Alcoholism Health Article

Causes and symptoms

In their article "Early Identification and Intervention for Adolescent Alcohol Use," Mark Werner and Hoover Adjer Jr., both fellows at the American Academy of Pediatrics (AAP), state that attitudes regarding alcohol use are developed quite early in life, usually by the age of eight. Parental attitudes regarding alcohol and behaviors related to alcohol use have a major impact on how children and young adults view drinking alcohol. Not every child or teen who experiments with alcohol becomes an alcoholic, but NCADD studies have shown that children who drink before the age of 15 are four times more likely to become alcoholic than those who begin drinking after the age of 21. Some evidence supports a genetic component to this disease. Parents who are themselves alcoholic or problem drinkers are more likely to have children who develop alcohol dependence. Statistically, one in five children who have an alcoholic parent becomes an alcoholic, too.

Physical symptoms seen in adult alcoholics, such as gastritis, pancreatitis, hepatitis, or even cirrhosis, usually are absent in childhood alcoholics. Such physical damage normally takes longer to develop and is more typical of long-term adult alcoholics. More often in potential childhood alcoholics, behavioral symptoms provide the most significant clues.

These behavioral warning signs, according to the AAP, typically include the following:

• decline in school functioning, decreased attendance, poorer grades, and/or general deterioration in social functioning in school
• increased isolation outside school; rejection of usual long-term friendships in favor of new or different friends
• frequent arguments or less communication with family members; being more secretive
• marked changes in grooming and clothing styles
• noticeable increase in unexplained injuries and fights
• running away from home
• depressive symptoms such as weight loss, sleep problems, lethargy, feelings of hopelessness, mood swings, suicidal feelings, or suicide attempts
• evidence of the presence of risk-taking behaviors such as either driving while under the influence of alcohol or driving with others who are intoxicated, engaging in violent behaviors such as fights, or participating in unsafe sex

When to call the doctor

It is worth noting that these behavioral warning flags can appear in non-alcoholic children or teens and also are usually not observed before the second or third stage of childhood alcoholism. Parents observing some or all of these warning signs need professional help to both clarify diagnosis and plan treatment. Individual and family denial is considered a large portion of any alcohol problem. Parents need objectivity and open and honest communication with their children in order to deal effectively with childhood alcoholism and to know when to seek help.

Diagnosis

As noted, behavioral symptoms help to determine the diagnosis, but not usually until the second and third stage of the disease. There are assessments available that can provide both earlier identification and intervention for childhood alcoholism.

Diagnostic assessments for alcoholism, according to the APA, include:

• CAGE, a mnemonic that points to four key questions by highlighting key words: "Cut down," "Annoyed," "Guilty," and "Early" (see below)
• Alcohol Use Disorders Inventory Test (AUDIT)
• Personal Experience Screening Questionnaire (PESQ)
• Problem Oriented Screening Instrument for Teenagers (POSIT)

CAGE is an assessment guide containing the following four questions:

• C: Have you ever felt the need to cut down on your drinking?
• A: Do you get annoyed at criticism by others about your drinking?
• G: Have you ever felt guilty about your drinking or something you have done while drinking?
• E: Have you ever felt the need for a drink early in the morning?

Treatment

Once assessment has led to a diagnosed problem with alcohol, its severity determines the treatment needed. In "Early Identification and Intervention for Adolescent Alcohol Use," Werner and Adjer divide problem teen drinkers into three groups:

• The first category includes those teens who are using alcohol occasionally but still doing well emotionally and developmentally and who are not drinking and driving. The treatment objectives for this group are to encourage abstinence and re-enforce safety by fostering the continuation of not driving while drinking and not driving with others who are drinking.
• The second category includes those teens who are more at-risk because while they are maintaining stability in physical, developmental, and emotional status, they are also drinking and driving. Professionals dealing with members of this group may not be able to maintain confidentiality, and people in this group may benefit from an introduction to organizations such as Students Against Drunk Driving (SADD).
• The third category includes those showing serious signs of impairment, including inability to follow through on obligations at school or on a job, alcohol-related encounters with police or the justice system, and mental health problems such as anxiety, depression, or oppositional-defiant behavior. These children may experience frequent acute intoxication or withdrawal symptoms, medical complications, or an inability to stop or reduce their alcohol intake. Werner and Adjer suggest that professionals dealing with members of this group probably need to set aside confidentiality in order to involve parents in the treatment process. Treatment may include detoxification in an in-patient facility and/or rehabilitation in a youth-centered substance abuse program.