A randomized clinical trial of a brief motivational intervention for alcohol-positive adolescents treated in an emergency department
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.
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ABSTRACT: Aims: We investigate the effect of motivational interviewing (MI), delivered in a brief intervention during an emergency care contact, on the alcohol consumption of young people who screen positively for present or previous risky alcohol consumption. Methods: MEDLINE, CINAHL, EMBASE, PsycARTICLES, PsycINFO, PSYNDEX and Scopus were searched for randomized controlled trials with adolescents or young adults that compared MI in an emergency care setting to control conditions and measured drinking outcomes. Results: Six trials with 1433 participants, aged 13-25 years, were included in the systematic review and meta-analysis. MI was never less efficacious than a control intervention. Two trials found significantly more reduction in one or more measures of alcohol consumption in the MI intervention group. One trial indicated that MI may be used most effectively in young people with high-volume alcohol consumption. Separate random effects meta-analyses were performed based on the highest impact that MI added on reducing the drinking frequency and the drinking quantity at any point in time during the different study periods. Their results were expressed as standardized mean differences (SMDs). The frequency of drinking alcohol decreased significantly more after MI than after control interventions (SMD ≤ −0.17, P ≤ 0.03). In addition, MI reduced the drinking quantity further than control interventions in a meta-analysis of the subset of trials that were implemented in the USA (SMD = −0.12, P = 0.04). Meta-analyses of the smallest mean differences between MI and control groups detected no differences in alcohol use (SMD ≤ 0.02, P ≥ 0.38). Conclusion: MI appears at least as effective and may possibly be more effective than other brief interventions in emergency care to reduce alcohol consumption in young people.Alcohol and Alcoholism 01/2015; DOI:10.1093/alcalc/agu098 · 2.09 Impact Factor
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ABSTRACT: The strongest evidence for effectiveness of screening, brief intervention, and referral to treatment (SBIRT) programs is in primary care settings. Emergency department (ED) studies have shown mixed results. Implementation of SBIRT into ED settings is complicated by the type of patients seen and the fast-paced, high-throughput nature of the ED environment that makes it difficult to reach patients flagged for SBIRT services. This study uses data from an ED-based SBIRT program to examine the relationship between screen-positive rate, ED patient flow, and SBIRT service delivery. Data for the study (N = 67137) were derived from weekly reports extracted directly from one hospital's electronic health record. Measures included time and day of patient entry, drug/alcohol screen result (positive or negative), and whether the patient was reached by SBIRT specialists. Factorial analysis of variance compared variations in screen-positive rates by day and time and the percentage of patients reached by SBIRT specialists during these periods. Overall, 56% of screen-positive patients received SBIRT services. Only 5% of patients offered SBIRT services refused. Day and time of entry had a significant interaction effect on the reached rate (F12,14166 =3.48, P < .001). Although patient volume was lowest between 11 pm and 7 am, screen-positive rates were highest during this period, particularly on weekends; and patients were least likely to be reached during these periods. When implementing an ED-based SBIRT program, thoughtful consideration should be given to patient flow and staffing to maximize program impact and increase the likelihood of sustainability. Copyright © 2014 Elsevier Inc. All rights reserved.American Journal of Emergency Medicine 10/2014; DOI:10.1016/j.ajem.2014.10.021 · 1.15 Impact Factor
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ABSTRACT: The aim of the study was to explore the evidence base on alcohol screening and brief intervention for adolescents to determine age appropriate screening tools, effective brief interventions and appropriate locations to undertake these activities. A review of existing reviews (2003-2013) and a systematic review of recent research not included in earlier reviews. The CRAFFT and AUDIT tools are recommended for identification of 'at risk' adolescents. Motivational interventions delivered over one or more sessions and based in health care or educational settings are effective at reducing levels of consumption and alcohol-related harm. Further research to develop age appropriate screening tools needs to be undertaken. Screening and brief intervention activity should be undertaken in settings where young people are likely to present; further assessment at such venues as paediatric emergency departments, sexual health clinics and youth offending teams should be evaluated. The use of electronic (web/smart-phone based) screening and intervention shows promise and should also be the focus of future research.Alcohol and Alcoholism 11/2013; 49(2). DOI:10.1093/alcalc/agt165 · 2.09 Impact Factor