Elsevier

Drug and Alcohol Dependence

Volume 79, Issue 3, 1 September 2005, Pages 365-371
Drug and Alcohol Dependence

Adolescent substance use and hospital presentations: A record linkage assessment of 12-month outcomes

https://doi.org/10.1016/j.drugalcdep.2005.03.016Get rights and content

Abstract

Aims:

To examine the prevalence of different substances used by adolescents admitted to hospital emergency departments (ED); to evaluate the impact of an ED based brief intervention (BI) on hospital events; to compare outcomes for those using ‘alcohol alone’, ‘alcohol plus illicit ± licit drugs’ (‘alcohol plus’), or ‘other drugs’ excluding alcohol, and investigate the relationship between hazardous alcohol consumption patterns and hospital events.

Design:

We used hospital record linkage to follow-up a randomised control trial cohort.

Participants:

Adolescents (12–19 years) recruited in ED with presentations involving alcohol or other drugs (AOD): 67 received usual care and 60 a BI that facilitated attendance at community drug agencies.

Measurements:

Drug-use categories were assigned from the substances used at the baseline presentation. Outcomes were assessed as hospital admissions plus ED presentations in the 12-month post-intervention. ‘Hazardous’ alcohol use was categorised via the AUDIT-3.

Results:

The drug-use categories were ‘alcohol alone’ (n = 67, 53%), ‘alcohol plus’ (n = 31, 24%) and ‘other drugs’ (n = 28, 22%). In the 12-month post-intervention, the randomisation groups had similar numbers of AOD hospital events. A Cox regression showed that in the usual care but not the BI group, for ‘other drugs’ there was a 8-fold increased hazard (‘risk’) of an AOD hospital event compared with ‘alcohol alone’ and a 10-fold increase compared to ‘alcohol plus’. Each pre-recruitment AOD event doubled the hazard of an AOD event. For the BI group, these were not significant predictors. The ‘other drugs’ group had more AOD events than either of the other groups. ‘Hazardous’ (77%) alcohol use was common but was not a predictor of AOD hospital events.

Conclusions:

BI can be delivered in ED and reduce hospital AOD morbidity associated with the use of drugs other than alcohol. Interventions should focus on those with prior AOD events and ‘other drugs’ presentations.

Introduction

The early use of alcohol or other drugs (AOD) is associated with a range of adverse outcomes. Those who start consuming alcohol before the age of 14 have an increased likelihood of a lifetime diagnosis of alcohol abuse or dependency, with the respective odds of these diagnoses declining by 8% and 14% for each year that onset can be delayed (Grant and Dawson, 1997). Similarly, by delaying the onset of other substance use, the odds of future abuse or dependency reduce by 4% and 5%, respectively (Grant and Dawson, 1998). Adolescent AOD consumption is also associated with deaths from a variety of causes (English et al., 1995) plus other serious outcomes including hospitalisation (Unwin et al., 1997a, Unwin et al., 1997b), increased risk of unintentional injuries (Hingson et al., 2000) and accidents (Brismar and Bergman, 1998). Thus, interventions with young people aimed at reducing AOD use may confer benefits.

However, AOD intervention programs delivered in schools will probably miss a critical group of adolescents, as those most likely to be significant substance users are those most likely to be outside the school system (Bauman and Phongsavan, 1999). One contact point for this group of higher risk adolescents is hospital emergency departments (ED). Interventions delivered via the health care system, such as ED, also have the advantage that they can be delivered at the time of health related contact when the message is particularly salient (Gentilello et al., 1988).

There exists a substantial literature to support the use and cost–benefits of brief interventions (BI) delivered in various health care locations among adults with AOD problems, particularly in those with less severe disorders (i.e., not dependence), and in opportunistic settings rather than at specialist treatment centres (Bien et al., 1993, Agosti, 1995, Miller and Wilbourne, 2002, Moyer et al., 2002, Fleming et al., 2002).

The BI approach has been found to be feasible with adolescents in ED with a high proportion (87%) consenting to initial screening and 70% of those subsequently followed-up reporting that ED was an appropriate location for intervention (Hungerford et al., 2003). Notwithstanding this, a recent review whilst supporting the effectiveness of BI among adolescents with alcohol problems noted that data were sparse on the utility of BI with other substance using adolescents (Tait and Hulse, 2003).

The current study's adolescent cohort was recruited in hospital ED following presentations involving the use of AOD between 1999 and 2002. This initial recruitment was to assess if use of a BI versus usual hospital care could facilitate attendance at community AOD treatment agencies. Four-month outcome data have previously been reported which evidenced benefits from the BI of increased attendance for AOD treatment and improved psychosocial well-being (Tait et al., 2004). However, at the time comprehensive hospital admission data were unavailable.

The aims of the current study were four-fold. First, to examine the prevalence of different substance types identified at adolescent ED presentations. Secondly, to investigate the impact of an ED based intervention on hospital events (hospital admissions plus ED presentations). Third, to compare outcomes for those using ‘alcohol alone’ with those using ‘alcohol plus illicit ± licit’ (‘alcohol plus’) drugs and users of ‘other drugs’ excluding alcohol. Fourth, to investigate the relationship between hazardous alcohol consumption patterns and hospital events.

Section snippets

Participants

We identified and approached 184 eligible adolescents (age range 12–19 years) in ED following presentation with a problem involving AOD usage. From these, we recruited 127 participants.

Procedure

The procedure has previously been described (Tait et al., 2004). In brief, the intervention group had their referral to an external treatment agency facilitated by the researcher. This involved identifying and discussing specific negative consequences associated with their personal drug use. The researcher

Results

We approached 184 adolescents, of whom 127 (69%) agreed to participate in the baseline study. Most attended ED with presentation related to alcohol use either alone 67 (53%) or in combination with other licit (12, 10%) or illicit substances (19, 15%). In addition there were 12 (10%) presentations involving other licit drugs and 16 (13%) illicit drugs not involving alcohol. Table 1 shows the key demographic and substance use variables; there were no significant differences between the study

Discussion

This study's primary objective was to assess the outcomes of a brief intervention among adolescents with alcohol or other drug problems who were recruited in ED following an AOD-related presentation. Outcomes were assessed in terms of hospital events. Previous research has found benefits from BI among alcohol using adolescents (Monti et al., 1999), however, there are few data to support the use of BI with adolescents who use other substances (Tait and Hulse, 2003). Accordingly, we also compared

Acknowledgements

This paper was written as part of ongoing research projects funded by the Alcohol Education and Rehabilitation Foundation and the Office of Mental Health, Department of Health, Western Australia.

References (30)

  • Australian Institute of Health and Welfare, 2002. National Drug Strategy Household Survey: First Results. AIHW,...
  • K.A. Bailey et al.

    Pilot randomized controlled trial of a brief alcohol intervention group for adolescents

    Drug Alcohol Rev.

    (2004)
  • T.H. Bien et al.

    Brief interventions for alcohol problems: a review

    Addiction

    (1993)
  • B. Brismar et al.

    The significance of alcohol for violence and accidents

    Alcohol Clin. Exp. Res.

    (1998)
  • C. Dunn et al.

    The use of brief interventions adapted from motivational interviewing across behavioral domains: a systematic review

    Addiction

    (2001)
  • Cited by (14)

    • Bridging the Gap: Drug and Alcohol Screening in Adolescent Trauma Patients

      2018, Journal of Emergency Nursing
      Citation Excerpt :

      These laws require that patients, parents, or guardians must authorize the sharing of protected health information for purposes other than treatment.50,52-54 When providers are authorized to share protected information, these laws limit what can be shared to the minimal amount of information necessary for the intended uses or disclosure of information.50,52 The Center for Adolescent Health and the Law (CAHL.org) is an online site that provides detailed information about each state’s regulations that specify adolescent and parent rights, including adolescent confidentiality.50

    • Emergency department based intervention with adolescent substance users: 10 year economic and health outcomes

      2016, Drug and Alcohol Dependence
      Citation Excerpt :

      A total of 127 adolescents (aged 12–19, mean 16.7 years, standard deviation 1.8) were recruited and randomized to receive either a brief intervention (n = 60) or treatment as usual (n = 67). The demographics of the two cohorts have previously been described in detail (Tait and Hulse, 2005; Tait et al., 2004). There were 67 (53%) alcohol only presentations, 31 (24%) alcohol plus another drug(s), 28 (22%) illicit ± licit and one missing data.

    View all citing articles on Scopus

    Research undertaken at Fremantle Hospital, Princess Margaret's Hospital for Children, Royal Perth Hospital and Joondalup Health Campus.

    View full text