liquor table wine 80-proof spirits		

or “hard liquor”

12 fl oz = 1 12 fl oz = 			1.5 5-fl oz glass = 1 a shot (1.5 oz ) = 1

16 fl oz = 1.3 16 fl oz = 2 25 fl oz = 5 750 ml (a “fifth”) = 17

40 fl oz = 3.3 40 fl oz = 4.5 (a regular 

750-ml bottle) 

1.75 L (a “handle”) = 39

These examples are a starting point for comparison. Alcohol content can vary greatly across 

different types of beer, malt liquor, and wine. “Flavored alcohol beverages” or “alcopops” have 

a particularly wide range, from about 5 percent to 12 percent alc/vol. For other beverages, the 

differences may be smaller than you might expect. The most popular light beers, for example, 

have almost as much alcohol as regular beer. 

What	do	you	mean	by	“incorporate	what	else	I	know”	about	my	patient	and	his	or	her	

family	in	my	risk	assessment	and	intervention?

Your awareness of family factors such as these would heighten concern about the degree of risk: 

• A history of alcohol problems in parents or siblings 

• Divorce or other challenging transition 

• Low parental involvement in kids’ lives 

• Kids who have too much unsupervised time or say they’re “bored” 

In addition, details you may already know about your patient’s strengths, interests, and health 

conditions can help personalize and strengthen your intervention messages. For example: 

• Athletes or scholars who drink could compromise their performance in sports or academics 

and, in schools with zero tolerance policies, be kicked off teams or clubs if caught drinking 

even once. 

• Kids with chronic conditions such as diabetes, anxiety, or depression can complicate 

management of their conditions by drinking.
 

What	are	“acute	danger	signs”—behaviors	so	potentially	dangerous	that	they	require	a	

“highest	risk”	intervention	on	the	spot?

The most common and potentially lethal danger sign is drinking and driving. Unless a patient 

who drinks and drives commits to stopping, an immediate intervention is warranted. This can 

include informing the patient’s parents, recommending that they take away car keys and driving 

privileges, and referring the patient for treatment. 
 

Frequently Asked Questions

• High, potentially lethal volume intake 

• Combining alcohol with other drugs, especially sedatives 

• Substance-related hospital visits or injuries; alcohol poisoning 

• Unplanned or unprotected sexual activity associated with alcohol use 

• Signs of alcohol addiction; drinking daily or near-daily; having memory blackouts 

• Use of intravenous drugs 

 

Besides drinking and driving, other signs of acute danger that indicate a “highest risk” 

intervention and probable referral include: 

About intervention 

See also the summary of “Brief Motivational Interviewing” on page 29. 

What	should	I	do	if	my	patient	says,	“I’m	not	going	to	stop”?

There are several ways you can choose to handle a negative response. 

For kids who seem at relatively lower risk, you can ask permission to give brief advice, provide 

the advice if accepted, and ask what they make of it. For example, you might say: “You ultimately 

make the decision, but at the same time, I recommend that you don’t drink alcohol at all. You are 

a good [student, athlete, sibling, friend]; I would hate to see alcohol get in the way of your future 

and the things you care about. What do you think?” For those who decline the advice, suggest 

that they think about your conversation a bit more. 

For kids who are at moderate or highest risk, motivational interviewing should be helpful. For 

example, you might say: “I understand you recently had a blackout from drinking too much 

and your parents were very upset. You agree that you drank too much that night, and that was 

dangerous and a little scary. How do you want to move forward?” Consider setting up a followup 

appointment, as just one additional session of motivational interviewing can make a difference. In 

some cases, you may need to break confidentiality and inform the patient’s parents. In others, you 

might suggest a referral to a counselor. 

What,	if	anything,	should	I	do	differently	if	I	know	that	one	or	both	of	my	patient’s	

parents	have	alcohol-related	problems?			

Though a minority, the youth in your practice whose parents have an alcohol use disorder are 

among those at the greatest risk. How you decide to approach this issue will depend on your 

assessment of the extent of the parental problems. If you sense that one parent would be an ally, 

then referring that parent to an expert for help in dealing with family drinking problems would be 

appropriate and advisable. 

If, however, both parents appear to be heavy drinkers or dependent on alcohol, your concern may 

be better expressed generically. As an example: “Justin is at an age when all parents need to be 

concerned about their children’s alcohol use. Kids this age often do not even know when they are 

in a dangerous situation. Of course, how much their friends drink is usually a big influence. But 

many people aren’t aware that the amount of drinking by family members and the easy availability 

of alcohol in the home may make it more difficult for their child to know how to manage when risky 

drinking situations occur. For this reason, I ask that families be open to the possibility that expert 

advice may be useful in keeping their children safe. We have some good resources available. May I 

make that connection for you? What are your thoughts about a referral?” 

22 | Alcohol Screening and Brief Intervention for Youth | A Practitioner’s Guide 
23 

Frequently Asked Questions

www.niaaa.nih.gov/YouthGuide

In these circumstances, even if the offer of help is refused, it is important for health care providers 

to make a point at each visit of expressing concern, with a focus on both the risk-taking behaviors 

and the specific vulnerabilities of the child’s developmental stage. 

Should	I	recommend	any	particular	specialty	treatment	for	patients	who	need	referrals?

One size doesn’t fit all when it comes to alcohol treatment options. Fortunately, a range of 

effective treatment choices is available. A recent meta-analysis found that several types of 

substance abuse treatment can reduce adolescent alcohol abuse (Tripodi, 2010), including 

individual-only and family-based interventions. In contrast to earlier meta-analyses, this study 

generally found larger effect sizes in individual over family-based interventions. Either can 

be effective, however, so the authors caution against unequivocally recommending individual 

therapy over family-based at this point. 

Of note, the analysis found that three of the therapies with large effect sizes included brief 

interventions. Among the longer-term treatments with larger effect sizes were cognitivebehavioral therapy integrated with a 12-step approach, cognitive-behavioral therapy with 

aftercare, and multidimensional family therapy. Also found effective, with medium effect sizes, 

were integrated family and cognitive behavioral therapy, behavioral treatment, and triple modality 

social learning. 

For suggestions on how to find adolescent substance abuse specialists and programs in your area, see 

Referral Resources, page 34. It is a good idea to develop working relationships with local resources 

and practitioners, so you can make solid, confident recommendations and provide a continuity of care. 

How	can	I	help	a	patient	who	struggles	to	remain	abstinent	or	who	relapses?	

Changing drinking behavior is a challenge, especially for patients who are alcohol dependent. 

Although you will have referred alcohol-dependent patients to specialty treatment, of course you 

will still see them for other visits. If you learn that a patient has relapsed, recognize that he or she 

may have developed a chronic disorder that requires continuing care, just like asthma or diabetes. 

The most important principle is to stay engaged with the patient and to maintain optimism about 

eventual improvement. In addition: 

• If the patient objected to the initial referral, seek another appropriate, acceptable option. 

• Assess and address possible triggers for struggle or relapse, including stressful events, 

interpersonal conflict, insomnia, chronic pain, or high-temptation situations. 

• Address depression, anxiety disorders, or conduct problems, referring to specialty treatment 

if needed. 

• Point out any progress while noting the difficulty and multi-step nature of making a change 

(see also Step 4, page 12). 

Depending on the family situation, you might also encourage family members to participate 

in mutual support groups such as Al-Anon. Continue to collaborate with the family and any 

treatment providers as the recovery process continues. 
 

Frequently Asked Questions

About office procedures 

How	can	a	clinic-	or	office-based	screening	system	be	implemented?		

One option is to allow patients to fill out a pen-and-pencil or computer-based questionnaire either 

in the waiting room or prior to the visit, as long as they have privacy to do so. Another is for 

the health care provider, preferably one who knows the patient well, to ask the questions during 

office visits. A third is for other clinical personnel to screen patients during check-in. If a clinical 

assistant will screen patients instead of the primary health care provider, be sure to work out 

record-keeping to facilitate followup in the exam room. 

For further guidance, see the American Academy of Pediatrics’ new manual on implementing 

mental health screenings called Addressing Mental Health Concerns in Primary Care: A Clinician’s 

Toolkit. Included in the Toolkit is a readiness to screen checklist and suggestions on how to prepare 

the office staff. You can access these materials at www.aap.org/mentalhealth. 

Can	I	be	reimbursed	for	conducting	alcohol	screening	and	brief	intervention?

Progress has been made in recent years, such that with proper coding it’s now possible to be 

reimbursed for alcohol screening and brief intervention. See the latest AAP publication Coding 

for Pediatrics for up-to-date, detailed information (AAP, 2011). Two caveats: Check with your 

patients’ insurers, as some companies reimburse only mental health care providers for substance 

use diagnoses. In addition, if you are treating a patient without the parent’s knowledge, be aware 

that confidentiality will be compromised if diagnostic codes are included in explanations of 

benefits sent to a parent. 

24 | Alcohol Screening and Brief Intervention for Youth | A Practitioner’s Guide 
www.niaaa.nih.gov/YouthGuide 25 

CONFIDENTIALITY 

Confidentiality often plays a role in providing health care to adolescents. When it comes to 

alcohol use by patients who are minors, don’t let concerns about confidentiality deter you from 

screening and intervening as needed. All of the major medical organizations and numerous 

current laws support the ability of clinicians to provide confidential health care, within established 

guidelines, for adolescents who use alcohol (Berlan & Bravender, 2009; Ford et al., 2004). 

It is important to give your patients an assurance of confidential care. Studies show that with 

confidentiality assurance, adolescents are more willing to seek health care (Ford et al., 1997), 

whereas without it, those who engage in risky behaviors will often forego care (Lehrer et al., 

2007). In addition, research indicates that most parents favor confidential care for their teens, and 

that education about privacy policies and teen risk-taking behaviors improves the opinions of 

most parents who hold negative opinions about confidentiality (Hutchinson & Stafford, 2005). 

This section provides a brief overview of patient rights and professional association guidance, 

along with practical suggestions for screening adolescent patients for alcohol use while respecting 

confidentiality and its limitations. 

Patient rights 

State laws govern minor patient rights to confidentiality of information shared with health care 

providers about alcohol and drug use. Across States, laws vary on provisions, including the 

definition of a minor (typically under age 18), the ability of a minor to consent to substance abuse 

treatment, parental notification of treatment, and the disclosure of medical records. It is important 

to be aware of specific laws in your State, which generally allow health care practitioners to 

use professional judgment in determining the limits of confidentiality. For information about 

your State’s laws, contact your State medical society. In addition, a summary of State minor 

consent laws, including confidentiality and disclosure provisions, is available from the Center for 

Adolescent Health and the Law (English et al., 2010; www.cahl.org). 

Federal medical privacy rules established by the Health Insurance Portability and Accountability 

Act (HIPAA) allow adolescent health care providers to “honor their ethical obligations to maintain 

confidentiality consistent with other laws” (Ford et al., 2004). For example, HIPAA only allows 

parents to have access to the medical records of a minor child if that access does not conflict with 

a State or other confidentiality law. If State or other laws are silent on this matter, clinicians can 

exercise professional judgment in deciding whether to allow access (Ford et al., 2004). 

Additionally, federally funded treatment centers are subject to the Code of Federal Regulations 

(42 CFR Part 2), which offers different guidance from HIPAA. These regulations protect the 

confidentiality of records on alcohol and drug use of minor patients. These records cannot be shared 

with anyone—including a parent or legal guardian—without written consent of the minor patient. 
 

Clinician Support Materials

Professional association guidance 

Professional associations have produced helpful guidelines, policies, and background information 

to help steer you through the complex framework of laws and issues related to minor consent, 

privacy, and confidentiality. A sampling of guidance from several organizations is offered below; 

visit your member association Web site(s) for the full picture, or visit the Center for Adolescent 

Health and the Law Web site (www.cahl.org) for a policy compendium (Morreale et al., 2005). 

“The most useful information will be obtained in an atmosphere of mutual trust and comfort,” 

states the American Academy of Pediatrics (Kulig & AAP Committee on Substance Abuse, 2005). 

To facilitate confidential care, the AAP recommends establishing a privacy policy and sharing it 

with parents and children around the time of the 7- or 8-year-old checkup, or at least by the 9- or 

10-year-old checkup (Hagan et al., 2008). Also around this time, and certainly by the 12-year-old 

checkup, you should routinely set aside a portion of the visit to spend time alone with the patient 

(Hagan et al., 2008). This sets the stage for regular private conversations between adolescents and 

clinicians throughout the second decade. 

Regarding the central question of how to involve parents in your patients’ care, the American 

Academy of Family Physicians (AAFP) advises health care providers to make a “reasonable 

effort to encourage the adolescent to include parents or legal guardians in health-related 

decisions” (AAFP, 2008). If you do not think parent involvement would be beneficial, however, 

the American Medical Association (AMA) advises that “parental consent or notification should 

not be a barrier to care” (AMA, Policy H-60.965). The Society for Adolescent Health and 

Medicine (SAHM) concurs, stating that “participation of parents in the health care of their 

adolescents should be encouraged, but should not be mandated” (Ford et al., 2004). 

Of course, there will be times when you’ll need to consider breaking confidentiality and involving 

parents (see page 28, “When is it appropriate to break confidentiality?”). As summarized by the 

AAFP, “Ultimately, the judgment of the physician should prevail in the best medical interest of 

the patient” (AAFP, 2008). 

Practical recommendations 

• Always explain your confidentiality policy: It can be very effective to explain your 

practice’s confidentiality policy to both the patient and the parent at the same time. 

For example: 

–	 Direct to patient: “I will be asking you some personal questions that I ask all of my 

patients so I can take the very best possible care of them. Everything we say here will 

be confidential, in other words, will stay between you and me, but within certain limits. 

The exception is if you tell me someone is hurting you physically or sexually, or if 

you are hurting or planning to hurt yourself or someone else, then we will have to tell 

others and get them involved to help keep you or the other person safe.” 

– Direct to parent: “What your daughter/son says to me is confidential, but obviously 

you are free to discuss any topics between yourselves at any time. If your daughter/ 

son is in immediate danger or needs further treatment, I will certainly inform you and 

include you in any discussions.” 

26 | Alcohol Screening and Brief Intervention for Youth | A Practitioner’s Guide 
www.niaaa.nih.gov/YouthGuide 27 

Establish private time for screening: If you offer a paper or electronic screening tool 

before the exam, then clearly communicate to the patient and parent that privacy is needed to 

complete the screen. If you ask the screening questions yourself, only do so when parents are 

not in the room. Because the initial screening sets the stage for later visits, establish private 

time, starting with the first screening. This way, you’ll avoid sending a message that you 

would disclose the content of these conversations to the parent in the future. 

Establish private time for talking: It is important to establish a standard routine for 

adolescent patients to spend part of each visit alone with the clinician. Typically, the visit 

starts with both patient and parent present, then the clinician spends time privately with 

the patient, and the end of the visit serves as a group wrap-up. The rationale for private 

time is both developmental (that is, acknowledging the patient’s emerging autonomy and 

encouraging him or her to acquire skills to get health needs met) as well as to encourage 

open communication about sensitive health issues. In deciding when to establish private time 

for a given patient, take more than just the patient’s age into account. A physically mature or 

provocatively dressed 10-year-old, for example, may be more in need of an alcohol screen 

than some of your older patients. 

Decide how and when to honor commitments to change: A key intervention goal for 

patients who have begun drinking but are not in acute danger is to obtain a commitment to 

stop or cut back drinking. With older adolescents, it is often best to maintain confidentiality 

(if requested) after accepting the patient’s commitment to avoid risky behaviors. If your 

patient refuses to commit, however, or if you doubt the sincerity of the commitment, you 

may want to consider breaking confidentiality. Furthermore, if at followup visits you find 

that a patient has not demonstrated a commitment to the agreed-upon plan or has escalated 

his or her use, you should also consider breaking confidentiality. This can be framed within 

a context of concern for the patient’s health and the need to get a trusted adult involved to 

facilitate getting the help or treatment the patient needs. 

Keep followup visits confidential: You can maintain confidentiality even if your 

patient’s alcohol use indicates the need for a followup visit. Many physicians schedule 

the next appointment with a medical “hook,” such as the need to follow up for acne or an 

immunization or to discuss medications or lab results. 

Talk about referrals: If you need to refer patients for further treatment, you may need to 

talk to them about breaking confidentiality to discuss the referral with their parents. This 

may be relatively simple, because in most cases when your patient is drinking enough to 

require a referral, the parents are already aware that their son or daughter is drinking. 

Be aware of practice procedures that can break confidentiality inadvertently: These 

may include appointment reminders and billing and reimbursement procedures. The SAHM 

advises you to develop strategies to “provide appropriate confidential care within this 

context where feasible” (Ford et al., 2004). Consider taking continuing education courses 

that not only keep you abreast of confidentiality matters in general but also touch on issues 

that may arise as electronic medical records become more prevalent. 

• 

• 

• 

• 

• 

• 

Clinician Support Materials
 

Clinician Support Materials

• Clarify risks of releasing medical records to parents: It is unusual for a parent to demand 

access to a child’s medical record without first trying to get answers from the child or 

health care provider. On the chance that a parent does request medical records containing 

confidential information, it’s important to know your State’s laws about release. Typically, 

minors should be able to control access to information about services for which they can 

legally provide consent, such as alcohol use and treatment in many States. If you are not able 

to protect the release of medical records, then it’s important to make it clear, prior to release, 

that by reading any sensitive health information, the parent may compromise your rapport 

and ability to work with the child. It may make it more difficult to elicit honest and accurate 

information from your patient, who will have lost trust in you. Suggest that the parent 

reconsider the request. 

When is it appropriate to break confidentiality? 

Your clinical judgment, together with your State’s minor consent laws, holds the answer. Below 

are general guidelines related to age levels and alcohol use. In addition, consider the reported 

alcohol-related behaviors and associated risks of significant injury, as well as the presence and 

seriousness of any co-morbid conditions (such as depression, risk of suicide, poorly controlled 

insulin-dependent diabetes). 

28 | Alcohol Screening and Brief Intervention for Youth | A Practitioner’s Guide 

Any Alcohol		

Use

Some Mild		

Problems

Significant Problems

or Probable

Dependence

Elementary School

(ages 9 –11) Yes Yes Yes

Middle School

(ages 11–14) Maybe Yes Yes

High School

(ages 14 –18) Maybe Maybe Yes
www.niaaa.nih.gov/YouthGuide 29 

BRIEF MOTIVATIONAL INTERVIEWING 

Given the time constraints of your busy practice, you may wonder about quick and effective ways 

to help children and teens adopt healthier behaviors. If it’s not already in your repertoire, consider 

adding brief motivational interviewing, a patient-centered communication style designed to 

enhance a patient’s own motivation to change. 

What is motivation? 

Over the past few decades, advances in behavior research and theory propelled a major shift in 

the concept of motivation (Tevyaw & Monti, 2004). It is no longer considered an all-or-nothing, 

unchanging character trait in which an individual is either motivated or not. Instead, motivation 

is viewed as a dynamic state of “readiness to change” that can be influenced by interpersonal 

interactions, with confrontation leading to resistance, and with understanding and empathy 

leading to change (Tevyaw & Monti, 2004; Levy et al., 2002). 

How do people move forward in the change process? According to behavior researchers, they 

become motivated when they “perceive a discrepancy between where they are and where they 

want to be” (Miller et al., 1992). As a trusted health care provider, you are in a prime position to 

help your patients recognize the disconnect between their behavior and their goals, values, and 

beliefs, and to make a change for the better. 

What is motivational interviewing? 

Motivational interviewing is a directive, patient-centered style of counseling that helps 

patients explore their natural ambivalence about changing. Its friendly, collaborative “spirit” 

is considered more important than any particular set of techniques. The broad goal is to elicit 

motivation from within the patient, not impose it from without. A core task is to help patients 

examine their own reasons for and against making a change, and then guide them to a resolution 

that triggers change in a healthy direction. Once patients commit to a change, they may or may 

not need further assistance as to how to make the change—where there is a will, there are many 

ways (Rollnick & Miller, 1995). 

Although this counseling style grew out of the substance abuse field, motivational interviewing 

is now used to address many other health behaviors, such as medication compliance and dietary 

control (Erikson et al., 2005; Rubak et al., 2005). Thus, you may find that skills development in 

this area will serve you well for any patient behavior change you would like to facilitate. 

How is it done? 

There is no single prescribed way to do motivational interviewing; each interaction will be as 

individual as the particular patient and his or her perspectives, goals, values, and beliefs. At its 

core, however, four basic principles underlie the approach (Miller et al., 1992): 

Express Empathy: Take a warm, nonjudgmental stance; listen actively and reflect back on what 

is said to help the patient feel heard. 

Develop Discrepancy: Raise awareness of the patient’s personal consequences of drinking; ask 

how his or her goals, values, or beliefs could be hindered or compromised by drinking. 
 

Clinician Support Materials

Roll with Resistance: Acknowledge the patient’s beliefs and feelings; avoid lecturing 

or debating; change gears and affirm autonomy if the patient shows resistance. 

Support Self-efficacy: Express confidence in the patient’s ability to make a change; point to 

patient’s strengths and other successes as examples. 

As with most skills, proficiency in motivational interviewing increases with a combination of 

training, practice, and feedback. For more background about motivational interviewing, along 

with information about workshops and coaching, visit www.motivationalinterview.org or 

www.motivationalinterview.net. You may also wish to refer to the book and journal articles 

referenced in this section. 

Versatile and tailor-made for teens 

You can apply motivational interviewing to address any level of alcohol use in your patients, from 

a first, isolated experience to regular, heavy, problematic drinking (Narr-King & Suarez, 2011; 

Tevyaw & Monti, 2004; Levy et al., 2002). It can be especially useful for adolescents in the early 

stages of readiness to change, whether they are not yet interested in changing or they are thinking 

about it, but are not yet ready to commit (Gold & Kokotailo, 2007). Patients who present with a 

drinking-related injury or other negative consequence may be especially receptive in that painful 

“teachable moment” (Macgowan & Engle, 2010). Even for patients with alcohol dependence, 

motivational interviewing can encourage the patient to accept a referral to specialty treatment 

(Levy et al., 2002) and engage more fully in care. 

Though initially developed for adults, motivational interviewing is especially well suited for 

adolescents. It avoids confrontation, which allows the adolescents their individuality. Its open and 

respectful exchange of views supports teens’ desire to have their viewpoints heard and their quest for 

autonomy. It can have benefits even when a patient does not admit to having a problem (Tevyaw & 

Monti, 2004), which is often the case. When patients aren’t ready to commit to a behavior change, 

motivational interviewing allows you to maintain rapport by “meeting them where they are” in their 

change process and negotiating for some interim steps. In the process, as you elicit and show that 

you value their opinions, teen patients get the opportunity to demonstrate their often remarkable 

resourcefulness and to build decision-making skills that will serve them well into adulthood. 

How effective is it? 

In adults, the effectiveness of brief motivational interviewing has been well established. A 

meta-analysis of 72 randomized controlled trials (RCTs) found that motivational enhancement 

interventions outperformed traditional advice for a range of health behaviors in 8 out of 10 studies 

(Rubak et al., 2005). Brief motivational interviewing can be effective in single visits as short as 

15 minutes, and adding one or more followup visits nearly “ensures” effectiveness (Rubak et 

al., 2005). Alcohol-focused studies have shown that motivational enhancement and other brief 

interventions can reduce heavy drinking in nondependent adults, often as well as more intensive 

treatment (Tevyaw & Monti, 2004). 

In adolescents, studies of brief motivational interviewing for alcohol interventions thus far are 

limited, but show promise (Macgowen & Engle, 2010). A 2010 review of 14 RCTs of brief alcohol 

interventions for adolescents in clinical settings indicated that motivational interviewing appeared 

more successful than other types of interventions and that even a single session can have positive 

effects (Wachtel & Staniford, 2010). A 2011 meta-analysis also supported the effectiveness of 

motivational interviewing interventions for adolescent substance use (Jensen et al., 2011). 

30 | Alcohol Screening and Brief Intervention for Youth | A Practitioner’s Guide 
www.niaaa.nih.gov/YouthGuide 31 

• Abstinence challenge: Ask permission from the adolescent to make a contract for 4–8 weeks 

of abstinence to help the two of you determine the severity of the problem. Discuss ways 

to successfully avoid drinking. At followup, reinforce success and discuss referral for more 

extensive assessment for those who failed the challenge or found it very stressful. 

• Cut back: For those who refuse to abstain, ask permission to negotiate and contract 

for drinking limits based on the patient’s history. In general, advise no substance use on 

weeknights, reducing quantity, and avoiding dangerous situations, such as drinking and 

driving. Elicit feedback from patients about your suggestions. At followup, continue to 

develop discrepancies and ask what additional steps they wish to take to reach their goals, 

building on prior successes. 

• Contingency: For more challenging or resistant patients who refuse even to cut back, see 

treatment as a process and accept any progress, such as discussing perspectives on their 

drinking, as partial success. Create a list of contingencies that indicate that a problem exists, 

and ask patients to agree to come see you if they occur. Avoid arguments, roll with resistance, 

and encourage them to continue thinking about their drinking and continue self-monitoring. 

Thus, the combination of solid evidence in adults and promising results in adolescents makes 

motivational interviewing arguably the most reasonable, as well as the most feasible, approach 

to recommend at this time for brief interventions with adolescents in clinical settings 

(Clark et al., 2010). 

Setting individual goals and action plans 

With youth who drink alcohol, setting goals and action plans in the course of motivational 

interviewing is trickier than it is with adults. Motivational interviewing involves encouraging 

a patient’s autonomy in choosing his or her course of action, as well as acknowledging and 

complimenting any change in a positive direction. People under age 21 who drink alcohol, 

however, legally do not have complete freedom of choice when it comes to drinking decisions. 

The goals you and your patient set need to be discussed in the context of both the patient’s safety 

and restrictions imposed by the law, parents, school, or other sources (Tevyaw & Monti, 2004). 

Your assessment (page 10) will help direct and shape the individual goals for your patient related 

to drinking. Abstinence would, of course, be the ideal goal for youth who drink. In many cases, 

however, cutting back and taking other steps to avoid harm are more realistic and achievable 

goals. For dependent and other higher risk patients, the goal will be accepting a referral to 

specialized treatment. 

The following sample action plans for youth who drink but are not dependent can help you and 

your patient chart constructive courses (adapted from Levy et al., 2002): 

Followup 

In general, followup is necessary. Negotiating a time frame for followup with the patient 

may enhance the likelihood that the patient returns. As noted by the American Academy of 

Pediatrics, sometimes a medical “hook” (e.g., a followup for acne or an immunization or to 

discuss lab results) can bring the patient back to your office (AAP Adolescent Health Update 

Editorial Board, 2007). Studies indicate that just one additional visit can significantly improve 

the effectiveness of your intervention (Rubak et al., 2005). 
 

Clinician Support Materials

 

ADDITIONAL WORKUP RESOURCES 

Using the quick two-question screening tool and risk level estimates in this Guide, you’ll have 

a good idea as to your patients’ level of risk for alcohol-related problems. You can further gauge 

the risk level and need for referral by asking more questions, as suggested on page 10, by using a 

formal tool, or both. 

Two short tools to consider are the Alcohol Use Disorders Identification Test (AUDIT), which 

delves more deeply into alcohol-related behaviors, and the CRAFFT, explained below, which 

inquires about other drug use in addition to alcohol use. Both the AUDIT and the CRAFFT can be 

used as a paper–pencil or electronic screen, and the CRAFFT can be verbally administered. Both 

identify problems that can be discussed during motivational interviewing. And both should, of 

course, be administered with patient privacy protected. 

The 10-question AUDIT instrument, available on the next page, was designed for use with adults 

and may be appropriate for adolescents, as well (Reinert & Allen, 2007). The AUDIT’s validity 

has been consistently confirmed in adults (Reinert & Allen, 2007). Research also supports use of 

the AUDIT for adolescents ages 14 to 18, with lower cut points of 2 for identifying any alcohol 

problem use and 3 for alcohol abuse or dependence (Knight et al., 2003). 

You may be familiar with the CRAFFT tool, which is incorporated into the American Association 

of Pediatrics Policy Statement on Substance Use Screening, Brief Intervention, and Referral 

to Treatment for Pediatricians (AAP Committee on Substance Abuse, 2011). The CRAFFT 

identifies adolescent alcohol and drug use and associated behaviors. Research indicates that a 

“yes” to two of the questions below signals a problem needing further evaluation and that a score 

of 4 or more “should raise suspicion of substance dependence” (Knight et al., 2002): 

C: Have you ever ridden in a CAR driven by someone (including yourself) who was “high” 

or had been using alcohol or drugs? 

R: Do you ever use alcohol or drugs to RELAX, feel better about yourself, or fit in? 

A: Do you ever use alcohol or drugs while you are by yourself, ALONE? 

F: Do you ever FORGET things you did while using alcohol or drugs? 

F: Do your family or FRIENDS ever tell you that you should cut down on your drinking or 

drug use? 

T: Have you ever gotten into TROUBLE while you were using alcohol or drugs? 

Along with the two-question screener in this Guide, these tools fit well with broader based, 

structured psychosocial interview schemes such as the HEADSS (questions about home, 

education, activities, drug and alcohol use, sexuality, and suicide) and interviews that add 

a focus on strengths that may help offset risks. The American Academy of Pediatrics notes: 

“Structured tools can be easily incorporated into the written or electronic health record to remind 

the practitioner to conduct screening and document the results” (AAP Committee on Substance 

Abuse, 2011). 

32 | Alcohol Screening and Brief Intervention for Youth | A Practitioner’s Guide 
www.niaaa.nih.gov/YouthGuide 33 

 

 

 

 

 

 

PATIENT: Because alcohol use can affect your health and can interfere with certain medications 

and treatments, it is important that we ask some questions about your use of alcohol. Your 

answers will remain confidential, so please be honest. 

Place an X in one box that best describes your answer to each question. 

Questions 0 1 2 3 4 

1. How often do you have a drink 

containing alcohol? 

Never Monthly 

or less 

2 to 4 

times a 

month 

2 to 3 

times a 

week 

4 or more 

times a 

week 

2. How many drinks containing 

alcohol do you have on a typical 

day when you are drinking? 

1 or 2 3 or 4 5 or 6 7 to 9 10 or more 

3. How often do you have 5 or more 

drinks on one occasion? 

Never Less than 

monthly 

Monthly Weekly Daily or 

almost daily 

4. How often during the last year 

have you found that you were 

not able to stop drinking once 

you had started? 

Never Less than 

monthly 

Monthly Weekly Daily or 

almost daily 

5. How often during the last year 

have you failed to do what 

was normally expected of you 

because of drinking? 

Never Less than 

monthly 

Monthly Weekly Daily or 

almost daily 

6. How often during the last year 

have you needed a first drink in 

the morning to get yourself going 

after a heavy drinking session? 

Never Less than 

monthly 

Monthly Weekly Daily or 

almost daily 

7. How often during the last year 

have you had a feeling of guilt or 

remorse after drinking? 

Never Less than 

monthly 

Monthly Weekly Daily or 

almost daily 

8. How often during the last year 

have you been unable to remember 

what happened the night before 

because of your drinking? 

Never Less than 

monthly 

Monthly Weekly Daily or 

almost daily 

9. Have you or someone else 

been injured because of 

your drinking? 

No Yes, but 

not in the 

last year 

Yes, during 

the last year 

10. Has a relative, friend, doctor, or 

other health care worker been 

concerned about your drinking or 

suggested you cut down? 

No Yes, but 

not in the 

last year 

Yes, during 

the last year 

Total 

Note: This questionnaire (the AUDIT) is reprinted with permission from the World Health Organization and the 

Generalitat Valenciana Conselleria De Benestar Social. To reflect standard drink sizes in the United States, the number 

of drinks in question 3 was changed from 6 to 5. A free AUDIT manual with guidelines for use in primary care is 

available online at www.who.org. 
 

Clinician Support Materials

REFERRAL RESOURCES 

When making referrals, involve your patient and a parent or guardian in the decision and schedule 

a referral appointment while your patient is in the office. If available in your community, arrange 

for an interagency facilitator to help make sure your patient connects with the treatment provider. 

Finding evaluation and treatment options 

• For patients with insurance: Contact a behavioral health case manager at the insurance 

company for referrals. 

• For patients who are uninsured or underinsured: Contact your local health department 

about substance abuse treatment services for adolescents. 

• For older patients who are employed or in college: Ask about access to an employee 

assistance or school counseling program that includes substance abuse treatment.
 

• To locate adolescent treatment options in your area: 

–	 Ask behavioral health practitioners affiliated with your practice for recommendations. 

–	 Seek local directories of behavioral health services. 

–	 Contact local hospitals and mental health service organizations. 

–	 Call the National Drug and Alcohol Treatment Referral Routing Service 

(1–800–662–HELP) or visit the Substance Abuse Treatment Facility Locator 

Web site at www.findtreatment.samhsa.gov. 

• For a helpful list of criteria for selecting a substance abuse treatment program for 

adolescents, see the American Association of Pediatrics Policy Statement on Substance Use 

Screening, Brief Intervention, and Referral to Treatment for Pediatricians (AAP Committee 

on Substance Abuse, 2011). 

Finding support groups 

• Groups specific to your area: Through those knowledgeable about your local behavioral 

health options, seek groups that provide treatment aftercare and support to adolescent 

patients and their families. 

• Nationwide groups: Consider contacting Alcoholics Anonymous (AA) to ask whether any 

local groups primarily draw young people (for phone numbers, visit www.aa.org). 

Note, however, that all AA groups are open to those of all ages at any time. To avoid a 

possible mismatch, it may be best to consider AA referrals only for older youth who 

have had a formal evaluation. For support groups for family members, contact Al-Anon 

(www.al-anon.alateen.org). 

Local resources 

List your local resources below. Make copies and keep them in exam rooms and other 

accessible locations. Develop working relationships with these resources to facilitate referrals 

and access to care. 

34 | Alcohol Screening and Brief Intervention for Youth | A Practitioner’s Guide 
35 

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Additional Resources

 

ADDITIONAL RESOURCES
 

For health care professionals 

Screening and risk assessment 

National Institute on Alcohol Abuse 

and Alcoholism (NIAAA) 

www.niaaa.nih.gov 

•		Web page for this Guide—additional 

background, resources, and updates 

www.niaaa.nih.gov/YouthGuide 

•		General information about alcohol, 

including standard drink sizes 

www.rethinkingdrinking.niaaa.nih.gov 

American Academy of Pediatrics (AAP) 

www.aap.org 

•		National Committee on Substance 

Abuse—policy statements 

www.aap.org/visit/cmte35.htm 

•		Children’s Mental Health in Primary 

Care—toolkit and other resources 

www.aap.org/commpeds/dochs/
 

mentalhealth/ 
 

Confidential care 

Center for Adolescent Health and the 

Law—monographs on minor consent 

laws and professional association policies 

www.cahl.org 

Society for Adolescent Health and Medicine— 

sample confidentiality statement, billing 

guidance, and other clinical care resources 

www.adolescenthealth.org 

Motivational interviewing 

For background and training information, visit: 

• www.motivationalinterview.org 

• www.motivationalinterview.net 

Treatment locator 

Substance Abuse Treatment Facility Locator 

(seek centers specializing in adolescents) 

1–800–662–HELP or 

www.findtreatment.samhsa.gov 

For parents 

Publications 

NIAAA’s Parenting to Prevent Childhood 

Alcohol Abuse 

pubs.niaaa.nih.gov/publications/adolescent/ 

adolflyer.htm 

NIAAA’s Make a Difference: Talk to Your 

Child About Alcohol 

pubs.niaaa.nih.gov/publications/MakeADiff_ 

HTML/makediff.htm 

Substance Abuse and Mental Health Services 

Administration (SAMHSA)’s Start Talking 

Before They Start Drinking: A Family Guide 

www.stopalcoholabuse.gov/media/Underage_ 

Brochure_508final.pdf 

AAP’s A Parent’s Guide to Teen Parties 

www.healthychildren.org/English/ages-stages/ 

teen/Pages/A-Parents-Guide-To-Teen-Parties.aspx 

38 | Alcohol Screening and Brief Intervention for Youth | A Practitioner’s Guide 
39 

Additional Resources

www.niaaa.nih.gov/YouthGuide

 

 

Web sites 

SAMHSA’s Talk Early, Talk Often, 

Get Others Involved 

www.underagedrinking.samhsa.gov/default.aspx 

AAP Parenting Web Site: www.healthychildren. 

org; in particular, “Alcohol—The Most 

Popular Choice”: www.healthychildren.org/ 

English/ages-stages/teen/substance-abuse/ 

pages/Alcohol-The-Most-Popular-Choice.aspx 

The Partnership at DrugFree.org 

www.drugfree.org/ 

NIAAA’s College Drinking Prevention 

Web site, parents page 

www.collegedrinkingprevention.gov/ 

CollegeParents 

Driving and safety agreements 

AAP’s Parent–Teen Driving Agreement 

www.healthychildren.org/English/ages-stages/ 

teen/safety/pages/Teen-Driving-Agreement.aspx 

Students Against Destructive Decisions 

“Contract for Life” 

www.sadd.org/contract.htm 

For patients 

For ages 11 to 13—NIAAA’s The Cool Spot, 

an interactive Web site to help kids identify 

and resist peer pressure to drink 

www.thecoolspot.gov/ 

Support for patients whose parents have 

drinking problems: 

• Al-Anon Family Groups, including Alateen 

www.al-anon.alateen.org 

• National Association for Children of 

Alcoholics “Just 4 Kids” page 

www.nacoa.org/kidspage.html 

Underage drinking facts and 

figures 

NIAAA’s Underage Drinking Research 

Initiative 

www.niaaa.nih.gov/AboutNIAAA/NIAAA 

SponsoredPrograms/Pages/underage.aspx 

NIAAA’s Alcohol Research & Health journal 

issue on underage drinking (2009) 

pubs.niaaa.nih.gov/publications/arh321/ 

toc32-1.htm 

Centers for Disease Control and Prevention’s 

page on Alcohol and Public Health 

www.cdc.gov/Alcohol/ 

Monitoring the Future 

www.monitoringthefuture.org 

Report to Congress on the Prevention and 

Reduction of Underage Drinking (May 2011) 

www.store.samhsa.gov/shin/content/SMA11­

4645/SMA11-4645.pdf 
 

Notes 

40 | Alcohol Screening and Brief Intervention for Youth | A Practitioner’s Guide 
Notes
 

www.niaaa.nih.gov/YouthGuide 41 
To order more copies of this Guide and Pocket Guide set, free of charge,
 

visit www.niaaa.nih.gov/YouthGuide
 

or call 301–443–3860
 
·

Produced in collaboration with the 

NIH Publication No. 11-7805