Brief in Person Interventions for Adolescents and Young Adults Following Alcohol-Related Events in Emergency Care: A Systematic Review and European Evidence Synthesis

Abstract

Background: Increasing numbers of youth in need of emergency medical treatment following alcohol intoxication have been a major public health concern in Europe in recent years. Brief interventions (BIs) in the emergency department (ED) could prevent future risky drinking. However, effectiveness and feasibility of this approach are currently unclear. Method: A systematic literature search on controlled trials including participants aged 12-25 years treated in an ED following an alcohol-related event was conducted. Additionally, a grey literature search was conducted to support findings from the systematic review with evidence from practice projects and uncontrolled trials. Data on effectiveness, acceptance, implementation and reach were extracted. Results: Seven randomised controlled trials (RCT), 6 practice projects, 1 non-randomised pilot study and 1 observational study were identified. Six RCTs found reductions of alcohol use for all participants. Four RCTs found effects on alcohol consumption, alcohol-related risk-behaviour or referral to treatment. Participation and referral rates varied strongly, whereas data on acceptance and implementation were rarely assessed. Conclusion: Heterogeneity of study designs and effects limit conclusions on effectiveness of BIs for young ED patients following an alcohol-related event. However, the number of practice projects in Europe indicates a need perceived by practitioners to address this population.

Binge drinking: Health impact, prevalence, correlates and interventions

“…The first review found no significant effects of BI on binge drinking reduction among patients younger than 20 compared to the control groups (Newton et al, 2013). The second review found little to no effect of BI among the 12-25 age group, and that the few preventive effects of BI found, varied considerably regarding the different alcohol outcomes considered (Diestelkamp et al, 2016). These results illustrate the need for high-quality studies in order to draw firmer conclusions on the usefulness of BI in emergency departments.…”

Short‐ to Midterm Effectiveness of a Brief Motivational Intervention to Reduce Alcohol Use and Related Problems for Alcohol Intoxicated Children and Adolescents in Pediatric Emergency Departments: A Randomized Controlled Trial

“…Thus, studies targeting adolescents are important, given the prevalence of high‐risk health‐related behavior such as excessive drinking in this age group . Moreover, existing evidence mainly comes from U. S.–American and Australian trials with unclear implications for high‐volume drinking countries in Europe such as Germany . RCTs involving the important group of intoxicated adolescents are missing even though these patients are regarded as a high‐priority group for preventive health services in Germany and the alcohol‐related PED visit is considered a window for opportunity to reach adolescents for interventions and preventive measures for long‐term problems …”

“…The sample size was calculated for the three primary outcomes: binge‐drinking frequency, number of alcoholic drinks on a typical occasion, and alcohol‐related problems at 3‐month follow‐up. To detect an anticipated effect size of d = 0.26, with a power of 80% and with a type I error of 5% for each of these outcomes, 306 patients (153 patients per group) had to be included, if randomization had occurred at patient level. With an assumed intra‐cluster correlation of 0.05 and an average of 1.264 patients per cluster, we calculated a design effect for cluster randomization of 1.013, which increased the required sample size to 312 patients (156 patients per group).…”

“…Annual hospital admissions for AAI as primary diagnosis total 119,000 patients in Germany with 22,400 individuals aged 19 years or younger, a number that is close to the estimated 3% 12‐month prevalence in Europe . Substantial proportions of this population are at risk for ongoing and further alcohol misuse that warrants appropriate treatment, yet the implementation of evidence‐based interventions is not standard practice in pediatric emergency departments (PEDs) across Europe thus far …”

“…However, emergency care in Europe has initiated practice projects to address this particular patient population (see Diestelkamp et al for an overview). In Germany the targeted alcohol prevention project HaLT‐Hart am LimiT [Stop‐Close to the Limit] involves a brief single counseling session based on motivational interviewing (MI) for AAI patients in PEDs.…”