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January 2019

Alcohol Use Screening and Behavioral Counseling With Adolescents in Primary Care: A Call to Action

Author Affiliations
  • 1Department of Pediatrics, University of Washington, Seattle
  • 2Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, Seattle, Washington
  • 3Adolescent Substance Use and Addiction Program, Division of Developmental Medicine, Boston Children’s Hospital, Boston, Massachusetts
  • 4Center for Adolescent Substance Abuse Research, Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital, Boston, Massachusetts
  • 5Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
JAMA Pediatr. 2019;173(1):12-14. doi:10.1001/jamapediatrics.2018.4171

The US Preventive Services Task Force (USPSTF) provides objective and rigorous reviews of the scientific evidence across areas, and their recommendations serve as a guide for health care systems and primary care clinicians in determining which screenings and interventions to provide to patients. Their latest recommendation statement1 and evidence report and systematic review2 published in this week’s issue of JAMA find that the state of the evidence is insufficient regarding the benefits and harms of screening and behavioral counseling to adolescents regarding unhealthy alcohol use. Despite 5 intervening years, this rating is unchanged from 2013. The “I” statement (The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening and brief behavioral counseling interventions for alcohol use in primary care settings in adolescents aged 12 to 17 years) runs counter to recommendations from a number of other professional organizations, such as the American Academy of Pediatrics, the American Society of Addiction Medicine, the National Institute on Alcohol Abuse and Alcoholism, and the US Surgeon General. In this editorial, we explore reasons for the discrepancy and consider how the broader research base might inform our thinking about whether to screen and/or counsel adolescents on substance use. We also outline future directions for research and funding needs to address this critical gap in evidence in the hopes of building enough evidence to achieve a more definitive statement on this topic by the next USPSTF recommendation and review.

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