**10. Hospital admittance**

After acute care, the focus shifts towards treatment and education. By informing the patients and their parents about the dangers of alcohol consumption, the effect of hospitalization is broadened towards prevention and intervention. This will be of use during follow up at the outpatient department.

Most patients are admitted in the evening or at night (40). The next morning, they are woken on time to start a short program before being discharged from hospital. First, the pediatrician speaks both to the patient and the parents, explaining the reason for admittance and emphasizing the seriousness of the event. The patient's medical and social histories are checked and questions are asked about further alcohol use. The dangers of alcohol use are explained. This is seen as an important moment for intervention and education. Patient and parents pay more attention shortly after the incident occurred. Later on, a pedagogic

A New Approach in Adolescent Alcohol Intoxication –

**12. Tools for screening** 

dependence.

was done in 72% of the patients for whom it was indicated.

So far, no standard screening method has been identified.

main goal. However, reliability is low because of self-report.

acid ethyl ester (FAEE) and ethyl glucuronide (EtG).

alcohol. It has no role in screening for alcohol use at the outpatient clinic.

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Preliminary results of the project are promising. At follow-up, 84-88 % of the patients had stopped binge drinking and 61% had stopped the consumption of alcohol. Awareness of the parents was another factor of interest; at follow up 82,5 % of the parents applied specific alcohol rules, including prohibition of alcohol under 16 years of age. Behavioral questionnaires were filled in by 89% of the study population. Neuropsychological screening

Screening for problematic alcohol use can be useful during follow up of the patients. It can be expected that questions about lifestyle are delicate, particularly during adolescence and in the direct vicinity of parents or adults. At the same time, detection of problematic alcohol use at a young age can reveal alcohol dependency and ensure a more effective intervention.

Various self-report questionnaires are available for rapid assessment of drinking behavior, such as the Alcohol Use Disorders Identification Test (AUDIT), TWEAK (Tolerance, Worried, Eye-opener, Amnesia, Cut Down), the Michigan Alcohol Screening Test, CAGE (Cut Down, Annoyed, Guilty, Eye Opener) and the Alcohol Dependence Scale. The AUDIT was developed by the World Health Organization (WHO) as a measure for alcohol consumption, dependence and alcohol-related problems. The TWEAK focuses more on tolerance. It was specifically developed for women and aims to identify possible hazardous drinking patterns. The CAGE places emphasis on behaviors consistent with alcohol

These various screening methods are rapid, non-invasive and inexpensive, but they have different outcome parameters and were developed for adults. Applicability for adolescents has been investigated and seems to support the AUDIT as the better screening method (42), due to its focus on frequency of use, quantity and frequency of binge drinking. This can be an advantage in adolescents, because here the early detection of drinking problems is the

Biological screening methods can offer more objectivity. Amongst them is the extensively used blood alcohol concentration, which is generally determined during the first care. However, this test only gives information during a short period after consumption of

Other traditional and new markers can add to the suspicion of problematic alcohol use. The more established markers of alcohol use are mean corpuscular volume (MCV), gammaglutamyltransferase (GGT), aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Increased values can lead to the differential diagnose of alcohol dependency. Direct markers, which are all products of ethanol metabolism, are acetyldehyde, acetic acid, fatty

Newer biomarkers include carbohydrate-deficient transferrin (CDT), total serum sialic acid (TSA) and 5-hydroxytryptophol (5-HTOL). Transferrin is a plasma protein that carries iron through the bloodstream to the bone marrow. Transferrin is a polypeptide with two Nlinked polysaccharide chains. The chains are branched with sialic acid residues. Consuming

employee or nurse will help the adolescent to answer questions on alcohol use on a government-funded website. Parents are also referred to websites for further information.

Most of the patients leave the hospital in good clinical health within a day after admittance. After discharge, a program starts at the outpatient department of pediatrics and child psychology.
