Alcohol Interventions Among Underage Drinkers in the ED: A Randomized Controlled Trial.
OBJECTIVE
This study examined the efficacy of emergency department (ED)-based brief interventions (BIs), delivered by a computer or therapist, with and without a post-ED session, on alcohol consumption and consequences over 12 months.


METHODS
Patients (ages 14-20 years) screening positive for risky drinking were randomized to: BI (n = 277), therapist BI (n = 278), or control (n = 281). After the 3-month follow-up, participants were randomized to receive a post-ED BI session or control. Incorporating motivational interviewing, the BIs addressed alcohol consumption and consequences, including driving under the influence (DUI), and alcohol-related injury, as well as other concomitant drug use. The computer BI was an offline, Facebook-styled program.


RESULTS
Among 4389 patients screened, 1054 patients reported risky drinking and 836 were enrolled in the randomized controlled trial. Regression models examined the main effects of the intervention conditions (versus control) and the interaction effects (ED condition × post-ED condition) on primary outcomes. The therapist and computer BIs significantly reduced consumption at 3 months, consequences at 3 and 12 months, and prescription drug use at 12 months; the computer BI reduced the frequency of DUI at 12 months; and the therapist BI reduced the frequency of alcohol-related injury at 12 months. The post-ED session reduced alcohol consequences at 6 months, benefiting those who had not received a BI in the ED.


CONCLUSIONS
A single-session BI, delivered by a computer or therapist in the ED, shows promise for underage drinkers. Findings for the fully automated stand-alone computer BI are particularly appealing given the ease of future implementation.
University of Michigan Injury Center, University of Michigan Medical School, Ann Arbor, Michigan; Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan; Department of Health Behavior and Health Education and Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; stroh@med.umich.edu.
Rebecca M
RM
Cunningham
University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, Michigan; Center for Clinical Management Research, Ann Arbor, Veterans Affairs Healthcare System, Department of Veterans Affairs, Ann Arbor, Michigan;
Stephen T
ST
Chermack
University of Michigan Injury Center, University of Michigan Medical School, Ann Arbor, Michigan; Department of Surgery, Section of Pediatric Surgery, CS Mott Children's Hospital, University of Michigan School of Medicine, Ann Arbor, Michigan.
Peter F
PF
Ehrlich
University of Michigan Injury Center, University of Michigan Medical School, Ann Arbor, Michigan; Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan; Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, Michigan;
Patrick M
PM
Carter
Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas; and.
Brenda M
BM
Booth
University of Michigan Injury Center, University of Michigan Medical School, Ann Arbor, Michigan; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan; University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, Michigan; Center for Clinical Management Research, Ann Arbor, Veterans Affairs Healthcare System, Department of Veterans Affairs, Ann Arbor, Michigan;
Frederic C
FC
Blow
University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, Michigan;
Kristen L
KL
Barry
University of Michigan Injury Center, University of Michigan Medical School, Ann Arbor, Michigan; Michigan Youth Violence Prevention Center, University of Michigan School of Public Health, Ann Arbor, Michigan; University of Michigan Addiction Center, Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, Michigan;
Maureen A
MA
Walton
D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D019973:Alcohol-Related Disorders / Q000628:therapy*; D000066448:Driving Under the Influence; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D062405:Motivational Interviewing / Q000379:methods*; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D000066608:Underage Drinking / Q000517:prevention & control*; D055815:Young Adult