Elsevier

The Journal of Pediatrics

Volume 145, Issue 3, September 2004, Pages 396-402
The Journal of Pediatrics

Clinical and Laboratory Observations
A randomized clinical trial of a brief motivational intervention for alcohol-positive adolescents treated in an emergency department

https://doi.org/10.1016/j.jpeds.2004.04.057Get rights and content

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.

Section snippets

Baseline recruitment

Adolescents 13 to 17 years old inclusive treated in the ED were eligible for the study if they had evidence of alcohol in blood, breath, or saliva (N = 142), or if they reported drinking alcohol in the 6 hours before the injury that required treatment in the ED (N = 10). Patients who were suicidal, were in police custody, did not speak English, or had suffered serious traumatic injury requiring admission were excluded. The study was described to 287 eligible patients, but 134 (47%) declined to

SC condition

This condition was designed to be consistent with general medical practice guidelines for treating alcohol-involved adolescents in an ED setting. Research interventionist contact with physicians was minimal. SC took approximately 5 minutes and included brief advice to stop drinking and a handout on avoiding drinking and driving.

MI condition

The MI protocol included the following 6 components: (1) emphasis on personal responsibility for change and that any decisions made about changing their drinking would

Preliminary analyses

Participants (N = 152) were not significantly different in sex or age from the 134 families approached who did not agree to participate. Further analyses comparing the two conditions (MI vs SC) on demographic variables are presented in Table I. There were no significant differences on any variables including BAC; MI (M = 149.8 mg/dL, SD = 82.5) or SC (M = 129.0 mg/dL, SD = 78.8). There were also no differences at baseline on alcohol measures (Table II). Of the driving age subjects, there was no

Discussion

The major clinical finding of this study was that those who screened positive for potential alcohol problems on the ADI at baseline had significantly lower average number of drinking days per month and high-volume drinking days if they received an MI rather than SC. There was no effect on frequency of intoxication or negative alcohol-related consequences. Nonetheless, the positive effects appear clinically significant with average number of drinking days per month about 4 in the MI group

Acknowledgements

Sincere appreciation is expressed to Cheryl Eaton, MA, for her assistance in data analyses, and William Miller, PhD, and Steven Rollnick, PhD, for training and feedback on this project's Motivational Interviewing protocol.

References (18)

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Supported by grant number AA09892 from the National Institute on Alcohol Abuse and Alcoholism.

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