Developing a brief motivational intervention for young adults admitted with alcohol intoxication in the emergency department – Results from an iterative qualitative design

Abstract

Background Unhealthy alcohol use among young adults is a major public health concern. Brief motivational interventions for young adults in the Emergency Department (ED) have shown promising but inconsistent results. Methods Based on the literature on brief intervention and motivational interviewing efficacy and active ingredients, we developed a new motivational intervention model for young adults admitted in the ED with alcohol intoxication. Using an iterative qualitative design, we first pre-tested this model by conducting 4 experimental sessions and 8 related semi-structured interviews to evaluate clinicians’ and patients’ perceptions of the intervention’s acceptability and feasibility. We then conducted a consultation meeting with 9 international experts using a nominal group technique. The intervention model was adjusted and finally re-tested by conducting 6 new experimental sessions and 12 related semi-structured interviews. At each round, data collected were analyzed and discussed, and the intervention model updated accordingly. Results Based on the literature, we found 6 axes for developing a new model: High level of relational factors (e.g. empathy, alliance, avoidance of confrontation); Personalized feedback; Enhance discrepancy; Evoke change talk while softening sustain talk, strengthen ability and commitment to change; Completion of a change plan; Devote more time: longer sessions and follow-up options (face-to-face, telephone, or electronic boosters; referral to treatment). A qualitative analysis of the semi-structured interviews gave important insights regarding acceptability and feasibility of the model. Adjustments were made around which information to provide and how, as well as on how to deepen discussion about change with patients having low levels of self-exploration. The experts’ consultation addressed numerous points, such as information and advice giving, and booster interventions. Discussion This iterative, multi-component design resulted in the development of an intervention model embedded in recent research findings and theory advances, as well as feasible in a complex environment. The next step is a randomized controlled trial testing the efficacy of this model.

A scoping review of brief alcohol interventions across young adult subpopulations.

“…Future research would be well served to interrogate questions of participant engagement (cf. Gaume et al, 2021; Helle et al, 2021), potential population-specific mechanisms of intervention effect and intervention outcomes, and moderation of intervention efficacy based on considerations of intersectionality (see Ehlinger et al, 2021). Importantly, in conducting this work, it is necessary to explicitly acknowledge high-risk alcohol use as a product of external, often systemic, forces (e.g., racism, transphobia, exposure to traumatic events) in addition to individual factors and be careful to not further stigmatize populations by essentializing such use as a group characteristic (Kypri et al, 2013).…”

Assessment of substance use among injured persons seeking emergency care in Nairobi, Kenya

“…This observed burden in the injured population suggests that the EC venue may be an impactful environment to access and provide care for substance use disorders in Kenya and other similar settings. Furthermore as the EC treatment period has been documented as a setting in which health promotion and readiness to change is present, interventions for substance use may be both feasible and efficacious [33] , [34] , [35] . However, there is an urgent need for research into how to best develop and implement substance use assistance interventions in the EC setting in sub-Saharan Africa.…”

The effectiveness of a mobile intervention to reduce young adults’ alcohol consumption to not exceed low-risk drinking guidelines

“…As in both groups almost 50% of the participants were in the action stage of their readiness to change, participating in this study might have been enough to activate them to develop this healthier lifestyle regardless of which group they were allocated to. Moreover, although solely alcohol-related information is of limited interest to young adults (39), the educational website can be seen as a minimal intervention and therefore could have been equally effective in reducing drinking behavior compared to the intervention. Several moderators were investigated in the current study, including sex, motivation to change alcohol use behavior, experienced engagement with the intervention, and adherence.…”