ER counseling on alcohol helps teens stop drinking/reckless behavior

Teens counseled in the emergency room have fewer subsequent drinking and driving incidents, alcohol-related injuries and other alcohol-related problems than teens who received standard ER care, according to a new Brown University study in the Journal of Consulting and Clinical Psychology.

PROVIDENCE, R.I. — Teens do much less harm to themselves and others after receiving brief counseling in the emergency room, says a new study of 94 young people, ages 18-19.

“The message is that we can effectively intervene in a 45-minute session and show a reduction in harm,” said study leader Peter Monti, associate director of the Brown University Center for Alcohol and Addiction Studies and professor in the Brown University School of Medicine. “After all, reducing harm is ultimately what counts.”

After six months, counseled teens had 32 percent fewer drinking and driving incidents, 50 percent fewer alcohol-related injuries, and many fewer alcohol-related problems, such as scrapes with friends, compared to those who had received standard treatment.

Motor vehicle records showed that counseled patients were much less likely to have a moving violation in the six months after treatment compared to standard-care patients. Overall, the researchers found that teens in both groups drank less.

“Alcohol-related reductions in both groups are due somewhat to the fact that the emergency room is a setting that maximizes a teachable moment in these kids’ lives,” Monti said. “This is a captive audience facing consequences. Attention from the counselors was important to the kids. Frequently, adults sweep the fact of teen drinking under the rug.”

Teens in the study were approached in the emergency room after being treated for mild to extreme intoxication or for injuries from an alcohol-related incident such as a car accident. The teens received standard emergency room treatment or 45 minutes of counseling. Standard treatment included an assessment of drinking behavior, list of alcohol treatment centers, and a handout on drinking and driving.

The counseling session was designed to be motivational, focusing on the harmful and risky effects of drinking. Counseling consisted of a review of the circumstances, open-ended discussion of the pros and cons of alcohol use, and the weighing of these advantages and disadvantages. Teens also received input on how they compared to peers in terms of drinking behavior, including teens entering treatment for alcohol addiction.

“We don’t tell teens what to do, but ask them how they would like things to be different,” said Suzanne Colby, study author and assistant professor of psychiatry and human behavior. “They generate ideas on how to change behavior. Together we strategize on how that might be accomplished. If people come up with their goals, they’re more likely to follow through.”

Teens who received the motivational intervention were given the same handouts as those in standard care, as well as information about the effects of alcohol on driving, and a personalized feedback sheet. All teens in the study received follow-up interviews at three and six months.

Two study authors, Robert Woolard, M.D., associate professor of medicine, and William Lewander, M.D., associate professor of pediatrics, run emergency rooms at Hasbro Children’s Hospital and Rhode Island Hospital, where the study took place. The physicians drove the message home to their own staffs that emergency rooms are perfect settings for reaching young people who need help.

“On average, these are teens at a much higher risk for alcohol-related problems,” Colby said. “It’s hard to do such an intervention in a high school where young people you target may be stigmatized for being labeled at risk. If you go into the emergency room and a teen comes in via an alcohol-related event, you can be confident that you are reaching a population at risk.

“If you speak with college students or young people in the workplace about alcohol abuse, the message will likely fall on deaf ears, because few are cognizant of the negative effects of their drinking,” Colby continued. “But if you catch young people in the middle of a negative experience caused by alcohol use, you can have an impact.”

The counseling is easy to learn and something social workers can be trained to do in hospitals, or counselors at colleges and school nurses at elementary and junior high, Colby said.

“Our intent is to be able to train other people to do this intervention,” Monti said. “We would like to see these types of protocols in emergency rooms across the country.”

The study has some limitations. For example, many potential patients approached to participate refused, as they’d already received medical care and wanted to leave the hospital. The research appears in the December issue of the Journal of Consulting and Clinical Psychology. The National Institute on Alcohol Abuse and Alcoholism funded it.

See also Dr. David Lewis’ op-ed on treatment and punishment options for juvenile substance abusers. Lewis is project director of the Physician Leadership on National Drug Policy (PLNDP).