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January 2001

Targeted Message Increases Teen Condom Use 
Tailoring safe-sex messages to teenage girls' individual needs may reduce their risky behavior in the future, study results suggest. 
In a study of 123 teenage girls being treated for sexually transmitted diseases (STDs), researchers found that those who were also given one-on-one safe-sex education increased their condom use. And compared with young women who received "standard education," girls receiving one-on-one counseling went on to have fewer partners and have lower risks for another STD one year after the program. Researchers led by Dr. Lydia A. Shrier of Harvard Medical School, in Boston, report the findings in the January issue of Archives of Pediatric and Adolescent Medicine. 
In an interview with Reuters Health, Shrier said that her team studied girls in this setting in hopes that that the "reality of an STD diagnosis" would encourage them to change their risky behavior. They also allowed the girls to shape the education by letting them choose topics that were most important to them. 
This tactic, Shrier said, "doesn't apply the same set of messages and activities to everyone, but recognizes that where a girl is in her thinking and behavior is going to affect what she will hear and be able to use from the intervention." 
The girls in the study ranged in age from 13 to 22 and were racially diverse. All came back for four follow-up visits over the course of a year. During those visits, Shrier's team found that risky sexual behavior was less common among girls in the intervention group. They were, for example, more likely than the other girls to use a condom "every time" they had sex. 
Parents can also use the principles from this intervention when talking to their kids about safe sex, according to Shrier. 
"Parents, too, need to tailor their messages," she said, noting that abstinent teenagers, those in monogamous relationships and those who have multiple partners are likely to have very different mind-sets. 
In order to get their own messages across, according to Shrier, parents need to recognize their competitors--the friends, media images and role models their kids take cues from. "Open eyes and open discussion," she said, will help. 
SOURCE: Archives of Pediatric and Adolescent Medicine 2001;155:73-79. 

Many Teens Don't Grow Out of Drinking Problems 
Research shows that for many high-school students, problem drinking is not something you grow out of over time, Reuters reported Jan. 22.
According to Dr. Paul Rohde and colleagues at the Oregon Research Institute in Eugene, adolescents with drinking problems are more likely to have alcohol abuse and other psychological problems in early adulthood.
Their conclusions were based on a long-term study of more than 900 Oregon high-school students who were interviewed between the ages of 14 and 18, and again at age 24. Of the original group, 82 students were diagnosed with alcohol-use disorder, which means they either abused alcohol or were dependent on it. Another 141 were called problem drinkers, defined as having some symptoms of alcohol dependence.
According to the research, students who had been diagnosed with alcohol-use disorder were more likely to have drinking problems and personality disorders at age 24 than those who had no drinking problem in high school. Students defined as problem drinkers also were more likely than other non-drinking students to have problems later on in life.
The researchers recommended screening teens for alcohol problems to lessen psychological difficulties and addiction in later life.
SOURCE: The study is published in the January issue of the Journal of the American Academy of Child and Adolescent Psychiatry. 

Emergency Care Lacking for Third-World Children 
For many children in the developing world, the hospital is not a place you go to get better, a new study shows. It reveals that hospitals' lack of proper diagnostic tools, poorly trained staff, or the family's inability to pay for medications put children younger than 5 at a life-threatening disadvantage when it comes to receiving emergency care. 
Although information about the fate of children who need hospital care in developing world hospitals is sparse, it seems that as many as 40% die within 24 hours, Dr. Nathaniel F. Pierce, from Johns Hopkins University School of Hygiene and Public Health, told Reuters Health. The rate is "much, much lower" in the developed world where modern medicine and highly trained staff can help often very sick children survive. 
Pierce, along with Professor Terry Nolan of the Royal Children's Hospital in Parkville, Australia and others, evaluated 21 hospitals in seven countries: Bangladesh, Dominican Republic, Ethiopia, Indonesia, Philippines, Tanzania, and Uganda. Highly trained evaluators visited each hospital during 1997. 
Their study, in the January 13th issue of The Lancet, represents "the first real attempt to get an overview of paediatric emergency care in hospitals in developing countries," Dr. Elizabeth Molyneux of the University of Malawi, Blantrye, writes in an accompanying editorial. 
According to the report, 73% of the doctors assessed were considered inadequate in "at least one area," as were 91% of nurses and medical assistants. In addition, at "19 of the 21 hospitals, parents of patients were required to pay for medications and intravenous fluids before the hospital's pharmacy would provide them, even for emergencies," the authors write. 
Pierce and colleagues point out that "assessments were based in part on the judgment of eight observers," making comparisons between countries difficult, and the countries studied were themselves very different in terms of development. 
Despite these limitations, "this study is important," Molyneux writes. "Without continuing stimulation and encouragement there will be no progress." 
Clearly, "there is substantial room for improvement," in emergency care in the developing world, although exactly what the best approach might be is not clear, Pierce said. 
A promising option would involve techniques to improve the morale of staff "who are often overburdened and demoralized," Pierce said, adding that encouraging regular staff reviews of problems would also help. 
Editorialist Molyneux agrees, noting that "training for the clinical team at their own workplace would address many of these features of care delivery and would give the local team a chance to collectively review and change their own activities." 
SOURCE: The Lancet 2001;357:86-87, 106-110. 

Study Unlocks Brain Mystery of Ritalin 
Doctors have been prescribing Ritalin for years to treat attention-deficit/hyperactivity disorder (ADHD) in children, but exactly how the stimulant helps young people calm down and pay attention has been unclear. 
Now, researchers at the Brookhaven National Laboratory in Upton and the State University of New York at Stony Brook report that the medication appears to work by increasing levels of the brain chemical dopamine. And they think they also know why the drug--unlike other dopamine-triggering medications--is not addictive when given to children. 
Dopamine, a hormone that plays a role in feelings of pleasure, is also intimately involved with the motivational process, according to the study's lead author, Dr. Nora D. Volkow. By increasing dopamine levels in the brain, the drug may increase interest in activities that normally do not hold the attention of a child with ADHD, she told Reuters Health in an interview. 
For instance, after taking Ritalin, an arithmetic problem might become more interesting to a child who is normally turned off by math, Volkow noted. 
"All of a sudden, it's not boring," she said. 
Previous research in animals and people had shown that Ritalin, also known by its generic name methylphenidate, increases dopamine levels, but the studies involved injections of doses much higher than normally prescribed to children. 
To see whether the smaller oral doses of Ritalin that are usually prescribed to children have the same effects, Volkow's team conducted a study involving 11 healthy men who did not have a history of drug or alcohol abuse and who were not taking any medications. 
The men's brains were scanned using technology called positron emission tomography. One scanning session occurred after the men had taken Ritalin, while the other took place after they had taken a placebo, which did not contain any medication. 
About an hour after the men took Ritalin, dopamine levels in their brains increased significantly, Volkow's team reports in the January 15th issue of The Journal of Neuroscience. The drug appears to raise levels of the hormone by blocking the activity of dopamine transporters, which remove dopamine once it has been released. 
According to Volkow, two groups of researchers have previously shown that some people with ADHD have too many of these dopamine transporters. What this means, she said, is that the transporters "clean up" dopamine in the brain too quickly, making it difficult for the brain to pay attention. By blocking these transporters, Ritalin appears to keep dopamine levels high enough so that a child does not lose interest, she explained. 
The findings may also help explain why Ritalin, when used as recommended, is not addictive, according to the New York researcher. 
Ritalin does increase dopamine levels, as do many addictive drugs including cocaine, alcohol and amphetamines, but the key difference may be the length of time the drugs take to reach the brain, Volkow said. She noted that a drug must reach the brain very quickly for it to become addictive. On average, it takes an oral dose of Ritalin about an hour to have an effect on the brain, she said, which prevents the drug from causing the "high" produced by most drugs that stimulate dopamine. 
This lag explains why children who take appropriate doses of Ritalin (based on a child's weight, age and metabolism) do not become addicted to the stimulant, Volkow said. However, she pointed out that Ritalin can become addictive when tablets are crushed and then either snorted or injected, which makes the drug reach the brain much more rapidly. 
SOURCE: The Journal of Neuroscience 2001;21:RC121. 

Study: Less TV = Less Violence 
A school-based program that discourages television and video game use makes grade-school children less aggressive, a Stanford University study suggests.
While previous research has linked exposure to media violence with increased aggression, few potential solutions have been evaluated, the authors said. Their findings indicate "that the effects of televised violence in kids are really reversible," said Dr. Thomas Robinson, the lead author and an assistant professor of pediatrics.
The study, published in the January edition of the Archives of Pediatrics and Adolescent Medicine, involved third- and fourth-grade children at two comparable public elementary schools in San Jose, Calif.
At one school, 120 participants received no intervention and served as a control group. At the other, 105 children received 18 lessons, 30 to 50 minutes long, over six months on reducing the use of television, videotapes and video games. Researchers trained regular classroom teachers, who led the program.
Challenged to Abstain from TV Children initially reported the amount of TV, videos and video games they watched. They were challenged to abstain for 10 days, and then to watch no more than seven hours a week.
The households involved had their televisions hooked up to a device that could prevent the set from being turned on if the child exceeded a limit that parents were encouraged to establish.
At the outset, the youngsters reported an average of about 15½ hours of television viewing weekly — five hours of viewing videotapes and three hours of playing video games. That fell by about one-third by the end of the program, to an average of about nine hours of television viewing, 3½ hours of videotapes and more than and hour of video games. Content of the programs and games kids watched was not assessed, though the authors assumed some were violent.
Children were asked to rate their classmates' aggressiveness at the beginning of the study, in September 1996, and at the end, the following April, identifying such things as who started fights or often said "give me that!"

Less Violence Reported 
Peer reports of aggression were similar at the two schools at the outset. By the study's end, there were about 25 percent fewer such reports among participants at the intervention school compared with the control group, Robinson said.
Researchers also measured changes in verbal and physical aggression by regularly observing the playground behavior of subgroups of about 50 participants at each school. At the end of the study, there were fewer observed incidents in the intervention group compared with the control group, he said.
The authors acknowledge limitations of their study, including that they only looked at two schools and didn't assess whether there was any violence in what kids watched.
But Dr. Katherine Kaufer Christoffel, a children's violence expert not involved in the study, said the findings are in line with research suggesting overexposure to even nonviolent media can make kids more aggressive.
That theory is plausible because children who watch lots of TV or video games may spend less time interacting with others and may thus have fewer social skills, said Christoffel, a professor of pediatrics and preventive medicine at Northwestern University.
She praised the study for bolstering "the notion that there is a relationship between media exposure and childhood behavior and that it is modifiable." However, she questioned whether the decreases noted in the study are lasting.
Robinson said he's testing the program's effects in a longer and larger study, of about 900 students at 12 schools, that may answer whether it results in long-term reductions in aggression. 
SOURCE: Archives of Pediatrics and Adolescent Medicine

Adolescent Alcohol Abuse Linked to Increased Psychopathology in Adulthood
Alcohol abuse during adolescence may presage significant and potentially long-term psychopathologic dysfunction, according to an investigation of Oregon high school graduates.
A total of 940 high school students were interviewed regarding alcohol abuse, as well as depressive, anxiety, and conduct or oppositional defiant disorders. Interviews were repeated at age 24 years, with an average time interval of 6.8 years.
According to Dr. Paul Rohde, of the Oregon Research Institute in Eugene, and associates, 82 subjects were diagnosed with alcohol use disorder during adolescence. A total of 141 were classified as problem drinkers, those who had no more than two symptoms of alcohol dependence.
Adolescents diagnosed with alcohol use disorder were at 3.7 times the risk of alcohol use disorder and borderline personality disorder at age 24 compared with the remaining subjects, the research team determined. They were at nearly 7 times the risk of exhibiting symptoms of antisocial personality disorder symptoms at age 24.
Problem drinkers, while not reaching the same levels of increased risk, were still at more than twice the risk of alcohol use disorder and nearly 4 times the risk of antisocial personality disorder at age 24.
"Problematic adolescent drinking at subthreshold levels should not be ignored," Dr. Rohde's team writes in the January issue of the Journal of the American Academy of Child and Adolescent Psychiatry. They advise systematic screening of adolescents for subthreshold alcohol problems, as well as thorough evaluation for the presence of psychiatric disorders in adolescents seeking treatment for alcoholism.
They add, "Given the high degree of continuity of alcohol problems from adolescence to young adulthood, treatment recommendations should include the development of booster or maintenance treatments."
SOURCE: Journal of the American Academy of Child and Adolescent Psychiatry

Teaching Young Girls About Dieting May Backfire 
With more girls developing eating disorders at increasingly tender ages, educators are debating how and when to broach the risks of dieting.
Now, a report suggests that programs targeting girls who have not begun menstruating may do more harm than good. Since the urge to diet does not generally strike until after menarche, or a girl's first period, attempts to warn them before this time may backfire.
"Educators must be sure that premenarchial students who are likely to have no real experience of dieting or weight loss behaviors are not inadvertently introduced to the concept of weight control by the very people who are trying to prevent eating problems," according to Drs. Suzanne Abraham and Jennifer A. O'Dea, from the University of Sydney in Australia.
Their study in the January issue of the International Journal of Eating Disorders found that girls who have begun menstruating were more likely to diet and exercise to lose weight, compared with girls who had not had their first period. These girls also had a higher body mass index (BMI), an indication that they had more body fat.
Before the onset of menstruation, girls equated dieting with healthy eating--not weight loss. They did not associate dieting and weight loss unless they were close to menarche or were already overweight. During puberty, the authors explain, an accumulation of body fat is one of the many changes a girl's body undergoes.
The findings suggest that "the concept of dieting that may result in weight loss ... did not develop until menarche and is likely to be associated with the rapid increase in height, weight and body fat that precedes menarche," Abraham and O'Dea conclude.
SOURCE: International Journal of Eating Disorders 2001;29:23-28.

“Party Drug” Has Deadly Effects Even Without Alcohol
A popular industrial solvent that's hitting the club circuit and being marketed on the Internet as a "nontoxic" dietary supplement that produces euphoric and sexual effects actually has a much more lethal side effect than other similarly marketed products--sudden death. A new study shows 1,4 butanediol, also known as BD or 1,4 BD, is toxic, addictive and potentially lethal, even in small doses.
BD is chemically related to gamma butyrolactone (GBL) and hydroxybutyric acid (GHB), which have been sold as dietary supplements for bodybuilding, weight loss and as sleep aids. Little is known about the effects of these drugs, especially BD, in humans, but the study, published in the January 11 issue of the New England Journal of Medicine, shows they may be even more hazardous than commonly thought.
"You don't need to take alcohol or other drugs in order for them to kill," says study co-author Stephen Smith, MD, faculty physician in the department of emergency medicine at Hennepin County Medical Center in Minneapolis, Minnesota. "That's a widespread misconception, that as long as you don't take them with alcohol or other drugs, you're safe."
Product names that contain BD include Thunder Nectar, Rejuv@nite, Ultradiol, Serenity, Enliven, SomatoPro, NRG3, Rest-Q, Liquid Gold, Amino Flex, Dormir, InnerG, Zen, and Weight Belt Cleaner. Most products are sold in liquid form and the active ingredient of 1,4-butanediol is commonly listed as tetramethylene glycol, butylene glycol or sucol-B.
The study looked at nine cases of toxic effects from BD alone reported at three emergency rooms from June through December 1999, including two deaths. Not only can use of the drug result in a coma, say researchers, it can produce a sudden loss of consciousness that makes driving especially dangerous.
Researchers say they found products with BD marketed on the Internet with health claims ranging from treating depression, increasing muscle mass and weight loss.
"Ironically and tragically they were also advertised for treatment of addiction," says study author Deborah Zvosec, PhD, research associate in the department of emergency medicine at Hennepin. "People who had been clean and off of alcohol for years, and in other cases people who had been trying to self-treat their own addiction became horribly addicted to this [BD], and in fact the withdrawal syndrome is potentially lethal."
Researchers say BD has also increasingly been implicated in sexual assaults or robberies when the tasteless chemical is slipped in a person's drink. Low doses of BD can produce increased libido, amnesia, euphoria, and passivity, which can make victims more susceptible to "date rape" or other types of assault.
Jerry Frankenheim, PhD, a pharmacologist at the National Institute on Drug Abuse (NIDA), says this study fills an important gap in the research about GHB-related substances, "This the first time it's been established that BD can kill by itself and produce other severe toxicity effects without other drugs being involved."
The Food and Drug Administration (FDA) classifies BD as a Class I Health Hazard--a potentially life-threatening risk. But Frankenheim says the chemical is difficult to regulate because it is not actually a drug, but a common industrial solvent.
"This 1,4 BD, even more than GDL, is very widely available as a chemical solvent. It can't be banned. It can be banned for use as a drug, but its existence can't be banned," says Frankenheim.
Researchers say it is vital for people to seek immediate medical attention if they suspect they have ingested BD, despite Internet claims that advise users to "sleep off" the chemical's effects.
Standard drug screening tests do not detect BD, which can make spotting its use in an emergency room tricky for doctors, but researchers say telltale symptoms include nausea, confusion, agitation, coma and going back and forth between coma and a state of agitation or combative behavior.
The FDA says people can protect themselves from being victimized with a drug like 1,4-butanediol with the following steps:

• Watch your drink from the moment it's poured until you finish it to make sure no one slips a foreign substance into it.
• Don't share a drink with someone else or accept a drink from a punch bowl or other common source.
• Designate a nondrinking friend to make sure you don't appear unusually intoxicated or sick and that you don't leave with someone under suspicious circumstances.

For more information on BD, GHB and other "club drugs," visit the NIDA Web site at http://www.nida.nih.gov/
SOURCE: New England Journal of Medicine. 11 January 2001

Adderall an Effective Initial Therapy for Children and Adolescents With ADHD
For most children and adolescents newly diagnosed with attention-deficit/hyperactivity disorder (ADHD), a product comprised of mixed amphetamine salts (Adderall) appears to be as safe and effective as methylphenidate.
Dr. Peter A. Ahmann and colleagues, from the Marshfield Clinic and the Marshfield Medical Research Foundation, Marshfield, Wisconsin, compared Adderall 0.15 mg/kg or 0.3 mg/kg against placebo. The subjects, 154 ADHD patients ages 5 to 18 years, received one of the dosages of Adderall for 7 days, then crossed over to the other.
Dr. Ahmann and colleagues found that, when they required concurrence between parent and teacher ratings of the child's behavior, 59% of the patients had a positive response to Adderall, based on prespecified criteria. Using parent ratings only, the response rate was 82%, according to the research team's report in the January issue of Pediatrics.
Loss of appetite, stomachaches, insomnia and headaches were the most common side effects with both doses of Adderall, with headaches being worse with the higher dose, the researchers report.
"Adderall is as efficacious as the other stimulant drugs and has the same side effect profile," Dr. Ahmann told Reuters Health. Adderall has advantages over Ritalin, he pointed out, in that it is cheaper and the dosing is less frequent.
"Part of our ongoing study is to reassess these children after 2 years on Adderall to see if the response is maintained," Dr. Ahmann explained. "A number of children have completed the 2 years and virtually all of them have maintained their positive response."
SOURCE: Pediatrics 2001;107(1). http://www.pediatrics.org/cgi/content/full/107/1/e10

Parents Should Guard Against Overreaction When Young Girl Is Overweight 
Parental concern about weight of daughters as young as 5 years can negatively affect the girls' developing self-concept, report researchers from Pennsylvania State University in University Park.
The investigators suggest that the parents should be encouraged to change the health lifestyle of the entire family instead of focusing their concern on the overweight child.
Dr. Leann Lipps Birch and Kirsten Krahnstoever Davison administered the Pictorial Scale of Perceived Competence and Social Acceptance for Young Children, as well as the Body Esteem scale, to 197 five-year-old girls. In addition, the investigators interviewed the girls' parents regarding their concern about the child's weight and how much they restricted the child's access to food.
Twenty-five percent of the girls were overweight based on weight for height scores, and 10% were obese, the investigators report in the January issue of the journal Pediatrics.
"It seemed logical to me that being overweight in and of itself wouldn't be associated with low self-concept in girls, but being overweight in combination with reactions by parents would potentially be associated with lower self-concept, and that's what we found," Davison told Reuters Health.
Higher concern among parents with their daughters' weight was associated with lower perceived cognitive ability and perceived physical ability, regardless of whether the child was obese, overweight, or of normal weight. Parents' restriction of the child's access to food was also associated with negative psychological outcomes.
Physicians shouldn't "simply alarm parents if a child exhibits being overweight, but should actually give some constructive ideas as to how they can combat this problem," Davison said. She suggests that they "do it in a way that focuses on a lifestyle change for the whole family rather than focusing on a single child and limiting foods that this child can have.
"For example," Davison proposed, "I believe that pediatricians can encourage the whole family to get out and be active, and to restructure the eating environment, making a large proportion of healthy foods available in the house." In other words, she said, "don't make eating a huge issue for these girls."
SOURCE: Pediatrics 2001;107:46-53.

Secrecy a Problem in Covert Drug Administration in UK
The primary problem with hiding medication in the food of mentally incapacitated patients who cannot give valid consent to treatment is the lack of openness and poor documentation for this practice, according to editorialists who comment in the January 6th issue of The Lancet.
Dr. Adrian Treloar of Guy's, King's, and St. Thomas' Medical Schools in London, and associates describe two prevailing ethical viewpoints. One is that all deception is wrong — the other is that there is a duty to care for patients who can not comprehend the results of their refusal to accept treatment.
The editorialists believe that proven treatments should be given in the least distressing or least restrictive fashion to those incapable of choosing or rejecting them.
However, this practice "is a potential form of patient abuse," Dr. Treloar's group points out. "Putting medicine in cups of tea, rather than taking the time and effort to persuade and work with distressed patients may be time efficient but may also reinforce tolerance of poor staffing levels and standards."
First, they write, "It must be explicit that the patient is incapacitated with regard to the decision in hand." The problem should then be discussed with relatives or advocates and other involved healthcare providers. Finally, each occasion of covert administration should be documented so that the practice can be monitored.
In an interview with Reuters Health, Dr. Michael Blumenfield, Chair of the Joint Commission on Public Affairs for the American Psychiatric Association, in Valhalla, New York, said, "under normal circumstances, you should always tell the patient what you are going to do and enlist their cooperation."
"Perhaps in earlier times," Dr. Blumenfield continued, "there was a more paternalistic view of treating patients and medication would be put in the food or something like that. But that certainly is not the way things are done today. We don't administer medication against the person's will unless they are deemed by a court to be incompetent or unless the patient's health or life is in immediate danger."
Lancet 2001;357:62-64.

Prevalence of Obesity Increasing Among British Children
The prevalence of obesity in English and Scottish children approximately doubled between 1984 and 1994, according to study results reported in the January 6th issue of the British Medical Journal.
These "rising trends in children will almost certainly be represented in later trends in adult overweight and obesity and probably in an increase in associated adult morbidity," Dr. Susan Chinn and Dr. Roberto J. Rona, of King's College London, UK, stress in the report.
The investigators review data obtained in 1974, 1984 and 1994 as part of a national study of health and growth in England and Scotland. During the whole period, more than 15,000 boys and almost 15,000 girls, ages 4 to 11 years, from each of the two countries were included. Obesity was characterized using recently published cutoffs for body mass index by age.
While little change in obesity was observed from 1974 to 1984, a noticeable increase occurred the following decade, Dr. Chinn and Dr. Rona say in the report. Specifically, the proportion of boys who were overweight increased from 5.4% in 1984 to 9.0% in 1994 in England and from 6.4% to 10.0% in Scotland. The corresponding increases in girls were 9.3% to 13.5% in England and 10.4% to 15.8% in Scotland.
During 1994, the overall prevalence of obesity in boys and girls reached 1.7% and 2.6%, respectively, in England, and 2.1% and 3.2%, respectively, in Scotland. Of note, the increases observed were greater in older age groups than in younger children.
SOURCE: British Medical Journal 2001;322:24-26.

Alcohol-Abusing Teens Risk Long-Term Problems
Most teenagers who are problem drinkers are not simply going through a "phase," new research suggests. Instead, kids who abuse alcohol often see their drinking problems and mental health worsen as they age.
In a study of 940 high school students who were followed until age 24, researchers found that those with diagnosed alcohol problems were at increased risk for further drinking problems, other substance abuse, depression and personality disorders as they got older. These risks were also elevated among kids with symptoms, but no diagnosis, of problem drinking.
Researchers led by Dr. Paul Rohde of the Oregon Research Institute in Eugene report the findings in the January issue of the Journal of the American Academy of Child and Adolescent Psychiatry.
While surveys show drinking to be common among American high school kids, some teenagers develop drinking problems early on. In fact, according to Rohde and his colleagues, one study has shown that more than 35% of adults with an alcohol problem developed symptoms by age 19.
Rohde's team looked at alcohol use disorders, which include alcoholism and alcohol abuse. People who abuse alcohol may not be dependent on drinking, as alcoholics are, but their excessive drinking does interfere with their lives.
To follow the evolution of these disorders, Rohde's team interviewed their subjects twice during adolescence and again at age 24. The researchers assessed them for alcohol problems and for depression and other psychiatric disorders. They also looked at whether the subjects' parents were alcoholics or abused alcohol.
The initial interviews revealed that 6% of the kids had an alcohol use disorder, while another 17% had some symptoms of problem drinking. The researchers also found that more than 80% of teenagers with an alcohol use disorder also had psychological problems such as depression or behavioral disorders. Many smoked or used other drugs.
When the researchers followed these kids over time, they found that their problems did not abate. Instead, adolescent drinking problems foreshadowed problems in adulthood. In addition, the researchers found that subjects whose fathers had an alcohol use disorder were about 60% more likely than others to have a problem themselves. "Clearly," Rohde and his colleagues write, "for many adolescents, (alcohol use disorders) and problematic alcohol consumption are not benign conditions that self-resolve."
Because even kids with only some symptoms of problem drinking were at risk for future alcohol use disorders, doctors should look for early signs of alcohol problems, according to the researchers. They also advise doctors to look for psychiatric disorder in teenagers who need help for an alcohol problem.
SOURCE: Journal of the American Academy of Child and Adolescent Psychiatry 2000;40:83-90.

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