A randomized clinical trial of a brief motivational intervention for alcohol-positive adolescents treated in an Emergency Department
Center for Alcohol and Addiction Studies, Brown Medical School, Brown University, Providence, RI 02912, USA. Journal of Pediatrics
(Impact Factor: 3.79).
10/2004; 145(3):396-402. DOI: 10.1016/j.jpeds.2004.04.057
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.
Available from: Stefan Kohler
- "Five RCTs found that young people consumed less alcohol after a hospital stay and brief intervention, regardless whether MI was used in the intervention or not (p ≤ 0.01). Based on the raw data summarized in Table 3, half of the trials observed some of the lowest amount of drinking at the initial follow-ups after 3 or 6 months, and rising consumption levels afterwards (Cunningham et al., 2009; Monti et al., 1999; Spirito et al., 2004). In four trials, some of the least frequent drinking occurred as well before the end of the study (Cunningham et al., 2009; Monti et al., 1999, 2007; Spirito et al., 2004) (supplementary Figures S1). "
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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.
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.
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).
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.
Available from: James Aaron Johnson
- "The strongest evidence for SBIRT's effectiveness comes from randomized controlled trials conducted in primary care settings     . The SBIRT studies in emergency departments (EDs) and trauma centers have shown both positive       and null   results, leading some experts in the field to question the push toward widespread dissemination of SBIRT in emergency settings . Deemed a " teachable moment " in much of the alcohol intervention literature   , an ED visit presents an opportunity to intervene "
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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.
- "Furthermore, longitudinal studies would be desirable to examine the course of development of drinking patterns, taking into account individual transitions from one drinking pattern to another and conditions under which these transitions occur. Future research should also investigate whether class membership is associated with differential intervention effectiveness, since prior research found baseline alcohol use moderating intervention effectiveness (Carey, Scott-Sheldon, Carey, & DeMartini, 2007; Spirito et al., 2004). Finally, future work is needed to evaluate whether tailoring of BIs according to latent class profiles enhances effectiveness. "
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