A brief motivational interview in a pediatric emergency department, plus 10-day telephone follow-up, increases attempts to quit drinking among youth and young adults who screen positive for problematic drinking
Open accessAbstract
ACADEMIC EMERGENCY MEDICINE 2010; 17:890–902 © 2010 by the Society for Academic Emergency Medicine Objectives: Adolescents in their late teens and early 20s have the highest alcohol consumption in the United States; binge drinking peaks at age 21‐25 years. Underage drinking is associated with many negative consequences, including academic problems and risk of intentional and unintentional injuries. This study tested the effectiveness of pediatric emergency department (PED) screening and brief intervention to reduce alcohol consumption and associated risks. Methods: A three‐group randomized assignment trial was structured to test differences between intervention (I) and standard assessed control (AC) groups in alcohol consumption and alcohol‐related behaviors from baseline to 12 months and to compare the AC group with a minimally assessed control (MAC) group to adjust for the effect of assessment reactivity on control group behavior. Patients aged 14–21 years were eligible if they screened positive on the Alcohol Use Disorders Identification Test (AUDIT) or for binge drinking or high‐risk behaviors. The MAC group received a resource handout, written advice about alcohol‐related risks, and a 12‐month follow‐up appointment. Patients in the AC group were assessed using standardized instruments in addition to the MAC protocol. The I group received a peer‐conducted motivational intervention, referral to community resources and treatment if indicated, and a 10‐day booster in addition to assessment. Measurements included 30‐day self‐report of alcohol consumption and alcohol‐related behaviors, screens for depression and posttraumatic stress disorder, and self‐report of attempts to quit, cut back, or change conditions of use, all repeated at follow‐up. Motor vehicle records and medical records were also analyzed for changes from baseline to 1‐year follow‐up. Results: Among 7,807 PED patients screened, 1,202 were eligible; 853 enrolled (I, n = 283; AC, n = 284; MAC, n = 286), with a 12‐month follow‐up rate of 72%. At 12 months, more than half of enrollees in Reaching Adolescents for Prevention (RAP) attempted to cut back on drinking, and over a third tried to quit. A significantly larger proportion of the I group made efforts to quit drinking and to be careful about situations when drinking compared to AC enrollees, and there was a numerically but not significantly greater likelihood (p = 0.065) among the I group for efforts to cut back on drinking. At 3 months, the likelihood of the I group making attempts to cut back was almost triple that of ACs. For efforts to quit, it was double, and for trying to be careful about situations when drinking, there was a 72% increase in the odds ratio (OR) for the I group. Three‐month results for attempts were sustained at 12 months for quit attempts and efforts to be careful. Consumption declined in both groups from baseline to 3 months to 12 months, but there were no significant between‐group differences in alcohol‐related consequences at 12 months or in alcohol‐related risk behaviors. We found a pattern suggestive of assessment reactivity in only one variable at 12 months: the attempt to cut back (73.3% for the I group vs. 64.9% among the AC group and 54.8% among the MAC group). Conclusions: Brief motivational intervention resulted in significant efforts to change behavior (quit drinking and be careful about situations while drinking) but did not alter between‐group consumption or consequences.
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Bernstein 2010 did not use intention-to-treat analysis.
“ITT: no.”
From Effectiveness of brief alcohol interventions in primary care populations (2018) · cites this paper as Bernstein 2010
The Outcomes Analysis section describes the primary comparisons but does not identify them as intention-to-treat analyses; the Results section reports only 72% follow-up at 12 months. However, the Sensitivity Analysis includes participants lost to follow-up by counting them as having made no quit attempt. Thus, 'ITT: no' may describe the primary analysis, but it overlooks an analysis that accounts for all enrollees. (LLM, conf=0.78)
Experimental — accuracy not yet measuredBernstein 2010 had unclear risk of bias for blinding of treatment providers.
“Blinding of treatment providers Unclear risk Appears that peer educators who delivered the intervention only saw intervention participants but this is not clear”
From Effectiveness of brief alcohol interventions in primary care populations (2018) · cites this paper as Bernstein 2010
The Procedures section (page not available) says peer educators delivered the intervention to the intervention group, and the Study Protocol section says research assistants who performed assessments were blinded. The paper does not say whether peer educators also saw control participants or explicitly rate the risk of bias for provider blinding; the cited assessment is therefore only partly grounded in its account. (LLM, conf=0.78)
Experimental — accuracy not yet measuredBernstein 2010 had unclear risk of bias for incomplete outcome data.
“Incomplete outcome data (attrition bias) All outcomes Unclear risk Loss to follow-up reported, but reasons not given.”
From Effectiveness of brief alcohol interventions in primary care populations (2018) · cites this paper as Bernstein 2010
The Results section (page not available) reports 70% follow-up at 3 months and 72% at 12 months, and the Sensitivity Analysis describes attrition as considerable. These passages support the reported loss to follow-up, but the paper does not itself assign an ‘unclear risk’ rating for incomplete outcome data; that is the citing authors’ assessment. (LLM, conf=0.82)
Experimental — accuracy not yet measuredBernstein 2010 had high risk of bias for selective reporting.
“Selective reporting (reporting bias) High risk Abstinence was recorded as first primary outcome, but this was not reported in results”
From Effectiveness of brief alcohol interventions in primary care populations (2018) · cites this paper as Bernstein 2010
The Outcome Measures section lists abstinence at 12 months as a primary outcome. The Consumption and Risk Factors results report other alcohol-consumption measures but do not give an abstinence result in the passages found. The paper does not itself assess selective-reporting bias or assign a high-risk rating; that is the citing authors’ judgment. (LLM, conf=0.83)
Experimental — accuracy not yet measuredIn 14 trials reporting baseline frequency of drinking convertible to days drinking per week, the mean was 2.07 days/week.
“We included 14 trials that reported baseline measures of frequency of drinking which could be converted to days drinking per week; the mean value was 2.07 days/week (Aalto 2000;Bernstein 2010;Cherpitel 2009;Daeppen 2007;Fleming 1997;Fleming 2010;Helstrom 2014;Monti 2007;Noknoy 2010;Rubio 2010;Schaus 2009;Senft 1997;Soderstrom 2007;Spirito 2004).”
From Effectiveness of brief alcohol interventions in primary care populations (2018) · cites this paper as Bernstein 2010
Frequency of drinking in terms of number of days drinking each week or each month was reported by 11 trials at 6 or 12 months.
“Frequency of drinking in terms of number of days drinking each week or each month was reported by 11 trials at 6 or 12 months (Bernstein 2010;Cherpitel 2009;Crawford 2004;Curry 2003;Daeppen 2007;Field 2010;Fleming 2010;Helstrom 2014;Maisto 2001;Senft 1997;Spirito 2004).”
From Effectiveness of brief alcohol interventions in primary care populations (2018) · cites this paper as Bernstein 2010
Of these 51 studies, 27 reported quantity and corresponding standard deviation at 12 months.
“Of these, 27 studies reported quantity and corresponding standard deviation at 12 months (Altisent 1997;Beich 2007;Bernstein 2010;Blow 2006;Córdoba 1998;Crawford 2004;Daeppen 2007;D'Onofrio 2008;D'Onofrio 2012;Drummond 2014;Fleming 1997;Fleming 1999;Fleming 2004;Fleming 2010;Helstrom 2014;Kaner 2013;Lock 2006;Maisto 2001;Richmond 1995;Rubio 2010;Schaus 2009;Scott 1990;Senft 1997;Soderstrom 2007;”
From Effectiveness of brief alcohol interventions in primary care populations (2018) · cites this paper as Bernstein 2010
10 trials compared brief intervention to no or minimal intervention and reported intensity of alcohol consumption in terms of number of drinks per occasion at 12 months.
“We included 10 trials that compared brief intervention to no or minimal intervention and reported intensity of alcohol consumption in terms of number of drinks per occasion at 12 months (Bernstein 2010;Cherpitel 2009;Crawford 2004;Curry 2003;Daeppen 2007;Helstrom 2014;Maisto 2001;Schaus 2009;Senft 1997;Spirito 2004).”
From Effectiveness of brief alcohol interventions in primary care populations (2018) · cites this paper as Bernstein 2010
Three trials in the primary meta-analysis (1638 participants) recruited only adolescents or young adults.
“Three trials in the primary meta-analysis (1638 participants) recruited only adolescents or young adults (defined as maximum 21 years, 24 years and 25 years in Bernstein 2010; Fleming 2010; Schaus 2009, respectively).”
From Effectiveness of brief alcohol interventions in primary care populations (2018) · cites this paper as Bernstein 2010
10 trials (6386 participants) in the primary meta-analysis took place in an emergency department.
“We included 10 trials (6386 participants) in the primary metaanalysis that took place in an emergency department (Bernstein 2010;Blow 2006;Crawford 2004;D'Onofrio 2008;D'Onofrio 2012;Daeppen 2007;Drummond 2014;Field 2010;Soderstrom 2007;Sommers 2013).”
From Effectiveness of brief alcohol interventions in primary care populations (2018) · cites this paper as Bernstein 2010
Reasons for losses to follow-up were not reported in 18 studies.
“Reasons for losses to followup were not reported in 18 studies (Bernstein 2010;Curry 2003;Daeppen 2007;D'Onofrio 2008;Fleming 2004;L'Engle 2014;Lane 2008;Maisto 2001;McDevitt-Murphy 2014;Mello 2008;Mertens 2014;Monti 2007;Noknoy 2010;Romelsjö 1989;Senft 1997;Spirito 2004;Watson 2013;Woolard 2013).”
From Effectiveness of brief alcohol interventions in primary care populations (2018) · cites this paper as Bernstein 2010
Four trials (6%) were at high risk of reporting bias because some aspect of reporting changed between protocol or methods section and reporting of results.
“We assessed four trials (6%) at high risk of reporting bias because some aspect of reporting changed between protocol or methods section and reporting of results (Babor 2006;Bernstein 2010;Field 2010;Moore 2011).”
From Effectiveness of brief alcohol interventions in primary care populations (2018) · cites this paper as Bernstein 2010
Bernstein 2010 had high risk of bias for blinding of participants.
“Blinding of participants High risk No reported attempt to blind participants.”
From Effectiveness of brief alcohol interventions in primary care populations (2018) · cites this paper as Bernstein 2010
Bernstein 2010 had low risk of bias for blinding of outcome assessment.
“Blinding of outcome assessment (detection bias) All outcomes Low risk”
From Effectiveness of brief alcohol interventions in primary care populations (2018) · cites this paper as Bernstein 2010
Bernstein 2010 had low risk of bias for allocation concealment.
“Allocation concealment (selection bias) Low risk A two-stage assignment was carried out using a double opaque envelope system.The first envelope indicated randomization to either minimal assessment (MAC) or assessed status (I or AC).The second sealed envelope (inside the first) distinguish between assessed controls and those participants eligible for an intervention (AC vs. I) (p.892)”
From Effectiveness of brief alcohol interventions in primary care populations (2018) · cites this paper as Bernstein 2010
Bernstein 2010 had low risk of bias for random sequence generation.
“Random sequence generation (selection bias) Low risk”
From Effectiveness of brief alcohol interventions in primary care populations (2018) · cites this paper as Bernstein 2010
Nine of the 13 trials reported improvement in at least one drinking-related outcome from brief intervention at one or more follow-up points.
“Nine of thirteen studies reported improvements in one or more drinking-related outcomes due to brief intervention at one or more time-points (55,57–59,61–65), and two studies did not examine drinking-related outcomes (56,60).”
Four trials used treatment agency or state administrative records to measure treatment use, while the remaining trials used self-report.
“Four studies used treatment agency or state administrative data to assess treatment utilization (54,56,60,61) and the rest used self-report.”
Trials in emergency departments or with mixed-severity samples had lower post-intervention alcohol treatment use, with 1.9-32.8% of intervention participants receiving treatment.
“In comparison, studies conducted in emergency departments and/or with mixed severity samples had a lower range of post-intervention alcohol treatment utilization (1.9–32.8% in the intervention groups obtained alcohol treatment) (59–63,66).”
In 11 of 13 trials, treatment use meant receiving at least one specialty addiction treatment session; the other two trials counted specialty addiction treatment visits.
“In 11 of 13 studies, the presence of treatment utilization was defined as receiving one or more sessions of specialty addiction treatment (33,54,55,58–65), whereas the remaining two studies analyzed counts of specialty addiction treatment visits (56,57).”
Interventions took place in medical inpatient units, general healthcare settings, and emergency departments.
“Interventions were delivered in medical inpatient units (33,54), general healthcare settings (55–57), and emergency departments (see Table 1) (58–65).”
Most interventions used brief advice or a motivational interview; some added counseling or booster sessions; one had no in-person contact and mailed a letter asking participants to book an appointment with a specialist.
“The majority of interventions involved brief advice or a motivational interview (33,54,58,59,61,62,64–66), several offered additional counseling or booster intervention sessions (55,57,61,66), and one intervention had no in-person contact and simply mailed a letter to participants requesting they make an appointment with a specialist (60).”
Six of the eight trials with referral-specific efforts kept those efforts in the intervention group only, while two gave the same information to the control group.
“In total, six of the eight studies with referral-specific efforts isolated these referral-specific efforts to the intervention group (54,59–63). The other two of studies only provided information about treatment options as the referral-specific effort, but provided the same information to the control group (64,65).”
All eight trials with a referral-specific intervention gave information about community alcohol treatment options, and three described more active efforts to encourage help seeking.
“All of these eight studies provided information about alcohol treatment options in the community (54,59–65), and three of them described more active efforts to encourage help seeking.”
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“Interventions were delivered in medical in-patient units [33,54], general health-care settings [55–57] and emergency departments (see Table 1) [58–65].”
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Screening, Brief Intervention, and Referral for Alcohol Use in Adolescents: A Systematic Review
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Brief Behavioral Interventions for Substance Use in Adolescents: A Meta-analysis
Steele, D. W., Becker, S. J., Danko, K. J., Balk, E. M., Adam, G. P., Saldanha, I. J., & Trikalinos, T. A. (2020) · Pediatrics · doi:10.1542/peds.2020-0351 · Cited by 99 · see citing works
Health care use over 3 years after adolescent SBIRT
Sterling, S., Kline-Simon, A. H., Jones, A., Hartman, L., Saba, K., Weisner, C., & Parthasarathy, S. (2019) · Pediatrics · doi:10.1542/peds.2018-2803 · Cited by 34 · see citing works
Interventions for Substance Use Disorders in Adolescents: A Systematic Review
Steele, D. W., Becker, S. J., Danko, K. J., Balk, E. M., Saldanha, I. J., Adam, G. P., Bagley, S. M., Friedman, C., Spirito, A., Scott, K., et al. (2020) · doi:10.23970/ahrqepccer225 · Cited by 34 · see citing works
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- Authors
- Bernstein, J., Heeren, T., Edward, E., Dorfman, D., Bliss, C., Winter, M., & Bernstein, E.
- Affiliations
- Boston University (US)
- Corresponding author
- Bernstein, Edward
- Venue
- Academic Emergency Medicine
- Publisher
- Wiley
- Published
- 2010-07-29
- Volume
- 17
- Issue
- 8
- Pages
- 890-902
- ISSN
- 1069-6563 (ISSN-L)
- 1553-2712
- PMC
- PMC2913305
- OpenAlex
- W2148767909
- Semantic Scholar
- e9f59d717537f80a27b374cf24d760fdd07d9266
- Cited by
- 120
- References
- 51
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 7 · 2022: 1 · 2020: 4 · 2019: 9 · 2018: 15 · 2017: 12 · 2016: 15 · 2015: 16 · 2014: 10 · 2013: 12 · 2012: 7
- FWCI
- 5.31
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Academic Emergency Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Alcohol Abuse and Alcoholism (P60AA013759)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Health Professions › General Health Professions › Homelessness and Social Issues
- Keywords
- motivational interviewing, screening and brief intervention, adolescent alcohol use, binge drinking, underage drinking, alcohol-related injuries, alcohol-related depression, post-traumatic stress disorder, peer-led intervention, telephone follow-up, emergency department, alcohol use disorder screening, alcohol-related motor vehicle crashes, alcohol-related hospitalizations
- MeSH terms
- Adolescent, Adolescent Behavior, Emergency Service, Hospital, Female, Humans, Interviews as Topic, Male, Motivation, Surveys and Questionnaires, Risk Factors, Telephone, Alcohol-Related Disorders, Directive Counseling, Young Adult
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