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Screening and brief interventions for adolescent alcohol use disorders presenting through emergency departments: a research programme including two RCTs
Programme Grants for Applied Research, Volume: 8, Issue: 2, Pages: 1 - 144
Swansea University Authors: Ceri Phillips, Rhys Pockett , Ian Russell
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DOI (Published version): 10.3310/pgfar08020
Background: Alcohol consumption and related harm increase steeply from the ages of 12 to 20 years. Adolescents in the UK are amongst the heaviest drinkers in Europe. Excessive drinking in adolescents is associated with increased risk of accidents, injuries, self-harm, unprotected and regretted sex,...
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Background: Alcohol consumption and related harm increase steeply from the ages of 12 to 20 years. Adolescents in the UK are amongst the heaviest drinkers in Europe. Excessive drinking in adolescents is associated with increased risk of accidents, injuries, self-harm, unprotected and regretted sex, violence and disorder, poisoning and accidental death. However, there is lack of clear evidence for the most effective and cost-effective screening and brief interventions for reducing or preventing alcohol consumption in adolescents attending emergency departments (ED).Objectives: To estimate the distribution of alcohol consumption, alcohol-related problems, and alcohol use disorders in adolescents attending ED; to develop age appropriate alcohol screening and brief intervention tools; to evaluate the effectiveness and cost-effectiveness of these interventions.Design: The research has been conducted in three linked stages: 1) prevalence study; 2) interventions development; 3) two linked randomised clinical trials (RCT).Setting: 12 EDs in England (London, North East, Yorkshire and The Humber).Participants: A total of 5,376 participants in the prevalence study (mean age 13.0, SD 2.0, 46.2% female) and 1,640 in the two linked RCTs (mean age 15.6 SD 1.0; 50.7% female).RCT Interventions: Personalised Feedback and Brief Advice (PFBA) and Personalised Feedback plus electronic Brief Intervention (eBI) compared with alcohol screening alone. These age-appropriate alcohol interventions were developed in collaboration with the target audience through a series of focus groups and evaluations during stage 2 of the research programme and following two literature reviews. .RCT Main outcome measures: Total alcohol consumed in standard UK units (1 unit = 8g ethanol) over the past 3 months at 12-month follow-up, assessed using the Alcohol Use Disorders Identification Test – Consumption version (AUDIT-C).Results: In the prevalence study 2,112 (39.5%) reported having had a drink of alcohol that was more than a sip in their lifetime, with prevalence increasing steadily with age and reaching 89.5% at 17. The prevalence of at-risk alcohol consumption was 15% (95% CI 14 – 16) and the optimum cut-off point of the AUDIT-C in identifying at-risk drinking was 3 or more. Associations of alcohol consumption and early onset of drinking with poorer health and social functioning were also found.In the RCT the analysis of the primary outcome (average weekly alcohol consumption at month 12) identified no significant differences in effect between the three groups in both trials. In the high-risk drinking trial the mean difference compared with control was 0.09 (-0.01 to 0.23) for PFBA and 0.03 (-0.12 to 0.18) for eBI. In the low-risk drinking trial the mean difference compared with control was 0.03 (-0.07 to 0.13) for PFBA and 0.01 (-0.10 to 0.11) for eBI. The health economic analysis showed that eBI and PFBA were not more cost effective than screening alone.Conclusions: The ED can offer an opportunity for the identification of at-risk alcohol use in adolescents. A simple, short, self-completed screening instrument, the AUDIT-C, is an effective tool for identifying adolescents who are at risk of alcohol related problems. Associations of alcohol consumption and earlier onset of drinking with poorer health and social functioning were observed in the prevalence study.The trials were feasible to implement and exceeded the recruitment target and minimum follow up rates. However, PFBA and eBI were not found to be more effective than screening alone in reducing or preventing alcohol consumption in 14-17-year-olds attending ED.
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