Alcohol Interventions Among Underage Drinkers in the ED: A Randomized Controlled Trial

Abstract

OBJECTIVES: This study examined the efficacy of emergency department (ED)-based brief interventions (BIs), delivered by a computer or therapist, with and without a post-ED session, on alcohol consumption and consequences over 12 months. METHODS:Patients (ages 14-20 years) screening positive for risky drinking were randomized to: BI (n = 277), therapist BI (n = 278), or control (n = 281). After the 3-month follow-up, participants were randomized to receive a post-ED BI session or control. Incorporating motivational interviewing, the BIs addressed alcohol consumption and consequences, including driving under the influence (DUI), and alcohol-related injury, as well as other concomitant drug use. The computer BI was an offline, Facebook-styled program.RESULTS: Among 4389 patients screened, 1054 patients reported risky drinking and 836 were enrolled in the randomized controlled trial. Regression models examined the main effects of the intervention conditions (versus control) and the interaction effects (ED condition 3 post-ED condition) on primary outcomes. The therapist and computer BIs significantly reduced consumption at 3 months, consequences at 3 and 12 months, and prescription drug use at 12 months; the computer BI reduced the frequency of DUI at 12 months; and the therapist BI reduced the frequency of alcohol-related injury at 12 months. The post-ED session reduced alcohol consequences at 6 months, benefiting those who had not received a BI in the ED.CONCLUSIONS: A single-session BI, delivered by a computer or therapist in the ED, shows promise for underage drinkers. Findings for the fully automated stand-alone computer BI are particularly appealing given the ease of future implementation. WHAT'S KNOWN ON THIS SUBJECT:Intervention strategies are needed to reduce underage drinking. Meta-analyses of youth alcohol brief interventions (BIs) conclude that therapist-delivered BIs are efficacious; however, to maximize public health impact, recommendations include using technology to streamline intervention delivery, for which evidence is lacking. WHAT THIS STUDY ADDS:A single-session BI, delivered by a computer or therapist in the emergency department, shows promise for underage drinkers. Findings for the stand-alone computer BI are particularly appealing given the ease of future implementation. Dr Cunningham was responsible for the study concept, design, acquisition, analysis, and interpretation of data; administrative, technical, or material support of the study; study supervision; and drafting of the manuscript, including both the initial draft and subsequent revisions. Dr Chermack was responsible for the study concept and design, study supervision, and critical revisions to the manuscript; Drs Ehrlich, Blow, and Barry were responsible for the study concept and design and critical revisions to the manuscript; Dr Carter was responsible for analysis and interpretation of data and critical revisions to the manuscript; and Dr Booth was responsible for the study concept, design, acquisition, analysis, and inter...

Underage drinking, brief interventions, and trauma patients

“…20, 21 Compared with the control condition, we found that both a therapist BI and computer BI significantly reduced alcohol consumption at 3 months and alcohol-related consequences at 3 months and 12 months. 17,18 …”

Alcohol Consumption, Early-Onset Drinking, and Health-Related Consequences in Adolescents Presenting at Emergency Departments in England

“…The ED also has a high level of staff expertise who are well placed to initiate safeguarding procedures where required and who provide a good point of onward referral to specialist services. The possibility of conducting alcohol screening among adolescents presenting at the ED in England should be investigated, and the potential for providing interventions to help reduce alcohol consumption in this population and setting established [15,39].…”

Computer-Based Prevention and Intervention to Reduce Substance Use in Youth

“…Another study [34] did not focus on substance use outcomes—despite its testing of a substance abuse prevention program. As a consequence, five studies [27, 46, 51, 52, 54] remain that experienced attrition of 35% or less, that reported at least 1-year behavioral outcomes in substance use, and that favored youths who received the tested computer-based intervention. If the 26 studies considered for this review typify current work, research on computer-based approaches to substance use prevention and intervention among youth will advance slowly.…”

“…Ten of the programs evaluated in the 26 studies engaged adults to a lesser or greater extent to deliver computer-based programming. Those adults were professionals, including nurses ( n = 1) [29], school staff and parents ( n = 1) [33], teachers ( n = 4) [34, 35, 38, 39], therapists ( n = 3) [46, 49, 50, 51], and mothers ( n = 1) [52]. A range of formats are extant in the field of computer-based programs to reduce substance use among youth.…”

“…Three studies happened in hospital emergency departments [49–51] or in primary care units [46]. In these busy settings, youths could access computer programs while awaiting other services.…”