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A POCKET GUIDE FOR

ALCOHOL SCREENING 

AND BRIEF INTERVENTION FOR YOUTH

2011 Edition 

This pocket guide is condensed from the NIAAA Guide, Alcohol Screening 

and Brief Intervention for Youth: A Practitioner’s Guide. It was produced 

in collaboration with the American Academy of Pediatrics. 

To order more copies of this Pocket Guide, 

or sets with the full 40-page Guide and the Pocket Guide, 

and for related professional support resources, 

visit www.niaaa.nih.gov/YouthGuide 

or contact the NIAAA Publications Distribution Center 

P.O. Box 10686, Rockville, MD 20849-0686 

301–443–3860 

·

NIH Publication No. 11-7806 

Printed December 2011 

Opportunities & Indications for 

Screening Youth for Alcohol Use 

•	 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: 

Ŧ depression 

Ŧ anxiety 

Ŧ ADD/ADHD 

Ŧ conduct problems 

– have health problems that might be alcohol related, 

such as: 

Ŧ accidents or injury 

Ŧ sexually transmitted infections or unintended pregnancy 

Ŧ changes in eating or sleeping patterns 

Ŧ gastrointestinal disturbances 

Ŧ chronic pain	 

– show substantial behavioral changes, such as: 

Ŧ increased oppositional behavior 

Ŧ significant mood changes 

Ŧ loss of interest in activities	 

Ŧ change of friends 

Ŧ a drop in grade point average 

Ŧ large number of unexcused absences in school 

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

Of them, half report having been drunk. 

You are in a prime position to help your patients 

avoid alcohol related harm. 

What Counts as a Drink? 

A Binge? 

The drinks shown below are different sizes, but each one has 

about the same amount of pure alcohol (14 grams or 0.6 fluid 

ounce) and counts as a single “standard” drink. These serve as 	

examples; alcohol content can vary greatly across different types 	

of beer, malt liquor, and wine. 

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 about about exactly

5% alcohol 7% alcohol 12% alcohol 40% alcohol 

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

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 

What kinds of alcohol are kids drinking these days? 

All kinds, with variations by region and fad. In many areas, hard 

liquor appears to be gaining on or overtaking beer and “flavored 

alcohol beverages” in popularity among youth, whereas wine 

appears less preferred. Young people are also mixing alcohol 

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 and more likely to take risks. 

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

Boys	 Girls 

Ages 9–13 3 drinks 

Ages Ages 14–15 4 drinks 3 drinks 9–17

Ages 16+ 5 drinks 

See the full Guide, page 15, for details about these estimates. 

Brief Intervention & 

Referral Resources 

Four Basic Principles of Motivational Interviewing: 

•	 Express Empathy with a warm, nonjudgmental stance, 

active listening, and reflecting back what is said. 

•	 Develop Discrepancy between the patient’s choice to drink 

and his or her goals, values, or beliefs. 

•	 Roll with Resistance by acknowledging the patient’s 

viewpoint, avoiding a debate, and affirming autonomy. 

•	 Support Self-efficacy by expressing confidence and 

pointing to strengths and past successes. 

 Fo r more information, see the full Guide, page 29, or visit: 

•	 www.motivationalinterview.org 

•	 www.motivationalinterview.net 

To Find Local Specialty Treatment Options: 

•	 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. 

•	 Contact the Substance Abuse Facility Treatment Locator 

(seek centers specializing in adolescents) at 1–800–662–HELP 

or visit www.findtreatment.samhsa.gov. 

•	 For more suggestions, see the full Guide, p. 34. 

List your local resources below. 

_____________________________________________________ 

_____________________________________________________ 

_____________________________________________________ 

_____________________________________________________ 

_____________________________________________________ 

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Questions About Providing 

Confidential Health Care to Youth? 

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. See the full Guide, page 25, for more information. 

For details specific to your specialty and State: 

•	 See confidentiality policy statements from professional 

organization(s): 

– American Academy of Pediatrics 

– American Academy of Family Physicians 

– Society for Adolescent Health and Medicine 

– American Medical Association 

•	 Contact your State medical society for information on your 

State’s laws. 

•	 Visit the Center for Adolescent Health and the Law for 

monographs on minor consent laws professional association 

policies: www.cahl.org. 

This Pocket Guide was produced by the National Institute 

on Alcohol Abuse and Alcoholism in collaboration with 

the American Academy of Pediatrics. 

Order copies of this Pocket Guide, 

along with the full 40-page Guide, from 

www.niaaa.nih.gov/YouthGuide 

or call 301–443–3860 
For ALL Patients ...	 

STEP 1: Ask the Two Screening Questions 

For elementary and middle school patients, start with the friends’ 

question. Choose the questions that align with the patient’s 

school level, as opposed to age, for patients ages 11 or 14. 

Exclude alcohol use for religious purposes. 

Elementary School (ages 9 –11) 

Friends: Any drinking? 	 Patient: Any drinking? 

“Do you have any friends “How about you—have you 

who drank beer, wine, or ever had more than a 

any drink containing few sips of any drink
 

alcohol in the past year?”
 containing alcohol?” 

ANY drinking by friends ANY drinking: 

heightens concern. Highest Risk 

Middle School (ages 11–14) 

Friends: Any drinking? Patient: How many days? 

“Do you have any friends	 “How about you—in the 

who drank beer, wine, or past year, on how many 

days have you had more any drink containing than a few sips of any alcohol in the past year?” drink containing alcohol?” 

ANY drinking by friends ANY drinking: heightens concern. Moderate or Highest Risk 

(depending on age and frequency) 

High School (ages 14 –18) 

Patient: How many days? Friends: How much? 

“In the past year, on how “If your friends drink, 

many days have you had how many drinks do 

more than a few sips of beer, they usually drink on 

wine, or any drink an occasion?” 

containing alcohol?” 

Lower, Moderate , or 

Binge drinking 


by friends 


Highest Risk heightens concern.
 

(See “What Counts as a Drink? A Binge?” (depending on age and frequency) on reverse) 

For Patients Who DO NOT Drink ...
 

STEP 2: Guide Patient 

 

 

 

NO YES Do friends 

drink? 

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 more about

 about that.” If the patient 

admits to drinking, go 

 to Step 2 for Patients 

Who Do Drink; 

 otherwise, see below.

Neither patient nor 

patient’s friends drink 

ASSESSMENT COMPLETE for patients who do not drink. 

• Praise choices of not 

 drinking and of having 

 nondrinking friends.

• Rescreen next year 

at the latest.

• Explore how your 

patient plans to stay 

alcohol free when 

friends drink.

• Advise against riding

 in car with driver who

 has been drinking or

 using drugs.

• Rescreen at next visit.

• Reinforce healthy choices with praise and encouragement.

• Elicit and affirm reasons to stay alcohol free.

• Educate, if the patient is open, about drinking risks related

 to brain development and later alcohol dependence. 

For Patients Who DO Drink ...
 

STEP 2: Assess 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 Age
 

≤11
 

12–15 

16 

17 

18 

Estimated risk levels by age and frequency in the past year 

Highest risk 

Tx: Brief motivational interviewing + possible referral 

Lower risk Moderate risk 

Tx: Brief advice Tx: Brief advice or motivational interviewing 

Factor in friends: 

•	 For elementary and middle school students: Having 


friends who drink heightens concern. 


•	 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 “What Counts as a Drink? A Binge?” 

on reverse). 

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 the drinking pattern: “How much do you usually 

have? What’s the most you’ve had at any one time?” If patient 

reports bingeing, ask: “How often do you drink that much?” 

•	 Ask about problems experienced or risks taken: 

Examples include getting lower grades or missing classes; 

drinking and driving or riding in a car driven by someone 

who has been drinking; having unplanned, unsafe sex; 

getting into fights; getting injured; having memory 

blackouts; and passing out. 

•	 Ask whether the patient has used anything else to get 

high in the past year, and consider using other formal tools 

to help gauge risk. 

STEP 3: Advise and Assist 

Lower Risk: 

• Provide brief advice to stop drinking. 

• Notice the good: Reinforce strengths and healthy decisions. 

• Explore and troubleshoot influence of friends who drink. 

Moderate Risk: 

•	 Does patient have alcohol-related problems? 

–	 If no, provide beefed-up brief advice. 

–	 If yes, conduct brief motivational interviewing. 

•	 Ask if parents know (see Highest Risk, below, for suggestions). 

•	 Arrange for followup, ideally within a month. 

Highest Risk: 

•	 Conduct brief motivational interviewing. 

• Ask if parents know ... 

–	 If no, consider breaking confidentiality to engage parent. 

–	 If yes, ask patient permission to speak with parent. 

•	 Consider referral for further evaluation or treatment. 

•	 If you observe signs of acute danger (e.g., drinking and 

driving, binge drinking, or using alcohol with other drugs) 

take immediate steps to ensure safety. 

•	 Arrange for followup within a month. 

FOR ALL PATIENTS WHO DRINK 

•	 Collaborate on a personal goal and action plan for 

your patient. Refer to page 31 in the full Guide 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. 

STEP 4: At Followup, Continue Support 

Was patient 

able to meet 

and sustain 

goal(s)? 

Patients may not return for 

an alcohol-specific followup, 

but they may do so for other 

reasons. In either case, ask 

about alcohol use and any 

associated problems. Review 

the patient’s goal(s) and assess 

whether he or she was able to 

meet and sustain them. 

No, patient was not able to meet/sustain goal(s): 

•	 Reassess the risk level (see Step 2 for drinkers). 

•	 Acknowledge that change is difficult, that it’s normal not 

to be successful 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 parents. 

– referring 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. 


Yes, patient was able to meet/sustain goal(s): 

•	 Reinforce and support continued adherence to 


recommendations.
 

•	 Notice the good: Praise progress and reinforce strengths 


and healthy decisions.
 

•	 Elicit future goals to build on prior ones. 

•	 Conduct, complete, or update the comprehensive 


psychosocial interview. 


•	 Rescreen at least annually.