Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Adolescent alcohol, opioid misuse linked to risky behaviors

Key clinical point: Adolescent alcohol and opioid misuse are associated with risky behaviors that threaten the adolescents’ health and lives.

Major finding: In the study of 2,785 adolescents, those who reported binge drinking in as seniors in high school had a higher likelihood of driving while impaired in subsequent waves, with nearly six times higher odds 2 years after graduation and more than twice as likely 4 years after graduation. In the study of 14,765 adolescents, 14% misused opioids. Those adolescents who reported misusing opioids were 2.8 times more likely to not use a seatbelt; were 2.8 times more likely to have been riding with an impaired driver; were 5.8 times more likely to have been driving while impaired; or 2.3 times more likely to have texted or emailed while driving.

Study details: The study on binge drinking and risky behaviors included 2,785 adolescents in the nationally representative, longitudinal NEXT Generation Health Study. The study on opioid misuse and risky behaviors included a nationally representative sample of 14,765 adolescents from the Centers for Disease Control and Prevention’s 2017 Youth Risk Behavior Surveillance Survey.

Disclosures: The study by Vaca et al was funded by the National Institutes of Health with support from the Intramural Research Program of the Eunice Kennedy Shriver National Institute of Child Health and Human Development; the National Heart, Lung, and Blood Institute; the National Institute on Alcohol Abuse and Alcoholism; the National Institute on Drug Abuse; and the Maternal and Child Health Bureau of the Health Resources and Services Administration. The study by Bhatia et al. had no external funding. The authors from both studies reported no relevant financial disclosures.


Vaca FE et al. Pediatrics. 2020; doi: 10.1542/peds.2018-4095. Bhatia D et al. Pediatrics. 2020; doi: 10.1542/peds.2019-2470.


These newly published reports indicate the high prevalence of risky behaviors and their associations – cross-sectionally and longitudinally – with major threats to adolescent health – so asking about alcohol use, opioid misuse, and associated health risks is truly “in the lane” of clinicians, school professionals, and parents who see and care about adolescents.

At this point, I think it’s incontrovertible that clinicians should screen adolescents to learn about their physical, emotional, and behavioral health. And they should seek opportunities for professional training, skills development, and expansion of their professional networks so they are able to address – individually or collaboratively via referrals – the behavioral and psychosocial health risks of their patients.

The good news is that there is growing awareness of the importance of using validated screening tools to identify patient behavioral health risks – including those pertaining to adolescent and young adult alcohol use and opioid misuse. “Best practice” dictates that screening approaches rely on asking questions using structured tools; intuition and “just winging it” are not effective or reliable for identifying patient behavior. Forward-looking clinics and practices could be asking patients to report about health behaviors in the waiting room (on a computer tablet, for example), or even remotely (using a secure app or data collection tool) in advance of a visit. Asking should be periodic – since behaviors can change fairly rapidly among young people. The benefit is that patient-reported information can be processed in advance to cue clinician follow-up and intervention. And youth tend to share more about their behaviors when they are asked electronically, rather than face to face. Intelligent screens can provide near real-time estimation of risk – to support in-office brief intervention tailored to the risk level of a young person or to trigger follow-up.

These studies indicate that binge alcohol use and misuse of prescription opioids among adolescents are real, pervasive, and deserving of our considered attention. There is no magic bullet. However busy clinicians may have a significant role to play in identifying and addressing these problems.

Elissa Weitzman, ScD, MSc, is an associate professor of pediatrics at Harvard Medical School, Boston, and an associate scientist based in adolescent/young adult medicine and the computational health informatics program at Boston Children’s Hospital. She was asked to comment on the articles by Vaca et al. and Bhatia et al. Dr. Weitzman said she had no relevant financial disclosures.