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Brief Intervention Cuts Alcohol Related Teen Violence

In 2006 there were nearly 20,000 emergency department (ED) visits by patients aged 15 to 24 years. These ED visits are an opportunity for intervention efforts to reach adolescents not attending school, who lack a primary care MD, or who are otherwise outside mainstream medical care. A recent study conducted at the Hurley Medical Center in Flint, Michigan looked at whether therapist and computer interventions could be effective in reducing adolescent violence and alcohol misuse. Over a 3-year period (2006-2009) 3,338 patients 14-18 years old completed a 15-minute computerized survey. Those reporting alcohol use or aggression were recruited for further testing. Participants were randomized and received either a therapist brief intervention or a computer-based brief intervention, or were assigned to a control group.

The SafERteens brief interventions used in the study were based on motivational interviewing but included alcohol refusal and conflict resolution skills practice. The therapist and computer interventions had similar content and were culturally relevant for urban youth. The content sections included “goals, personalized feedback for alcohol, violence, and weapon carriage, decisional balance exercise for the potential benefit of staying away from drinking and fighting, 5 tailored role plays (e.g., anger management, conflict resolution, alcohol refusals, not drinking and driving), and referral.” The computer intervention was an interactive animated program with touch screens and audio. Both the computer and therapist interventions were consistent with motivational interviewing but it was not possible for the computer to provide the complex interpersonal responses of a skilled therapist. Follow-up consisted of self-administered computerized assessments 3 and 6 months after the ED intervention.

Results indicated that brief intervention with adolescent patients in an urban ED shows promise. The findings show that a therapist brief intervention (with computerized feedback and structure) decreases the occurrence of peer violence in the 3 months following an ED visit. In addition, both the therapist and the computer brief interventions were effective at reducing alcohol consequences over 6 months. The researchers point out that a leading cause of mortality and morbidity in this age group is violence. Thus a reduction in severe violence following a single-session brief intervention is clinically meaningful. (Walton M, Chermack, S, Shope, J, Bingham, R, Zimmerman, M, Blow, F, Cunningham, R: Effects of a brief intervention for reducing violence and alcohol misuse among adolescents. J. Amer. Med. Assoc. 304:527-535, 2010

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