Effect of a Novel Brief Motivational Intervention for Alcohol-Intoxicated Young Adults in the Emergency Department A Randomized Clinical Trial

IMPORTANCE Heavy drinking among young adults is a major public health concern. Brief motivational interventions in the emergency department have shown promising but inconsistent results. OBJECTIVE To test whether young adults receiving a newly developed brief motivational intervention reduce their number of heavy drinking days and alcohol-related problems over 1 year compared with participants receiving brief advice. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial was conducted at an emergency department of a tertiary care university hospital in Lausanne, Switzerland. Recruitment ran from December 2016 to August 2019. Follow-up was conducted after 1, 3, 6, and 12 months. All adults aged 18 to 35 years presenting for any cause and presenting with alcohol intoxication were eligible (N = 2108); 1764 were excluded or refused participation. Follow-up rate was 79% at 12 months and 89% of participants provided follow-up data at least once and were included in the primary analyses. Statistical analysis was performed from September 2020 to January 2021. INTERVENTIONS The novel intervention was based on motivational interviewing and comprised in-person discussion in the emergency department and up to 3 booster telephone calls. The control group received brief advice. MAIN OUTCOMES AND MEASURES Primary outcomeswere the number of heavy drinking days (at least 60 g of ethanol) over the previous month and the total score on the Short Inventory of Problems (0-45, higher scores indicating more problems) over the previous 3 months. Hypotheses tested were formulated before data collection. RESULTS There were 344 young adults included (median [IQR] age: 23 [20-28] years; 84 women [24.4%]). Among the 306 participants providing at least 1 follow-up point, a statistically significant time x group interaction was observed (beta = -0.03; 95% CI, -0.05 to 0.00; P =.02), and simple slopes indicated an increase of heavy drinking days over time in the control (beta = 0.04; 95% CI, 0.02 to 0.05; P <.001) but not in the intervention group (beta = 0.01; 95% CI, -0.01 to 0.03; P =.24). There was no effect on the Short Inventory of Problems score (beta = -0.01; 95% CI, -0.03 to 0.02; P =.71). CONCLUSIONSANDRELEVANCE This randomized clinical trial found that a brief motivational intervention implemented in the emergency department provided beneficial effects on heavy drinking, which accounts for a substantial portion of mortality and disease burden among young adults.