Clinical approaches to improving alcohol education and counseling in adolescents and young adults.
ABSTRACT Clinical prevention trials (approaches to educating and counseling) of adolescents (teens and young adults aged 12 to 25) about risks related to alcohol use indicate that reduction in adolescent alcohol use is possible with nonphysicians as interventionists and physicians as interventionists supported by patient counseling guides and resources. Opportunities for personalized, interactive adolescent education with goal setting appears key to intervention success. Physicians might also be more effective if they are aware of emerging alcohol problems among youth, systems-level resources for counseling adolescents about prevention, and appropriate guidance for parents. Recommendations and resources for clinicians working with adolescents regarding alcohol misuse are provided.
Article: A randomized clinical trial of a brief motivational intervention for alcohol-positive adolescents treated in an emergency department.[show abstract] [hide abstract]
ABSTRACT: We tested whether a brief motivational interview (MI) would reduce alcohol-related consequences and use among adolescents treated in an emergency department (ED) after an alcohol-related event. Patients aged 13 to 17 years (N = 152) with a positive blood alcohol concentration (BAC) by lab test or self-report were recruited in the ED and randomly assigned to receive either MI or standard care (SC). Both conditions resulted in reduced quantity of drinking during the 12-month follow-up, whereas alcohol-related negative consequences were relatively low and stayed low at follow-up. Adolescents who screened positive for problematic alcohol use at baseline reported significantly more improvement on 2 of 3 alcohol use outcomes (average number of drinking days per month and frequency of high-volume drinking) if they received MI compared with SC. We conclude that brief interventions are recommended for adolescents who present to an ED with an alcohol-related event and report preexisting problematic alcohol use.Journal of Pediatrics 10/2004; 145(3):396-402. · 4.11 Impact Factor
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ABSTRACT: High-risk alcohol use in persons 18 to 30 years of age is a critical public health problem. It is the number 1 cause of death in this population. This article reports the results of a subanalysis of young adults (aged 18 to 30 years) who participated in Project TrEAT (Trial of Early Alcohol Treatment) conducted in the offices of 64 primary care physicians located in 10 counties in southern Wisconsin. Project TrEAT was a randomized clinical trial designed to test the efficacy of a brief intervention protocol to reduce alcohol use, improve health status, and decrease health care utilization. A total of 226 young adults were randomly assigned to either a usual care or brief intervention group. There were no significant differences between the 2 groups at baseline on a number of potential confounders. During the 4-year follow-up period, there were significant reductions in number of persons drinking more than 3 drinks per day, average 7-day alcohol use, number of persons drinking 6 or more drinks per occasion, and number of binge drinking episodes in the previous 30 days (P < .01 to P < .001). There were also significant differences (P < .05) in emergency department visits (103 vs 177), motor vehicle crashes (9 vs 20), total motor vehicle events (114 vs 149), and arrests for controlled substance or liquor violation (0 vs 8). In this 4-year subanalysis of young adults who participated in Project TrEAT, we found long-term reductions in high-risk drinking behaviors and consequences. The findings of this study support more widespread implementation of brief interventions in primary care settings.The Annals of Family Medicine 2(5):474-80. · 5.36 Impact Factor
Article: A randomized controlled trial of an emergency department-based interactive computer program to prevent alcohol misuse among injured adolescents.[show abstract] [hide abstract]
ABSTRACT: To determine whether an emergency department (ED)-based laptop computer intervention reduces the normative age-related increase in alcohol misuse compared with standard of care. This was a randomized controlled trial conducted from October 11, 1999, to April 14, 2001, in a community teaching hospital and university medical center. Subjects were aged 14 to 18 years and with a minor injury. Controls and intervention participants completed a computer-based questionnaire. Intervention participants also completed a laptop-based interactive computer program to affect alcohol misuse. Main outcome measures were Alcohol Misuse Index (Amidx) and binge-drinking episodes. Follow-up occurred by telephone at 3 and 12 months. Analysis included repeated-measures analysis of variance (alpha=0.05; power 0.80; effect size 0.10). Three hundred twenty-nine participants were randomized to the intervention group, and 326 participants were randomized to the control group. Two hundred ninety-five (89.7%) intervention subjects and 285 (87.4%) control subjects completed 3- and 12-month follow-ups. For intervention and control groups, respectively, mean age was 16.0 and 15.9 years and men composed 66.8% and 66.3% of the groups; Amidx scores were 2.2 and 2.0; binge-drinking episodes were 1.2 and 1.0. Outcomes for intervention and control, respectively, were Amidx (3 months) 1.5 and 1.4; Amidx (12 months) 1.8 and 2.1; binge drinking (3 months) 0.9 and 0.8; and binge drinking (12 months) 1.4 and 1.2. Overall, there were no significant effects (effect size 0.04). No detrimental effects were noted. Subgroup analysis suggested that the intervention may have an effect among subjects with experience drinking and driving (5% of the sample). The intervention was not effective in decreasing alcohol misuse among the study population. Further research will be required to determine effectiveness among the subgroup of adolescent minor injury patients who have experience drinking and driving.Annals of emergency medicine 05/2005; 45(4):420-9. · 4.23 Impact Factor