title: Brief emergency department interventions for youth who use alcohol and other drugs: a systematic review.
abstract: OBJECTIVE
  Brief intervention (BI) is recommended for use with youth who use alcohol and other drugs. Emergency departments (EDs) can provide BIs at a time directly linked to harmful and hazardous use. The objective of this systematic review was to determine the effectiveness of ED-based BIs.
  
  
  METHODS
  We searched 14 electronic databases, a clinical trial registry, conference proceedings, and study references. We included randomized controlled trials with youth 21 years or younger. Two reviewers independently selected studies and assessed methodological quality. One reviewer extracted and a second verified data. We summarized findings qualitatively.
  
  
  RESULTS
  Two trials with low risk of bias, 2 trials with unclear risk of bias, and 5 trials with high risk of bias were included. Trials evaluated targeted BIs for alcohol-positive (n = 3) and alcohol/other drug-positive youth (n = 1) and universal BIs for youth reporting recent alcohol (n = 4) or cannabis use (n = 1). Few differences were found in favor of ED-based BIs, and variation in outcome measurement and poor study quality precluded firm conclusions for many comparisons. Universal and targeted BIs did not significantly reduce alcohol use more than other care. In one targeted BI trial with high risk of bias, motivational interviewing (MI) that involved parents reduced drinking quantity per occasion and high-volume alcohol use compared with MI that was delivered to youth only. Another trial with high risk of bias reported an increase in abstinence and reduction in physical altercations when youth received peer-delivered universal MI for cannabis use. In 2 trials with unclear risk of bias, MI reduced drinking and driving and alcohol-related injuries after the ED visit. Computer-based MI delivered universally in 1 trial with low risk of bias reduced alcohol-related consequences 6 months after the ED visit.
  
  
  CONCLUSIONS
  Clear benefits of using ED-based BI to reduce alcohol and other drug use and associated injuries or high-risk behaviours remain inconclusive because of variation in assessing outcomes and poor study quality.
authors: Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada. mandi.newton@ualberta.ca
authors: Amanda S
authors: AS
authors: Newton
authors: Kathryn
authors: K
authors: Dong
authors: Neelam
authors: N
authors: Mabood
authors: Nicole
authors: N
authors: Ata
authors: Samina
authors: S
authors: Ali
authors: Rebecca
authors: R
authors: Gokiert
authors: Ben
authors: B
authors: Vandermeer
authors: Lisa
authors: L
authors: Tjosvold
authors: Lisa
authors: L
authors: Hartling
authors: T Cameron
authors: TC
authors: Wild
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D064829:Alcohol Abstinence; D019973:Alcohol-Related Disorders / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D000437:Alcoholism / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D001334:Automobile Driving; D015982:Bias; D002648:Child; D002986:Clinical Trials as Topic; D015897:Comorbidity; D003617:Dangerous Behavior; D016206:Databases, Bibliographic; D004635:Emergency Medicine / Q000379:methods*; D004636:Emergency Service, Hospital; D015340:Epidemiologic Research Design; D006801:Humans; D009042:Motivation; D010342:Patient Acceptance of Health Care; D011614:Psychotherapy, Brief; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D016896:Treatment Outcome; D014754:Violence; D055815:Young Adult