Study supports efficacy of brief intervention in reducing alcohol use, violence among adolescents

Brief interventions among adolescents reporting to emergency departments may be associated with a reduction in the experience of peer violence and alcohol misuse in this population, according to a study in the August 4 issue of JAMA, a theme issue on violence and human rights.

"The emergency department is an important contact point for medical care for adolescents, especially underinsured or uninsured patients," the authors note as background to the study. "Adolescents seeking care in the emergency department are an important population for injury prevention based on increased risk of problems related to alcohol and violence."

Between September 2006 and September 2009, Maureen A. Walton, M.P.H., Ph.D., of the University of Michigan, Ann Arbor, and colleagues studied 726 adolescents age 14 to 18 who reported to a level I emergency department in Flint, Mich. between 12 p.m. and 11 p.m. All patients participated in a computerized assessment and were then randomly placed into three groups: a control group receiving a brochure, or one of two receiving a 35-minute brief intervention delivered by either a computer or therapist in the emergency department, followed by assessments at three and six months. "Combining motivational interviewing with skills training, the brief intervention for violence and alcohol included a review of goals, tailored feedback, decisional balance exercise, role plays and referrals."

Compared with adolescents in the control group, those in the therapist intervention showed self-reported reductions in the occurrence of peer aggression, experience of peer violence and violence consequences at three months. Additionally, participants in the therapist intervention decreased the number of violence consequences at the three-month mark compared with those in the control group.

Participants in the therapist intervention reported higher reductions in alcohol consequences at the six-month review than those in the control group, and participants in the computer intervention also reported reductions in alcohol consequences. "Given that a leading cause of mortality and morbidity in this age group is violence, the reduction in the occurrence of severe violence following a single-session brief intervention is clinically meaningful," the authors note.

"…findings support the efficacy of a therapist brief intervention (with computerized feedback and structure) in decreasing the occurrence of experiencing peer violence in the three months following an emergency department visit," the authors conclude. "Computerized approaches could assist in translating research findings into routine clinical practice by standardizing intervention delivery and have wide applicability across other content areas and settings."

"Violence and alcohol use are risk factors for the three leading causes of death among individuals aged 12 to 20 years: unintentional injuries, homicide and suicide. Thus, the devastating health effects of alcohol and violence on youth lead to an appropriately overwhelming desire to intervene in clinical practice," write Richard Saitz, M.D., M.P.H., and Timothy Naimi, M.D., M.P.H., of Boston Medical Center and Boston University School of Medicine, in an accompanying editorial.

"Brief counseling could be an answer," they write. However, little evidence supports its use for either alcohol or violence. "Despite the lack of evidence for the effectiveness of interventions to reduce alcohol use and violence separately, it does seem logical to address these risky behaviors together, because they so often co-occur. This was the approach taken by Walton et al in this issue of JAMA."

"Overall, positive results were noted for few outcomes, effect sizes were small and none of the observed three-month benefits were sustained at six months," they continue. "Even a modest benefit of a relatively inexpensive intervention for common health problems might be worth pursuing on a large scale. However, there are barriers to the widespread implementation of screening and brief intervention programs in clinical settings."

"The most proven and effective method to reduce youth drinking, and likely alcohol-related violence, is to implement population-based strategies such as raising alcohol excise taxes and enforcing minimum legal drinking age laws. These strategies have been neglected."