Screening and brief interventions for adolescent alcohol use disorders presenting through emergency departments: a research programme including two RCTs
Background: Alcohol consumption and related harm increase steeply from the ages of 12–20 years. Adolescents in the UK are among the heaviest drinkers in Europe. Excessive drinking in adolescents is associated with increased risk of accidents, injuries, self-harm, unprotected or regretted sex, violen...
| Main Authors: | , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
NIHR Journals Library
2020-01-01
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| Series: | Programme Grants for Applied Research |
| Subjects: | |
| Online Access: | https://doi.org/10.3310/pgfar08020 |
| _version_ | 1828491773540827136 |
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| author | Paolo Deluca Simon Coulton Mohammed Fasihul Alam Sadie Boniface Kim Donoghue Eilish Gilvarry Eileen Kaner Ellen Lynch Ian Maconochie Paul McArdle Ruth McGovern Dorothy Newbury-Birch Robert Patton Tracy Pellatt-Higgins Ceri Phillips Thomas Phillips Rhys Pockett Ian T Russell John Strang Colin Drummond |
| author_facet | Paolo Deluca Simon Coulton Mohammed Fasihul Alam Sadie Boniface Kim Donoghue Eilish Gilvarry Eileen Kaner Ellen Lynch Ian Maconochie Paul McArdle Ruth McGovern Dorothy Newbury-Birch Robert Patton Tracy Pellatt-Higgins Ceri Phillips Thomas Phillips Rhys Pockett Ian T Russell John Strang Colin Drummond |
| author_sort | Paolo Deluca |
| collection | DOAJ |
| description | Background: Alcohol consumption and related harm increase steeply from the ages of 12–20 years. Adolescents in the UK are among the heaviest drinkers in Europe. Excessive drinking in adolescents is associated with increased risk of accidents, injuries, self-harm, unprotected or regretted sex, violence and disorder, poisoning and accidental death. However, there is lack of clear evidence for the most clinically effective and cost-effective screening and brief interventions for reducing or preventing alcohol consumption in adolescents attending emergency departments (EDs). Objectives: To estimate the distribution of alcohol consumption, alcohol-related problems and alcohol use disorders in adolescents attending EDs; to develop age-appropriate alcohol screening and brief intervention tools; and to evaluate the clinical effectiveness and cost-effectiveness of these interventions. Design: The research has been conducted in three linked stages: (1) a prevalence study, (2) intervention development and (3) two linked randomised controlled trials (RCTs). Setting: Twelve EDs in England (London, North East, and Yorkshire and The Humber). Participants: A total of 5376 participants in the prevalence study [mean age 13.0 years, standard deviation (SD) 2.0 years; 46.2% female] and 1640 participants in the two linked RCTs (mean age 15.6 years, SD 1.0 years; 50.7% female). 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. Main outcome measures: Total alcohol consumed in standard UK units (1 unit = 8 g of ethanol) over the previous 3 months at 12-month follow-up, assessed using the Alcohol Use Disorders Identification Test, Consumption (3 items) (AUDIT-C). Results: In the prevalence study, 2112 participants (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 the age of 17 years. The prevalence of at-risk alcohol consumption was 15% [95% confidence interval (CI) 14% to 16%] and the optimum cut-off point of the AUDIT-C in identifying at-risk drinking was ≥ 3. 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 0.57 (95% CI –0.36 to 1.70) for PFBA and 0.19 (95% CI –0.71 to 1.30) for eBI. In the low-risk drinking trial, the mean difference compared with control was 0.03 (95% CI –0.07 to 0.13) for PFBA and 0.01 (95% CI –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- to 17-year-olds attending EDs. Limitations and future work: Only one-third of participants engaged with the application program; this is likely to have limited the effect of the intervention. We recommend that future research should focus on methods to maximise engagement with digital interventions and evaluate the effect of such engagement on clinical outcomes. Trial registration: Current Controlled Trials ISRCTN45300218. Funding: This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 8, No. 2. See the NIHR Journals Library website for further project information. |
| first_indexed | 2024-12-11T11:08:41Z |
| format | Article |
| id | doaj.art-1cdfdc9a00604db4a42776e712ed128d |
| institution | Directory Open Access Journal |
| issn | 2050-4322 2050-4330 |
| language | English |
| last_indexed | 2024-12-11T11:08:41Z |
| publishDate | 2020-01-01 |
| publisher | NIHR Journals Library |
| record_format | Article |
| series | Programme Grants for Applied Research |
| spelling | doaj.art-1cdfdc9a00604db4a42776e712ed128d2022-12-22T01:09:37ZengNIHR Journals LibraryProgramme Grants for Applied Research2050-43222050-43302020-01-018210.3310/pgfar08020RP-PG-0609-10162Screening and brief interventions for adolescent alcohol use disorders presenting through emergency departments: a research programme including two RCTsPaolo Deluca0Simon Coulton1Mohammed Fasihul Alam2Sadie Boniface3Kim Donoghue4Eilish Gilvarry5Eileen Kaner6Ellen Lynch7Ian Maconochie8Paul McArdle9Ruth McGovern10Dorothy Newbury-Birch11Robert Patton12Tracy Pellatt-Higgins13Ceri Phillips14Thomas Phillips15Rhys Pockett16Ian T Russell17John Strang18Colin Drummond19Addictions Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UKCentre for Health Services Studies, University of Kent, Canterbury, UKDepartment of Public Health, College of Health Sciences, Qatar University, QatarAddictions Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UKAddictions Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UKNorthumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UKInstitute of Health and Society, Newcastle University, Newcastle upon Tyne, UKInstitute of Health and Society, Newcastle University, Newcastle upon Tyne, UKPaediatric Emergency Medicine, Imperial College London, London, UKNorthumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UKInstitute of Health and Society, Newcastle University, Newcastle upon Tyne, UKSchool of Health and Social Care, Teesside University, Middlesbrough, UKSchool of Psychology, University of Surrey, Guildford, UKCentre for Health Services Studies, University of Kent, Canterbury, UKSwansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UKAddictions Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UKSwansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UKMedical School, Swansea University, Swansea, UKAddictions Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UKAddictions Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UKBackground: Alcohol consumption and related harm increase steeply from the ages of 12–20 years. Adolescents in the UK are among the heaviest drinkers in Europe. Excessive drinking in adolescents is associated with increased risk of accidents, injuries, self-harm, unprotected or regretted sex, violence and disorder, poisoning and accidental death. However, there is lack of clear evidence for the most clinically effective and cost-effective screening and brief interventions for reducing or preventing alcohol consumption in adolescents attending emergency departments (EDs). Objectives: To estimate the distribution of alcohol consumption, alcohol-related problems and alcohol use disorders in adolescents attending EDs; to develop age-appropriate alcohol screening and brief intervention tools; and to evaluate the clinical effectiveness and cost-effectiveness of these interventions. Design: The research has been conducted in three linked stages: (1) a prevalence study, (2) intervention development and (3) two linked randomised controlled trials (RCTs). Setting: Twelve EDs in England (London, North East, and Yorkshire and The Humber). Participants: A total of 5376 participants in the prevalence study [mean age 13.0 years, standard deviation (SD) 2.0 years; 46.2% female] and 1640 participants in the two linked RCTs (mean age 15.6 years, SD 1.0 years; 50.7% female). 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. Main outcome measures: Total alcohol consumed in standard UK units (1 unit = 8 g of ethanol) over the previous 3 months at 12-month follow-up, assessed using the Alcohol Use Disorders Identification Test, Consumption (3 items) (AUDIT-C). Results: In the prevalence study, 2112 participants (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 the age of 17 years. The prevalence of at-risk alcohol consumption was 15% [95% confidence interval (CI) 14% to 16%] and the optimum cut-off point of the AUDIT-C in identifying at-risk drinking was ≥ 3. 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 0.57 (95% CI –0.36 to 1.70) for PFBA and 0.19 (95% CI –0.71 to 1.30) for eBI. In the low-risk drinking trial, the mean difference compared with control was 0.03 (95% CI –0.07 to 0.13) for PFBA and 0.01 (95% CI –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- to 17-year-olds attending EDs. Limitations and future work: Only one-third of participants engaged with the application program; this is likely to have limited the effect of the intervention. We recommend that future research should focus on methods to maximise engagement with digital interventions and evaluate the effect of such engagement on clinical outcomes. Trial registration: Current Controlled Trials ISRCTN45300218. Funding: This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 8, No. 2. See the NIHR Journals Library website for further project information.https://doi.org/10.3310/pgfar08020alcoholbrief interventionelectronic brief interventionalcohol screeningadolescentemergency departmenteffectivenesscost-effectiveness |
| spellingShingle | Paolo Deluca Simon Coulton Mohammed Fasihul Alam Sadie Boniface Kim Donoghue Eilish Gilvarry Eileen Kaner Ellen Lynch Ian Maconochie Paul McArdle Ruth McGovern Dorothy Newbury-Birch Robert Patton Tracy Pellatt-Higgins Ceri Phillips Thomas Phillips Rhys Pockett Ian T Russell John Strang Colin Drummond Screening and brief interventions for adolescent alcohol use disorders presenting through emergency departments: a research programme including two RCTs Programme Grants for Applied Research alcohol brief intervention electronic brief intervention alcohol screening adolescent emergency department effectiveness cost-effectiveness |
| title | Screening and brief interventions for adolescent alcohol use disorders presenting through emergency departments: a research programme including two RCTs |
| title_full | Screening and brief interventions for adolescent alcohol use disorders presenting through emergency departments: a research programme including two RCTs |
| title_fullStr | Screening and brief interventions for adolescent alcohol use disorders presenting through emergency departments: a research programme including two RCTs |
| title_full_unstemmed | Screening and brief interventions for adolescent alcohol use disorders presenting through emergency departments: a research programme including two RCTs |
| title_short | Screening and brief interventions for adolescent alcohol use disorders presenting through emergency departments: a research programme including two RCTs |
| title_sort | screening and brief interventions for adolescent alcohol use disorders presenting through emergency departments a research programme including two rcts |
| topic | alcohol brief intervention electronic brief intervention alcohol screening adolescent emergency department effectiveness cost-effectiveness |
| url | https://doi.org/10.3310/pgfar08020 |
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