[psychiatry-research] ER counseling on alcohol helps teens stop drinking/reckless behavior
- FOR RELEASE: 1 DECEMBER 1999 AT 00:00 ET US
ER counseling on alcohol helps teens stop drinking/reckless behavior
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
"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 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.