A brief therapist-delivered intervention reduces self-reported aggression and alcohol consequences in adolescents who present for emergency care
- Correspondence to Georgiana Wilton
Department of Family Medicine, University of Wisconsin, 1100 Delaplaine Court, Madison, WI 53715, USA;
Scope of the problem
Alcohol use by adolescents is a leading public health problem in the USA resulting in related harms from violence and accidents and in death (eg, homicides, suicides and motor vehicle crashes).1 2 Associated with impaired development,3 adolescents who abuse alcohol oftentimes possess intrapersonal risk factors including aggression, problems with emotional regulation and low-harm avoidance.4
Although intervention for adolescents who abuse alcohol usually involves substance abuse treatment programmes, there is convincing evidence to support immediate brief intervention (BI) for this population in medical settings including emergency departments (EDs) and primary care. BIs are one option and are typically delivered to adolescents in medical settings or school thereby capitalising on a critical window of opportunity and access.5 In fact, the American Academy of Pediatrics includes screening and BI in their guidelines for the healthcare of children.2
Conducting BI in an ED setting
Walton and colleagues explored the efficacy of a BI to address violence and alcohol use among adolescents in an urban ED. The SafERteens randomised controlled trial was conducted with patients aged 14–18 who were seen in the ED of a level 1 trauma centre in Flint, Michigan, USA. Over 3000 adolescent patients were screened, with 829 meeting eligibility criteria (patients who reported both aggression and alcohol consumption in the past year). Consenting teens (n=726) were randomly assigned to one of three groups as follows: a brochure, a session with a counsellor or a computer-based session. The single 30 min intervention was based on the principles of motivational interviewing and was designed with similar content regardless of the mode of administration – counsellor or computer. Both intervention groups utilised tailored feedback for participants. Follow-up was conducted via computer at 3- and 6-month post intervention.
Effects on alcohol consumption and violence between groups were mixed. At the 3-month follow-up, patients who received the intervention by a counsellor were less likely than controls to report severe peer aggression, experience of peer violence and violence consequences (and in fact decreased the number of violence consequences). This effect did not hold up over the 6-month follow-up. However, participants who received either the counsellor or computer-based intervention were less likely to report alcohol-related consequences than controls at 6 months. None of the interventions was successful in reducing the frequency of alcohol consumption.
The authors thus concluded that given the promising results for these critical health and safety issues in adolescents, this study's novel results hold promise for future studies to continue to work to find mechanisms to reduce the experience of violence in teenagers and consequences related to alcohol.
The results of this study are consistent with BI research in clinical settings.5,–,7 Although some studies in the late 1990s did not show much success in reducing alcohol use in this population, many utilised motivational interviewing (MI) techniques that were not adapted for use with adolescents. The current study utilised the principles of MI, and the authors also included education around skills building (conflict resolution skills practice and alcohol refusal) to provide this special population with the necessary tools to continue to work on alcohol and violence concerns.
Admittedly more research is needed in the area of BI as it applies to this special population. This study adds a novel component to our growing body of evidence. The combination of techniques to address co-occurring issues (alcohol use and violence) within one counselling session provides increased alternatives for clinicians. The computerised tablet that assists interventionists in tailoring feedback for immediate use makes this a more user-friendly option for busy health clinics.
The authors addressed several study limitations (non-blinding of participants and limited generalisabilty). For future research, I would review the definitions of binge drinking as it applies to adolescents and take into account the growing body of evidence supporting gender-responsive treatment and health implications. The newer, more accepted definition of binge drinking for females is lower than males (≥4) and may have had some implications on eligibility for this study.
Implications for nursing practice
Alcohol use and abuse and co-occurring violence among adolescents represent significant health risks. Nurses and other clinical personnel are in a unique position to carry out recommendations to screen and intervene with patients at risk. Although additional research is needed to develop appropriate, cost-effective interventions to reduce alcohol use, violence and related harms in adolescents, we should not forget that mechanisms do currently exist to employ evidence-based techniques to reduce these risks now.