Needs in adolescents

Parker et al’s review of the diagnosis and treatment of alcohol misuse did not deal with the problems and needs of adolescent drinkers, who often present to emergency departments when drunk.¹ Alcohol misuse is common in this age group and its incidence is rising, at great cost to individuals, families, and wider society. It is significantly associated with risk of suicide, violence, and accidents—the most common causes of death for young people.² It is also an important marker of serious social problems, with significantly higher levels of physical and sexual abuse within the family for teenage drinkers, issues that must be explored with all those who present to health services.³

Despite this, emergency department doctors often don’t screen for alcohol misuse in young people and are poor at recognising it without formalised screening tools. AUDIT and its derivatives can be used in adolescents, although lower cut-off scores than for adults are probably wise. Just asking, “How often do you get drunk?” identifies young people at risk of traumatic injury through drinking,⁴ and the Paddington alcohol test identifies “binge” drinkers.⁵

Testing blood alcohol levels at presentation is no substitute for formally investigating drinking habits and risk behaviour because young people are drunk at lower blood alcohol concentrations than adults and binge drinking is intermittent. Although it has been reported that young people are more prone than adults to hypoglycaemia when drunk, this is rare. Other pathologies must be considered in intoxicated adolescents with hypoglycaemia, including infection or additional toxic and metabolic insults.