Alcohol-interactive meds linked to less drinking in chronically ill youth

Last Updated: 2018-09-19

By Anne Harding

NEW YORK (Reuters Health) - Many youth with chronic medical conditions drink heavily, but those who are on alcohol-interactive medications consume less alcohol, according to new findings.

"Very surprisingly we found that youth who perceived the potential for alcohol to interact with their treatments drink less than their peers who did not think alcohol could interact with their treatments," said Dr. Elissa R. Weitzman of Boston Children's Hospital and Harvard Medical School in Boston.

"This is a clear signal that we need to consistently communicate these risks to youth and reinforce the value of acting to protect their health," she told Reuters Health by email. "Youth who are living with a chronic illness are motivated to keep their condition under control - and well managed. We need to build on that."

About one-third of high school-aged youth with chronic medical conditions report drinking in the past year, while one-third of this group reports binge drinking, Dr. Weitzman and her team note in Pediatrics, online September 18.

Chronically ill young people are at greater risk than their healthy peers to become problem drinkers. And youth with chronic medical conditions who drink are less likely to adhere to treatment.

Another concern, the authors note, is that many chronically ill young people are on alcohol-interactive medications. Dual exposure to alcohol and alcohol-interactive medications is common among adults, they add, but its prevalence in adolescents has not been studied.

To investigate, Dr. Weitzman and her colleagues surveyed 396 youth with type 1 diabetes, juvenile idiopathic arthritis, moderate persistent asthma, cystic fibrosis, attention-deficit/hyperactivity disorder, or inflammatory bowel disease about their alcohol use and exposure to alcohol-interactive medication.

Alcohol-interactive medication use was reported by 86.4% of study participants, 35.4% of whom said they had used alcohol in the past year. Among those who were not taking alcohol-interactive medications, 46.3% reported drinking in the past year. Youth on such drugs had 43% lower odds of having used alcohol and had a lower total alcohol consumption.

The association between drinking and using alcohol-interactive medication was partially mediated by perceptions about alcohol-medication interference.

The American Academy of Pediatrics recommends substance-use screening for all patients, the authors note.

"There are gaps in screening for all youth" including youth with chronic medical conditions, Dr. Weitzman added. "What's really clear is that there are gaps in screening and messaging for youth with chronic medical conditions that link the experience of a chronic condition and the safety/efficacy of its management to risks posed by alcohol - and this is exactly the information that youth with a chronic illness want to understand and appear to hear and respond to by adjusting their behavior."

She added: "Some youth have knowledge and awareness gaps about alcohol as a risk factor for them - and outreach to these youth is key as these youth are at very high risk for using alcohol and binge drinking.'

"Understanding issues such as alcohol use are highly important for understanding what's going on with a medical condition, treatment adherence, lab values, safety etc," Dr. Weitzman said. "These are not peripheral, tangential or immaterial issues to specialty care (or any type of care). They are right there in the middle of the bullseye. Young patients understand this, perhaps more than the healthcare system right now. We need to catch up with them."

She and her colleagues are now testing a program to prevent alcohol use in chronically ill youth. "And we are working to understand the many mechanisms and risk factors that contribute to health harms for these youth - as well as those that make them resilient and resourceful," Dr. Weitzman said.

SOURCE: https://bit.ly/2QNLFXc

Pediatrics 2018.