Emergency Room Motivational Intervention for Adolescents with Intoxication or Alcohol-Related Injuries

 

Nancy Barnett, Ph.D., Brown University

This project was a randomized controlled trial with adolescents ages 13-19 who were treated for intoxication and/or alcohol-related injuries at a Level 1 trauma center in Rhode Island. Following assessment, patients were assigned to receive either a brief Motivational Interview (MI) or standard care (SC). Assessments and intervention were conducted in the Emergency Room during or after the patient's medical treatment. The MI included discussion of pros and cons of drinking and of driving after drinking, normative feedback about alcohol consumption and risk factors, and provision of information and advice about drinking and about drinking and driving. Parents of patients aged 13-17 also received a brief intervention designed to enhance their awareness of adolescent drinking and to plan their response to the episode. Standard care was designed to be consistent with general practice for the treatment of alcohol-involved adolescents in an urgent care setting and included providing a handout on avoiding drinking and driving and a referral list of local mental health agencies.

Older adolescents (ages 18-19) responded very well to MI. Six months after their ER visit these patients had fewer alcohol-related injuries, fewer alcohol-related problems, less driving after drinking, and fewer traffic violations than patients in the SC condition (Monti et al., in press). At one year follow-up the group differences on alcohol-related injuries and alcohol problems were maintained. There was a significant reduction in alcohol consumption from baseline to 3 months, but no group differences in alcohol consumption at any follow-up time point (Monti et al., 1999).

Results for the 13-17 year old group of patients (N = 149) show that drinking, drunkenness, and marijuana use declined from baseline to 3 months for both groups, and at 3 months there were additional harm-reduction effects in the MI group in the form of less drinking and driving (drivers only) and fewer alcohol-related injuries. Preliminary (i.e., not the whole sample) one-year follow-up results show the reductions in alcohol use and the group difference on drinking and driving are maintained (Colby et al., 1999).

Summary and future directions: Apparently the MI developed for use in the ER on this project was effective in reducing harm associated with drinking among older adolescents. Younger adolescents may have shown a different pattern of results due to higher level of attention given to them by medical staff (thereby raising the standard of care), lower baseline rates of drinking, or a possible greater response to the precipitating event itself. The next phase of this project will study young adult ER patients (ages 18-24) who are either being treated for an alcohol-related event or are problem drinkers (based on AUDIT score). This project will compare a brief MI plus two booster sessions to a feedback only condition in which patients will receive interpretive feedback about their alcohol consumption and risks in written format.

For more information please contact Nancy P. Barnett, Ph.D., Project Director, Nancy_Barnett@brown.edu

References

Colby, S. M., Monti, P. M., Barnett, N. P., Rohsenow, D. J., Spirito, A., Woolard, R., Myers, M., & Lewander, W. (June, 1999). Motivational interviewing for alcohol-related emergencies: Outcome for 13-17 year olds. In R. Longabaugh and P. M. Monti (Chairs), Brief Motivational Interventions in the Emergency Department for Adolescents and Adults. Symposium conducted at the annual meeting of the Research Society on Alcoholism, Santa Barbara, CA.

Monti, P. M., Colby, S. M., Barnett, N. P., Spirito, A., Rohsenow, D. J., Myers, M., Woolard, R., & Lewander, W. (in press). Brief intervention for harm reduction with alcohol-positive older adolescents in a hospital Emergency Department. Journal of Consulting and Clinical Psychology.

Monti, P. M., Colby, S. M., Barnett, N. P., Rohsenow, D. J., Spirito, A., Woolard, R., Myers, M., & Lewander, W. (June, 1999). Brief intervention for harm reduction with alcohol-positive older adolescents in a hospital Emergency Room. In R. Longabaugh and P. M. Monti (Chairs), Brief Motivational Interventions in the Emergency Department for Adolescents and Adults. Symposium conducted at the annual meeting of the Research Society on Alcoholism, Santa Barbara, CA.

In cooperation with the Motivational Interviewing Network of Trainers (MINT), William R. Miller, Ph.D., and Stephen Rollnick, Ph.D. 

Revised 1/03