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Screening and brief interventions for adolescent alcohol use disorders presenting through emergency departments: a research programme including two RCTs

Paolo Deluca, Simon Coulton, Mohammed Fasihul Alam, Sadie Boniface, Kim Donoghue, Eilish Gilvarry, Eileen Kaner, Ellen Lynch, Ian Maconochie, Paul McArdle, Ruth McGovern, Dorothy Newbury-Birch, Robert Patton, Tracy Pellatt-Higgins, Ceri Phillips, Thomas Phillips, Rhys Pockett Orcid Logo, Ian Russell Orcid Logo, John Strang, Colin Drummond

Programme Grants for Applied Research, Volume: 8, Issue: 2, Pages: 1 - 144

Swansea University Authors: Ceri Phillips, Rhys Pockett Orcid Logo, Ian Russell Orcid Logo

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DOI (Published version): 10.3310/pgfar08020

Abstract

Background: Alcohol consumption and related harm increase steeply from the ages of 12 to 20 years. Adolescents in the UK are amongst the heaviest drinkers in Europe. Excessive drinking in adolescents is associated with increased risk of accidents, injuries, self-harm, unprotected and regretted sex,...

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Published in: Programme Grants for Applied Research
ISSN: 2050-4322 2050-4330
Published: National Institute for Health Research 2020
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URI: https://cronfa.swan.ac.uk/Record/cronfa49175
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fullrecord <?xml version="1.0"?><rfc1807><datestamp>2021-01-07T16:59:43.2463097</datestamp><bib-version>v2</bib-version><id>49175</id><entry>2019-03-12</entry><title>Screening and brief interventions for adolescent alcohol use disorders presenting through emergency departments: a research programme including two RCTs</title><swanseaauthors><author><sid>932c7a406ab4b6e4a881d422ca03c289</sid><firstname>Ceri</firstname><surname>Phillips</surname><name>Ceri Phillips</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>8a3882ebcc6a8fb3b2c13fc2ff716bf2</sid><ORCID>0000-0003-4135-7383</ORCID><firstname>Rhys</firstname><surname>Pockett</surname><name>Rhys Pockett</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>07f8ce1304fdfe94981330301c2b3977</sid><ORCID>0000-0002-0069-479X</ORCID><firstname>Ian</firstname><surname>Russell</surname><name>Ian Russell</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2019-03-12</date><deptcode>FGMHL</deptcode><abstract>Background: Alcohol consumption and related harm increase steeply from the ages of 12 to 20 years. Adolescents in the UK are amongst the heaviest drinkers in Europe. Excessive drinking in adolescents is associated with increased risk of accidents, injuries, self-harm, unprotected and regretted sex, violence and disorder, poisoning and accidental death. However, there is lack of clear evidence for the most effective and cost-effective screening and brief interventions for reducing or preventing alcohol consumption in adolescents attending emergency departments (ED).Objectives: To estimate the distribution of alcohol consumption, alcohol-related problems, and alcohol use disorders in adolescents attending ED; to develop age appropriate alcohol screening and brief intervention tools; to evaluate the effectiveness and cost-effectiveness of these interventions.Design: The research has been conducted in three linked stages: 1) prevalence study; 2) interventions development; 3) two linked randomised clinical trials (RCT).Setting: 12 EDs in England (London, North East, Yorkshire and The Humber).Participants: A total of 5,376 participants in the prevalence study (mean age 13.0, SD 2.0, 46.2% female) and 1,640 in the two linked RCTs (mean age 15.6 SD 1.0; 50.7% female).RCT Interventions: Personalised Feedback and Brief Advice (PFBA) and Personalised Feedback plus electronic Brief Intervention (eBI) compared with alcohol screening alone. These age-appropriate alcohol interventions were developed in collaboration with the target audience through a series of focus groups and evaluations during stage 2 of the research programme and following two literature reviews. .RCT Main outcome measures: Total alcohol consumed in standard UK units (1 unit = 8g ethanol) over the past 3 months at 12-month follow-up, assessed using the Alcohol Use Disorders Identification Test &#x2013; Consumption version (AUDIT-C).Results: In the prevalence study 2,112 (39.5%) reported having had a drink of alcohol that was more than a sip in their lifetime, with prevalence increasing steadily with age and reaching 89.5% at 17. The prevalence of at-risk alcohol consumption was 15% (95% CI 14 &#x2013; 16) and the optimum cut-off point of the AUDIT-C in identifying at-risk drinking was 3 or more. Associations of alcohol consumption and early onset of drinking with poorer health and social functioning were also found.In the RCT the analysis of the primary outcome (average weekly alcohol consumption at month 12) identified no significant differences in effect between the three groups in both trials. In the high-risk drinking trial the mean difference compared with control was 0.09 (-0.01 to 0.23) for PFBA and 0.03 (-0.12 to 0.18) for eBI. In the low-risk drinking trial the mean difference compared with control was 0.03 (-0.07 to 0.13) for PFBA and 0.01 (-0.10 to 0.11) for eBI. The health economic analysis showed that eBI and PFBA were not more cost effective than screening alone.Conclusions: The ED can offer an opportunity for the identification of at-risk alcohol use in adolescents. A simple, short, self-completed screening instrument, the AUDIT-C, is an effective tool for identifying adolescents who are at risk of alcohol related problems. Associations of alcohol consumption and earlier onset of drinking with poorer health and social functioning were observed in the prevalence study.The trials were feasible to implement and exceeded the recruitment target and minimum follow up rates. However, PFBA and eBI were not found to be more effective than screening alone in reducing or preventing alcohol consumption in 14-17-year-olds attending ED.</abstract><type>Journal Article</type><journal>Programme Grants for Applied Research</journal><volume>8</volume><journalNumber>2</journalNumber><paginationStart>1</paginationStart><paginationEnd>144</paginationEnd><publisher>National Institute for Health Research</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>2050-4322</issnPrint><issnElectronic>2050-4330</issnElectronic><keywords/><publishedDay>1</publishedDay><publishedMonth>1</publishedMonth><publishedYear>2020</publishedYear><publishedDate>2020-01-01</publishedDate><doi>10.3310/pgfar08020</doi><url/><notes>Full text available via publisher DOI link.</notes><college>COLLEGE NANME</college><department>Medicine, Health and Life Science - Faculty</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>FGMHL</DepartmentCode><institution>Swansea University</institution><apcterm/><lastEdited>2021-01-07T16:59:43.2463097</lastEdited><Created>2019-03-12T15:33:41.7421636</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">School of Health and Social Care</level></path><authors><author><firstname>Paolo</firstname><surname>Deluca</surname><order>1</order></author><author><firstname>Simon</firstname><surname>Coulton</surname><order>2</order></author><author><firstname>Mohammed Fasihul</firstname><surname>Alam</surname><order>3</order></author><author><firstname>Sadie</firstname><surname>Boniface</surname><order>4</order></author><author><firstname>Kim</firstname><surname>Donoghue</surname><order>5</order></author><author><firstname>Eilish</firstname><surname>Gilvarry</surname><order>6</order></author><author><firstname>Eileen</firstname><surname>Kaner</surname><order>7</order></author><author><firstname>Ellen</firstname><surname>Lynch</surname><order>8</order></author><author><firstname>Ian</firstname><surname>Maconochie</surname><order>9</order></author><author><firstname>Paul</firstname><surname>McArdle</surname><order>10</order></author><author><firstname>Ruth</firstname><surname>McGovern</surname><order>11</order></author><author><firstname>Dorothy</firstname><surname>Newbury-Birch</surname><order>12</order></author><author><firstname>Robert</firstname><surname>Patton</surname><order>13</order></author><author><firstname>Tracy</firstname><surname>Pellatt-Higgins</surname><order>14</order></author><author><firstname>Ceri</firstname><surname>Phillips</surname><order>15</order></author><author><firstname>Thomas</firstname><surname>Phillips</surname><order>16</order></author><author><firstname>Rhys</firstname><surname>Pockett</surname><orcid>0000-0003-4135-7383</orcid><order>17</order></author><author><firstname>Ian</firstname><surname>Russell</surname><orcid>0000-0002-0069-479X</orcid><order>18</order></author><author><firstname>John</firstname><surname>Strang</surname><order>19</order></author><author><firstname>Colin</firstname><surname>Drummond</surname><order>20</order></author></authors><documents><document><filename>49175__18995__74f08b7a243840da911210291854f588.pdf</filename><originalFilename>3031627 (1)-compressed.pdf</originalFilename><uploaded>2021-01-07T12:52:10.7540389</uploaded><type>Output</type><contentLength>52243076</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>All NIHR Journals Library reports have been produced under the terms of a commissioning contract issued by the Secretary of State for Health. 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spelling 2021-01-07T16:59:43.2463097 v2 49175 2019-03-12 Screening and brief interventions for adolescent alcohol use disorders presenting through emergency departments: a research programme including two RCTs 932c7a406ab4b6e4a881d422ca03c289 Ceri Phillips Ceri Phillips true false 8a3882ebcc6a8fb3b2c13fc2ff716bf2 0000-0003-4135-7383 Rhys Pockett Rhys Pockett true false 07f8ce1304fdfe94981330301c2b3977 0000-0002-0069-479X Ian Russell Ian Russell true false 2019-03-12 FGMHL Background: Alcohol consumption and related harm increase steeply from the ages of 12 to 20 years. Adolescents in the UK are amongst the heaviest drinkers in Europe. Excessive drinking in adolescents is associated with increased risk of accidents, injuries, self-harm, unprotected and regretted sex, violence and disorder, poisoning and accidental death. However, there is lack of clear evidence for the most effective and cost-effective screening and brief interventions for reducing or preventing alcohol consumption in adolescents attending emergency departments (ED).Objectives: To estimate the distribution of alcohol consumption, alcohol-related problems, and alcohol use disorders in adolescents attending ED; to develop age appropriate alcohol screening and brief intervention tools; to evaluate the effectiveness and cost-effectiveness of these interventions.Design: The research has been conducted in three linked stages: 1) prevalence study; 2) interventions development; 3) two linked randomised clinical trials (RCT).Setting: 12 EDs in England (London, North East, Yorkshire and The Humber).Participants: A total of 5,376 participants in the prevalence study (mean age 13.0, SD 2.0, 46.2% female) and 1,640 in the two linked RCTs (mean age 15.6 SD 1.0; 50.7% female).RCT Interventions: Personalised Feedback and Brief Advice (PFBA) and Personalised Feedback plus electronic Brief Intervention (eBI) compared with alcohol screening alone. These age-appropriate alcohol interventions were developed in collaboration with the target audience through a series of focus groups and evaluations during stage 2 of the research programme and following two literature reviews. .RCT Main outcome measures: Total alcohol consumed in standard UK units (1 unit = 8g ethanol) over the past 3 months at 12-month follow-up, assessed using the Alcohol Use Disorders Identification Test – Consumption version (AUDIT-C).Results: In the prevalence study 2,112 (39.5%) reported having had a drink of alcohol that was more than a sip in their lifetime, with prevalence increasing steadily with age and reaching 89.5% at 17. The prevalence of at-risk alcohol consumption was 15% (95% CI 14 – 16) and the optimum cut-off point of the AUDIT-C in identifying at-risk drinking was 3 or more. Associations of alcohol consumption and early onset of drinking with poorer health and social functioning were also found.In the RCT the analysis of the primary outcome (average weekly alcohol consumption at month 12) identified no significant differences in effect between the three groups in both trials. In the high-risk drinking trial the mean difference compared with control was 0.09 (-0.01 to 0.23) for PFBA and 0.03 (-0.12 to 0.18) for eBI. In the low-risk drinking trial the mean difference compared with control was 0.03 (-0.07 to 0.13) for PFBA and 0.01 (-0.10 to 0.11) for eBI. The health economic analysis showed that eBI and PFBA were not more cost effective than screening alone.Conclusions: The ED can offer an opportunity for the identification of at-risk alcohol use in adolescents. A simple, short, self-completed screening instrument, the AUDIT-C, is an effective tool for identifying adolescents who are at risk of alcohol related problems. Associations of alcohol consumption and earlier onset of drinking with poorer health and social functioning were observed in the prevalence study.The trials were feasible to implement and exceeded the recruitment target and minimum follow up rates. However, PFBA and eBI were not found to be more effective than screening alone in reducing or preventing alcohol consumption in 14-17-year-olds attending ED. Journal Article Programme Grants for Applied Research 8 2 1 144 National Institute for Health Research 2050-4322 2050-4330 1 1 2020 2020-01-01 10.3310/pgfar08020 Full text available via publisher DOI link. COLLEGE NANME Medicine, Health and Life Science - Faculty COLLEGE CODE FGMHL Swansea University 2021-01-07T16:59:43.2463097 2019-03-12T15:33:41.7421636 Faculty of Medicine, Health and Life Sciences School of Health and Social Care Paolo Deluca 1 Simon Coulton 2 Mohammed Fasihul Alam 3 Sadie Boniface 4 Kim Donoghue 5 Eilish Gilvarry 6 Eileen Kaner 7 Ellen Lynch 8 Ian Maconochie 9 Paul McArdle 10 Ruth McGovern 11 Dorothy Newbury-Birch 12 Robert Patton 13 Tracy Pellatt-Higgins 14 Ceri Phillips 15 Thomas Phillips 16 Rhys Pockett 0000-0003-4135-7383 17 Ian Russell 0000-0002-0069-479X 18 John Strang 19 Colin Drummond 20 49175__18995__74f08b7a243840da911210291854f588.pdf 3031627 (1)-compressed.pdf 2021-01-07T12:52:10.7540389 Output 52243076 application/pdf Version of Record true All NIHR Journals Library reports have been produced under the terms of a commissioning contract issued by the Secretary of State for Health. Reports may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Permission to reproduce material from a published report is covered by the UK government’s non-commercial licence for public sector information. true eng http://www.nationalarchives.gov.uk/doc/non-commercial-government-licence/version/2/
title Screening and brief interventions for adolescent alcohol use disorders presenting through emergency departments: a research programme including two RCTs
spellingShingle Screening and brief interventions for adolescent alcohol use disorders presenting through emergency departments: a research programme including two RCTs
Ceri Phillips
Rhys Pockett
Ian Russell
title_short Screening and brief interventions for adolescent alcohol use disorders presenting through emergency departments: a research programme including two RCTs
title_full Screening and brief interventions for adolescent alcohol use disorders presenting through emergency departments: a research programme including two RCTs
title_fullStr Screening and brief interventions for adolescent alcohol use disorders presenting through emergency departments: a research programme including two RCTs
title_full_unstemmed Screening and brief interventions for adolescent alcohol use disorders presenting through emergency departments: a research programme including two RCTs
title_sort Screening and brief interventions for adolescent alcohol use disorders presenting through emergency departments: a research programme including two RCTs
author_id_str_mv 932c7a406ab4b6e4a881d422ca03c289
8a3882ebcc6a8fb3b2c13fc2ff716bf2
07f8ce1304fdfe94981330301c2b3977
author_id_fullname_str_mv 932c7a406ab4b6e4a881d422ca03c289_***_Ceri Phillips
8a3882ebcc6a8fb3b2c13fc2ff716bf2_***_Rhys Pockett
07f8ce1304fdfe94981330301c2b3977_***_Ian Russell
author Ceri Phillips
Rhys Pockett
Ian Russell
author2 Paolo Deluca
Simon Coulton
Mohammed Fasihul Alam
Sadie Boniface
Kim Donoghue
Eilish Gilvarry
Eileen Kaner
Ellen Lynch
Ian Maconochie
Paul McArdle
Ruth McGovern
Dorothy Newbury-Birch
Robert Patton
Tracy Pellatt-Higgins
Ceri Phillips
Thomas Phillips
Rhys Pockett
Ian Russell
John Strang
Colin Drummond
format Journal article
container_title Programme Grants for Applied Research
container_volume 8
container_issue 2
container_start_page 1
publishDate 2020
institution Swansea University
issn 2050-4322
2050-4330
doi_str_mv 10.3310/pgfar08020
publisher National Institute for Health Research
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str School of Health and Social Care{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}School of Health and Social Care
document_store_str 1
active_str 0
description Background: Alcohol consumption and related harm increase steeply from the ages of 12 to 20 years. Adolescents in the UK are amongst the heaviest drinkers in Europe. Excessive drinking in adolescents is associated with increased risk of accidents, injuries, self-harm, unprotected and regretted sex, violence and disorder, poisoning and accidental death. However, there is lack of clear evidence for the most effective and cost-effective screening and brief interventions for reducing or preventing alcohol consumption in adolescents attending emergency departments (ED).Objectives: To estimate the distribution of alcohol consumption, alcohol-related problems, and alcohol use disorders in adolescents attending ED; to develop age appropriate alcohol screening and brief intervention tools; to evaluate the effectiveness and cost-effectiveness of these interventions.Design: The research has been conducted in three linked stages: 1) prevalence study; 2) interventions development; 3) two linked randomised clinical trials (RCT).Setting: 12 EDs in England (London, North East, Yorkshire and The Humber).Participants: A total of 5,376 participants in the prevalence study (mean age 13.0, SD 2.0, 46.2% female) and 1,640 in the two linked RCTs (mean age 15.6 SD 1.0; 50.7% female).RCT Interventions: Personalised Feedback and Brief Advice (PFBA) and Personalised Feedback plus electronic Brief Intervention (eBI) compared with alcohol screening alone. These age-appropriate alcohol interventions were developed in collaboration with the target audience through a series of focus groups and evaluations during stage 2 of the research programme and following two literature reviews. .RCT Main outcome measures: Total alcohol consumed in standard UK units (1 unit = 8g ethanol) over the past 3 months at 12-month follow-up, assessed using the Alcohol Use Disorders Identification Test – Consumption version (AUDIT-C).Results: In the prevalence study 2,112 (39.5%) reported having had a drink of alcohol that was more than a sip in their lifetime, with prevalence increasing steadily with age and reaching 89.5% at 17. The prevalence of at-risk alcohol consumption was 15% (95% CI 14 – 16) and the optimum cut-off point of the AUDIT-C in identifying at-risk drinking was 3 or more. Associations of alcohol consumption and early onset of drinking with poorer health and social functioning were also found.In the RCT the analysis of the primary outcome (average weekly alcohol consumption at month 12) identified no significant differences in effect between the three groups in both trials. In the high-risk drinking trial the mean difference compared with control was 0.09 (-0.01 to 0.23) for PFBA and 0.03 (-0.12 to 0.18) for eBI. In the low-risk drinking trial the mean difference compared with control was 0.03 (-0.07 to 0.13) for PFBA and 0.01 (-0.10 to 0.11) for eBI. The health economic analysis showed that eBI and PFBA were not more cost effective than screening alone.Conclusions: The ED can offer an opportunity for the identification of at-risk alcohol use in adolescents. A simple, short, self-completed screening instrument, the AUDIT-C, is an effective tool for identifying adolescents who are at risk of alcohol related problems. Associations of alcohol consumption and earlier onset of drinking with poorer health and social functioning were observed in the prevalence study.The trials were feasible to implement and exceeded the recruitment target and minimum follow up rates. However, PFBA and eBI were not found to be more effective than screening alone in reducing or preventing alcohol consumption in 14-17-year-olds attending ED.
published_date 2020-01-01T03:59:58Z
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