Effect of a Novel Brief Motivational Intervention for Alcohol-Intoxicated Young Adults in the Emergency Department

Abstract

ImportanceHeavy drinking among young adults is a major public health concern. Brief motivational interventions in the emergency department have shown promising but inconsistent results.ObjectiveTo test whether young adults receiving a newly developed brief motivational intervention reduce their number of heavy drinking days and alcohol-related problems over 1 year compared with participants receiving brief advice.Design, Setting, and ParticipantsThis randomized clinical trial was conducted at an emergency department of a tertiary care university hospital in Lausanne, Switzerland. Recruitment ran from December 2016 to August 2019. Follow-up was conducted after 1, 3, 6, and 12 months. All adults aged 18 to 35 years presenting for any cause and presenting with alcohol intoxication were eligible (N = 2108); 1764 were excluded or refused participation. Follow-up rate was 79% at 12 months and 89% of participants provided follow-up data at least once and were included in the primary analyses. Statistical analysis was performed from September 2020 to January 2021.InterventionsThe novel intervention was based on motivational interviewing and comprised in-person discussion in the emergency department and up to 3 booster telephone calls. The control group received brief advice.Main Outcomes and MeasuresPrimary outcomes were the number of heavy drinking days (at least 60 g of ethanol) over the previous month and the total score on the Short Inventory of Problems (0-45, higher scores indicating more problems) over the previous 3 months. Hypotheses tested were formulated before data collection.ResultsThere were 344 young adults included (median [IQR] age: 23 [20-28] years; 84 women [24.4%]). Among the 306 participants providing at least 1 follow-up point, a statistically significant time × group interaction was observed (β = −0.03; 95% CI, −0.05 to 0.00; P = .02), and simple slopes indicated an increase of heavy drinking days over time in the control (β = 0.04; 95% CI, 0.02 to 0.05; P < .001) but not in the intervention group (β = 0.01; 95% CI, −0.01 to 0.03; P = .24). There was no effect on the Short Inventory of Problems score (β = −0.01; 95% CI, −0.03 to 0.02; P = .71).Conclusions and RelevanceThis randomized clinical trial found that a brief motivational intervention implemented in the emergency department provided beneficial effects on heavy drinking, which accounts for a substantial portion of mortality and disease burden among young adults.Trial RegistrationISRCTN registry: 13832949

Who benefits from brief motivational intervention among young adults presenting to the emergency department with alcohol intoxication: A latent‐class moderation analysis

“…In conjunction with the inherent motivating effect of ED presentation (Castro et al, 2021;Longabaugh et al, 1995) rather large for such analyses and included young adults presenting to the ED in routine practice, thus supporting external validity. Third, this study is a secondary analysis of a RCT with significant effects on HDD over 1 year (Gaume et al, 2022), and thus constitutes an important next step in the clinical field by determining which patients' profiles benefitted more from an effective bMI.…”

“…Details on the parent study procedures are described elsewhere (Gaume et al, 2022). Briefly, all patients between 18 and 35 years old presenting to the ED of Lausanne University Hospital between December 2016 and August 2019 with an alcohol intoxication (blood alcohol concentration >0.5 g/L or clinical indication of intoxication) were eligible ( N = 2108).…”

“…This study was a secondary analysis of data collected from a RCT (Gaume et al, 2022) that examined the effects of a bMI for young adults presenting to the ED with alcohol intoxication. This trial was registered in the ISRCTN registry (http://www.isrctn.com/ISRCT N1383 2949) and approved by the Ethics Committee of Canton Vaud, Switzerland (protocol 2016-01476).…”

“…Details on the parent study procedures are described elsewhere (Gaume et al, 2022). Briefly, all patients between 18 and…”

“…Important additional features included guidance on which information to provide, how to provide it while supporting patient's autonomy, as well as extending the intervention to maintain change efforts over time (e.g., booster letter, phone booster sessions, and offer potential referral to treatment). In the second phase, we conducted a randomized controlled trial (RCT) which showed that bMI helped young adults with alcohol intoxication to maintain a lower number of heavy drinking days (HDD, i.e., days with 60 g of pure alcohol or more) over 1 year, compared to a Brief Advice (BA) control group (Gaume et al, 2022). Specifically, there was a significant increase of 1.8 HDD per month in the control group between 1‐month and 12‐month follow‐up, while this was much smaller and nonsignificant in the bMI group (+0.4 HDD per month).…”