Emergency department-based intervention with adolescent substance users: 12-month outcomes.

We evaluated the 12-month outcomes of a brief intervention, enhanced by a consistent support person, which aimed to facilitate referral attendance for substance use treatment following a hospital alcohol or other drug (AOD) presentation. Outcomes were assessed as: attendance for substance use treatment; the number of hospital AOD ED presentations; change in AOD consumption and psychological wellbeing (GHQ-12). We recruited 127 adolescents, with 60 randomised to the intervention and 67 receiving usual care. At 12 months, 87 (69%) were re-interviewed. Significantly more of the intervention than the usual care group (12 versus 4) had attended a treatment agency. Excluding the index presentations, there were 66 AOD hospital presentations post intervention, with the proportion of AOD events falling for the intervention group, whilst no change occurred for the usual care group. Irrespective of randomisation, those who attended for substance use treatment had a greater decline in total self-reported drug use than the remainder. Both intervention and usual care groups had improved GHQ-12 scores by 12 months, with reduction in GHQ scores correlated with reduced drug use. In conclusion, while brief intervention in ED only has limited success in facilitating adolescents to attend for subsequent AOD treatment, it can significantly reduce the number of AOD related ED presentations.

Effectiveness of a brief-intervention and continuity of care in enhancing attendance for treatment by adolescent substance users.

AIMS: To evaluate the effectiveness of a brief intervention enhanced by a consistent support person in facilitating attendance for substance use treatment following a hospital alcohol or other drug (AOD) presentation. PARTICIPANTS: We recruited 127 adolescents (aged 12-19 years) from hospital emergency departments, 57 were female. Sixty were randomly assigned to receive the intervention and 67 to receive standard hospital care. For the purpose of comparison, normative data were also collected (at baseline) from 122 non-AOD presenting adolescents. INTERVENTION: The brief intervention involved identifying impediments to treatment service attendance and facilitating attendance via a consistent support person. RESULTS: At 4 months, a significantly greater proportion of the intervention group, both daily and "occasional" drug users, had attended treatment than the usual care group. Regardless of attendance at the treatment service the intervention group showed a greater improvement in GHQ-12 scores than the usual care group. Across groups, a greater proportion of those who attended treatment moved to "safer" drug use behaviour (non-hazardous alcohol consumption and/or non-injecting drug use (IDU)), and showed a greater decline on a composite total drug use score. CONCLUSIONS: Adolescent attendance for treatment can be improved by brief intervention with harmful substance use behaviours reduced for both "occasional" and daily users. Improvements in psychosocial well-being is observed regardless of attendance at a treatment service.

Multiple hospital presentations by adolescents who use alcohol or other drugs.

AIMS: To investigate 'all cause' and the subset of 'alcohol or other drug' (AOD) related hospital emergency department (ED) presentations over 12 months by adolescents with a previously identified AOD ED presentation. DESIGN AND SETTING: A retrospective review of medical records in four metropolitan hospitals in Perth, Australia. PARTICIPANTS: One hundred and fifty-two adolescents (13-19 years) identified during a previous 4-week study. The median age was 17.5 (interquartile range (IQR) 16-19); 61 (40%) were female. METHOD: Medical records were reviewed for the 6 months either side of a previously identified index AOD presentation. Hospital events in this period were collapsed as 'all cause' morbidity with a subclassification of AOD related. FINDINGS: Over half (n=87, 57%) had no additional hospital events and 10 (7%) had only 'follow-up' treatment for their index event. The drug identified for both these groups was primarily alcohol or alcohol plus other drugs compared with mainly heroin or prescription drugs for those with multiple presentations. There were 55 (36%) adolescents who had 236 presentations, including 39 with 147 AOD presentations: six polydrug users accounted for 47% of multiple presentations. Polydrug users had more 'all cause' and AOD presentations (Mann-Whitney U=168.5, P < 0.001) than single drug users, as did 'heroin users' compared with other AOD users (U=177.5, P < 0.001). There were no significant gender differences in the total number of 'all cause' or AOD presentations. CONCLUSIONS: Alcohol users were the largest group at index presentation, but accounted for few of the presentations over 12 months. Polydrug users typically had multiple presentations and may benefit from additional non-medical hospital support. A more labour-intensive and structured approach might help the small number of polydrug users who accounted for a large proportion of repeat presentations over the 12-month period.

A review of the validity of the General Health Questionnaire in adolescent populations.

OBJECTIVE: To comprehensively review the validity of the General Health Questionnaire (GHQ) [1] with adolescents (aged 12-19). Although the GHQ has been extensively used and validated with adults and has been frequently used with adolescents, the validity data for this group are sporadic. METHOD: Systematic review of the English language peer-reviewed literature. RESULTS: Eight studies were identified validating the GHQ with young people of which four included only adolescents and four studies involved young adults and adolescents. Of these eight studies, four used an English language version of the GHQ and four used a translated version. CONCLUSION: The GHQ has demonstrated validity with older adolescents (17 + years) from the UK and Hong Kong (Chinese translation) and with girls aged 15 in the UK, but there are few data for either gender, aged less than 15 years. Studies in Australia and Italy reported a high proportion of misclassified cases while the studies in Spain and Yugoslavia included some older subjects (20 + years). Therefore, the validity of the GHQ for adolescents in populations other than the UK and Hong Kong remains to be demonstrated. IMPLICATIONS: Psychiatrists and other mental health professionals need to be aware of the above limitations when using the GHQ as a screening instrument with adolescents. Further studies are required to: (i) determine the minimum age at which it can be employed, (ii) compare the use of adult versus adolescent criterion interviews, (iii) assemble relevant normative data, and (iv) establish the validity of translated versions.