Optimizing Brief Alcohol Intervention for Underage Drinkers in the ER

酒精滥用的筛查为早期发现和提供发展性治疗提供了机会。 在医疗环境中对青少年和年轻成人患者进行适当干预。虽然 筛查和简单的干预措施已经显示出在青少年和年轻人中的希望， 急诊科（艾德），很少有研究充分测试有前途的筛选和简短的 干预/治疗/转诊组成部分，可能是由于后勤和实际障碍， 在这种情况下通过。因此，拟议的研究将使用触摸式计算机筛查- 屏幕电脑平板电脑与音频（约5,700名患者），并将测试发育适当，量身定制 两因子设计（3x 2）中的干预策略。具体而言，艾德的900名14-20岁患者 有问题的酒精使用筛查呈阳性（AUDIT评分>=2，14-17岁，>=3，18-20岁）， 过去3个月将被随机分配到三种基于ED的条件的组合（计算机简介 干预-CBI;干预者提供简短干预-IBI;加强常规护理-EUC），以及两个 随访条件（适应性动机增强治疗-AMET;增强常规护理-EUC） 将在ED后3个月进行。干预措施将针对个体差异进行调整 (e.g.,酒精使用模式、变化阶段、变化的障碍/好处） 转换（例如，获得驾驶执照，独立生活等）所有参加者将获得 关于社区资源的书面信息;符合AUD标准的个人将额外 接受物质使用治疗转诊。分层随机分配[按性别、年龄（14-17岁; 18- 对于所有基于ED的疾病和随访疾病，将在基线时制定AUD标准。 认识到简短的发言对于所有人的变革都很重要，但不一定足够， 对于滥用酒精的青少年和年轻人，拟议研究的主要具体目标将 确定即时“现场”ED简短干预的独立有效性 条件，3个月随访简短治疗条件，以及条件组合，用于降低 酒精使用和改善健康相关的结果（包括伤害，心理健康和其他风险） 在6个月和12个月的随访中。使用最先进的计算机技术， 筛查和简单干预有可能接触到更多的未成年饮酒者 在艾德那里的表现比人工筛查和简单干预更有可能。 制定方法，以高效和有效地优化筛选和简短干预组成部分 具有广泛而强大的公共卫生影响，可以改变风险轨迹， 酒精滥用和防止未成年饮酒者中AUD的发展。

Screening for alcohol misuse offers opportunities for early detection and delivery of developmentally appropriate interventions among adolescent and young adult patients in medical settings. Although screening and brief interventions have shown promise among adolescents and young adults in the Emergency Department (ED), few studies have fully tested promising screening and brief intervention/treatment/referral components, perhaps due to logistical and practical impediments for the adoption in this setting. Therefore, the proposed study will use computerized screening using touch- screen computer tablets with audio (~5,700 patients) and will test developmentally appropriate, tailored intervention strategies in a two-factorial design (3x2). Specifically, 900 patients aged 14-20 in the ED who screen positive for problematic alcohol use (AUDIT score >=2 ages 14-17 and >=3 ages 18-20) in the past 3 months will be randomized to the combinations of three ED-based conditions (computer brief intervention-CBI; intervener delivered brief intervention-IBI ; enhanced usual care-EUC), and two follow-up conditions (adapted motivational enhancement therapy-AMET; enhanced usual care-EUC) that will take place 3 months post-ED. Interventions will be tailored to address individual differences (e.g., alcohol use patterns, stage of change, barriers/benefits of change) across key developmental transitions (e.g., acquiring a driver's license, living independently, etc.) All participants will receive written information regarding community resources; individuals who meet AUD criteria will additionally receive substance use treatment referrals. Stratified random assignment [by gender, age (14-17; 18- 20), and criteria for AUD] will take place at baseline for all ED-based and follow-up conditions. Recognizing that brief interventions are important, but not necessarily sufficient, for change in all adolescents and young adults who misuse alcohol, the primary specific aims of the proposed study will determine the independent effectiveness of immediate "on-the-spot" ED-based brief intervention conditions, 3-month follow-up brief treatment conditions, and combinations of conditions, for decreasing alcohol use and improving health-related outcomes (including injury, mental health, and other risk behaviors) at 6- and 12-months follow-up. The use of state-of-the-art computer technology for screening and brief interventions has the potential to reach greater numbers of underage drinkers presenting to the ED than is possible with person-delivered screening and brief intervention. Developing methods to efficiently and effectively optimize screening and brief intervention components has wide-ranging and powerful public health implications for modifying risk trajectories to reduce alcohol misuse and to prevent the development of AUD's among underage drinkers.