Optimizing Brief Alcohol Intervention for Underage Drinkers in the ER

描述（由申请人提供）：酒精滥用筛查为医疗环境中的青少年和年轻成人患者提供了早期发现和提供发育适当干预的机会。虽然筛查和简单干预在急诊科（艾德）的青少年和年轻人中显示出了希望，但很少有研究充分测试了有希望的筛查和简单干预/治疗/转诊组成部分，这可能是由于在这种情况下采用的后勤和实际障碍。因此，拟定的研究将使用带音频的触摸屏平板电脑进行计算机化筛查（约5，700例患者），并将在双因子设计（3x 2）中测试发育适当的定制干预策略。具体来说，艾德的900名年龄在14-20岁之间的患者，他们对有问题的酒精使用筛查呈阳性（AUDIT评分>=2，14-17岁，>=3，18-20岁）将被随机分配至三种基于ED的条件的组合计算机简短干预-CBI;干预者提供简短干预-IBI;增强的常规护理-EUC）和两种将在ED后3个月进行的随访条件（适应性动机增强治疗-AMET;增强的常规护理-EUC）。干预措施将针对个体差异（例如，酒精使用模式、变化阶段、变化的障碍/益处）跨越关键发展转型（例如，获得驾驶执照，独立生活等）所有参与者都将收到有关社区资源的书面信息;符合AUD标准的个人将额外获得物质使用治疗转诊。对于所有基于ED的和随访条件，将在基线时进行分层随机分配[按性别、年龄（14-17岁; 18- 20岁）和AUD标准]。认识到简短的干预措施对于改变所有滥用酒精的青少年和年轻人很重要，但不一定足够，拟议研究的主要具体目标将确定立即“现场”ED的独立有效性基于简短的干预条件，3个月的随访简短治疗条件，以及条件的组合，在6个月和12个月的随访中，用于减少酒精使用和改善健康相关结果（包括损伤，心理健康和其他危险行为）。使用最先进的计算机技术进行筛查和简短干预，有可能接触到更多的未成年饮酒者，这些未成年饮酒者向艾德就诊，而不是亲自进行筛查和简短干预。开发有效和高效地优化筛查和简短干预成分的方法，对于修改风险轨迹以减少酒精滥用和预防未成年饮酒者中AUD的发展具有广泛而强大的公共卫生意义。公共卫生相关性：急诊室（艾德）设置是接触未成年饮酒者（14-20岁）的独特入口。借助计算机技术，本研究将筛查艾德中的青少年和年轻人，并充分测试基于ED的短期干预和3个月随访的酒精滥用短期治疗方法。开发有效优化这些方法的方法对改善未成年饮酒者的结果具有强大的公共卫生意义。

DESCRIPTION (provided by applicant): 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. PUBLIC HEALTH RELEVANCE: The Emergency Department (ED) setting is a unique point of access for reaching underage drinkers (age 14-20). With the aid of computer technology, this study will screen adolescents and young adults in the ED and fully test promising ED-based brief intervention and 3-month follow-up brief treatment approaches for alcohol misuse. Developing methods to efficiently and effectively optimize these approaches has powerful public health implications for improving outcomes for underage drinkers.