Young Adults and Drinking : Screening

by National Institute of Health

(Page 2 of 5)

Because young adults do not tend to identify themselves as having alcohol problems, proactive screening should be conducted in locations where they are likely to present with alcohol-related injuries or illness. Among 18- to 24-year-olds, these environments may include hospital emergency departments, college counseling centers, college- sponsored judicial review programs for alcohol-related infractions of campus policies, and worksites.

Hospital Emergency Departments

A study of 18- and 19-year-old patients who visited an ED for medical treatment found that patients who were treated for an alcohol-related event, such as a car crash, were significantly more likely to report more alcohol use and more alcohol-related problems than patients treated in the ED for events that did not involve alcohol. This finding bolsters the notion that EDs are a useful venue for identifying young people who may have alcohol problems. Given the prevalence of alcohol use reported by young adults in the armed forces, it also would be beneficial for EDs on military installations or in the surrounding communities to screen military personnel who present with alcohol-related injuries.

Emergency departments use different methods to screen for alcohol use. One study examining young adults admitted to a trauma center through an ED found that 41 percent of the sample tested positive for alcohol, and more than 22 percent had blood alcohol concentrations in the legally intoxicated range. The same study showed that among patients who had been drinking, a substantial proportion had injuries that stemmed from their alcohol use. However, research among young adults who present to emergency rooms has found that blood alcohol levels alone are not sufficiently reliable or sensitive to identify people with alcohol problems. A more comprehensive approach, using both screening instruments and self-reports of alcohol consumption preceding the event that led to the ED visit, can be more useful in identifying alcohol problems.

College Campus Venues

College counseling centers and health clinics can be other important venues for alcohol screening among young adults. O'Hare and Sherrer examined the validity and reliability of one screening measure, the Alcohol Use Disorders Identification Test, with college students who had violated campus alcohol policies. Their study found that the AUDIT was a psychometrically sound screening instrument for detecting harmful alcohol use in this population. In one large-scale screening of college students conducted as part of the 1999 National Alcohol Screening Day, 13,053 students were screened at 499 campuses. Of these students, 4,005 reported scores that were indicative of hazardous drinking. These findings support the idea that college campuses can provide an important context in which to identify young adults who are engaging in risky alcohol use. Nevertheless, some evidence indicates that few college health clinics routinely screen for alcohol and other drug use and abuse in students; Rickman and Mackey found that only 37 percent of 277 college student health clinics conducted such screening. Given the wide reach that student health clinics and counseling centers have on campuses, more efforts to screen students in these sites should yield valuable results.

College Judicial Review Programs

Violations of campus alcohol policies lead to most of the judicial penalties colleges impose on students. From a prevention perspective, the need to screen students for alcohol use and misuse before they commit alcohol-related infractions is obvious. However, more and more researchers are recognizing the advantages of screening students who are mandated to attend alcohol education classes on campus as a penalty for violating college alcohol policy. This group is an appropriate target for alcohol screening because they already have begun to experience adverse consequences as a result of their drinking (that is, their referral to mandated education programs). In addition, the number of these "mandated students" is large and growing. In one survey of 199 schools, the number of students required to attend alcohol programs nearly doubled between 1993 and 2001 (i.e., from 1.8 percent to 3.5 percent of the schools' student populations). Another recent study, which surveyed 4,711 2- and 4-year schools, indicated that the number of mandated students increased by 4.7 percent from 2000 to 2001.

On the Job

The workplace is another promising venue for screening young adults for alcohol-related problems. Researchers used the AUDIT as a workplace screening measure in a large-scale study of 4,193 law enforcement personnel conducted in Australia. Results indicated that participants between ages 18 and 25 reported the highest average alcohol consumption rates, and had higher rates of alcohol-related problems and higher AUDIT scores, than other age groups in the sample. Approximately one-third of the total sample was found to be at risk for hazardous alcohol consumption, further underscoring the desirability of screening young adults in the workplace.

About the Author

NIH is the nation's medical research agency - making important medical discoveries that improve health and save lives. The National Institutes of Health (NIH), a part of the U.S. Department of Health and Human Services, is the primary Federal agency for conducting and supporting medical research.