Differential Effectiveness of a Brief Motivational Intervention for Alcohol Intoxicated Children and Adolescents in the Emergency Department

Background. Brief interventions (BI) in the emergency department (ED) provide an
opportunity to motivate children and adolescents with risky alcohol use to reduce consumption. However, evidence of effectiveness of this approach is inconclusive. Against the theoretical background of motivational interviewing and the dual process framework of adolescent risk behaviour, this cumulative dissertation examined effectiveness and differential effectiveness of a
brief motivational intervention (BMI) delivered in the presumed teachable moment potentially associated with medical treatment as a result of an acute alcohol intoxication (AAI).
Method. The methodological, conceptual, and empirical background for investigation of this research question were elaborated in a study protocol for a randomized controlled trial (RCT) testing the effectiveness of this approach, a systematic review on effectiveness of alcohol BIs for adolescent ED patients and an intervention manual for the delivery of a BMI for children and adolescents following an AAI. Characteristics of the target population with regard to habitual
drinking and associated psychosocial problems were investigated using latent class analysis. Effectiveness of the BMI was tested in a RCT against treatment as usual (TAU), which comprised an information leaflet on alcohol-associated risks. Patient variables, counsellor variables and intervention content were examined as potential moderators of Intervention effectiveness.
Results. N = 316 ED patients aged 12 to 17 years participated in the RCT. Latent class analysis of habitual drinking identified 5 distinct classes with 61.2% habitually consuming at low-risk. At-risk and high-risk drinking classes showed heterogeneous patterns of habitual drinking with high-risk drinking being most strongly associated with psychosocial problems. Mixed-effects analysis of covariance of data from the RCT revealed that participants who received the BMI
did not reduce alcohol consumption and alcohol-related problems statistically significant stronger than participants who received TAU. Among the potential moderators analysed, multiple regression analyses revealed that perceived counsellors' positive affirmation was associated with greater readiness to change alcohol use after the BMI as was younger age of study participants and finishing the BMI with a goal setting agreement.
Conclusion. Superiority of the BMI over TAU in reducing alcohol consumption and related problems in adolescent AAI patients was not found in this study. However, analysis of habitual drinking and moderator analyses hold implications for further developments of the BMI in order to potentially enhance effectiveness of support for this target population.