Developing and evaluating interventions for adolescent alcohol use disorders presenting through emergency departments

UK Department of Health's advice to children under 15 years (2009) is to abstain from alcohol due to risks of harm, and 15-17 year olds are advised not to drink, but if they do drink it should be no more than 3-4 units and 2-3 units per week in males and females, respectively. In contrast, alcohol use is increasing in adolescents in the UK: the average amount consumed by 11-15 year olds doubled in the last 13 years to 2007. Adolescents in the UK are now 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. Early drinking in adolescence is associated with intellectual impairment and an increased risk of more serious alcohol problems in later life. Methods of alcohol screening and early intervention have been developed for adolescents in the USA, and show evidence of benefit, but have not been studied in the UK. Further these methods have several shortcomings including not providing screening and intervention methods appropriate to the age and developmental stage of the younger adolescent.

This programme of research aims to address the gaps in the evidence base on alcohol screening and intervention by targeting younger adolescent emergency department (ED) attenders. The research will be conducted in 3 related stages over five years: first the prevalence of alcohol consumption and problems related to alcohol in adolescents will be studied in 10 typical EDs in England, and the methods used to identify at risk adolescents will be evaluated. The second stage will develop and pilot different screening and intervention approaches to assess feasibility and acceptability. The final stage is an exploratory clinical trial of the effectiveness and cost effectiveness of alcohol screening and intervention in younger adolescents in ED and will only be conducted if evidence from stages 1 and 2 indicate feasibility around recruitment, consent and follow-up.

This research will have important implications and impact both on the way adolescent drinkers are managed in ED, and on the prevention of future alcohol-related harm in this population through targeted early interventions. Outputs from the research will include age appropriate screening and intervention methods for use by NHS staff, including training packages and methods. The research team is highly experienced in addiction research and has recently completed a similar programme of research in adults in ED and other health and criminal justice settings for the Department of Health.