Adolescent substance use and hospital presentations: A record linkage assessment of 12-month outcomes☆
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.
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Research undertaken at Fremantle Hospital, Princess Margaret's Hospital for Children, Royal Perth Hospital and Joondalup Health Campus.