Brief ER Interventions for Youth Drug Use Showed Mostly Inconclusive Results | Research

The takeaway

A systematic review of 9 trials found mostly inconclusive evidence that brief emergency department interventions reduce youth alcohol and drug use, with some evidence for motivational interviewing reducing cannabis use, drinking-and-driving, and alcohol-related injuries.

Read this if you work in emergency medicine or public health and want to understand the evidence for brief drug use interventions with young people.

Most comparisons showed no significant benefit over standard care

What the researchers found

Nine randomized controlled trials of emergency department-based brief interventions (BIs) for youth ages 21 and under were reviewed. Five trials had high risk of bias, 2 had unclear risk, and only 2 had low risk. Universal and targeted BIs did not significantly reduce alcohol use compared to standard care.

Some specific findings were promising: in one trial (high risk of bias), peer-delivered motivational interviewing for cannabis increased abstinence and reduced physical altercations. In two trials (unclear risk of bias), MI reduced drinking and driving and alcohol-related injuries. Computer-based MI in one low-risk trial reduced alcohol-related consequences at 6 months. However, variation in outcome measurement and poor study quality prevented firm conclusions.

Why it matters

Emergency departments are a logical setting for substance use intervention, as youth may be presenting during or after harmful use. If brief interventions work, they could reach a large at-risk population at a teachable moment. The inconclusive evidence means more research is needed before recommending routine implementation.

The numbers in context

9 RCTs included. 2 low risk, 2 unclear risk, 5 high risk of bias. Most comparisons showed no significant differences. Peer MI for cannabis: increased abstinence, reduced altercations (1 trial, high risk). Computer MI: reduced alcohol consequences at 6 months (1 trial, low risk).

How the study worked

Systematic review searching 14 databases, trial registry, conference proceedings, and references. Included RCTs of youth 21 and under. Two independent reviewers selected studies and assessed quality. Qualitative synthesis (no meta-analysis due to heterogeneity).

What this study cannot tell us

Most trials had high risk of bias. Outcome measures varied widely across studies, preventing meta-analysis. Small number of trials overall. Most focused on alcohol rather than other drugs. Youth in EDs may differ from general substance-using youth populations.

How to read the evidence

Systematic review with comprehensive search; moderate methodology but weak underlying trial quality.

When this study was published

Published in 2013. Research on ER-based youth substance interventions has continued with larger and better-designed trials.

The bigger picture

Brief interventions work well for adult alcohol use in primary care settings, but this review suggests the evidence does not extend clearly to youth in emergency departments. The youth population, the emergency setting, and the inclusion of drugs beyond alcohol may all require different intervention approaches.

Questions still open

Do ED-based interventions need to be longer or more intensive for youth? Are certain delivery methods (peer, computer, therapist) more effective? Should cannabis-specific interventions be developed separately from alcohol interventions?

Common questions

Do emergency room interventions help teens stop using drugs?

The evidence is mostly inconclusive. This systematic review found that most ER-based brief interventions did not significantly reduce youth alcohol or drug use compared to standard care. However, some specific approaches showed promise: peer-delivered motivational interviewing for cannabis use increased abstinence, and computer-based MI reduced alcohol consequences. The overall evidence quality was low.

What is a brief intervention?

A brief intervention is a short, structured conversation (usually 5-30 minutes) designed to help someone recognize risky substance use and consider changing their behavior. In emergency departments, this is delivered during or after treatment for an injury or illness, taking advantage of a "teachable moment" when the consequences of substance use may be especially salient.

Read the original research

Brief emergency department interventions for youth who use alcohol and other drugs: a systematic review.

Pediatric emergency care, 29(5), 673-84

View on PubMed ↗Publisher’s paper ↗

Citation

Newton, Amanda S; Dong, Kathryn; Mabood, Neelam; Ata, Nicole; Ali, Samina; Gokiert, Rebecca; Vandermeer, Ben; Tjosvold, Lisa; Hartling, Lisa; Wild, T Cameron. (2013). Brief emergency department interventions for youth who use alcohol and other drugs: a systematic review.. Pediatric emergency care, 29(5), 673-84. https://doi.org/10.1097/PEC.0b013e31828ed325