D IFFERENTIAL EFFECTIVENESS OF A BRIEF MOTIVATIONAL INTERVENTION FOR CHILDREN AND ADOLESCENTS FOLLOWING ACUTE ALCOHOL INTOXICATION IN THE EMERGENCY DEPARTMENT Inaugural-Dissertation zur Erlangung des Doktorgrades (Dr. phil.) an der der Universität Hamburg, Fakultät für Psychologie und Bewegungswissenschaft, Institut für Psychologie vorgelegt von Silke Diestelkamp, Dipl. – Psych. aus Kiel Wissenschaftliche Betreuung Prof. Dr. med. Dr. phil. Martin Härter PD Dr. phil. Regine Klinger Hamburg, 2017 Silke Diestelkamp: Effectiveness of a brief alcohol intervention ii D IFFERENTIELLE W IRKSAMKEIT EINER MOTIVIERENDEN K URZINTERVENTION F Ü R K I N D E R U N D J UGENDLICHE NACH AKUTER A LKOHOLINTOXIKATION I M N OTFALLSETTING Silke Diestelkamp: Effectiveness of a brief alcohol intervention iii Datum der Disputation: 12. Juli 2017 Mitglieder des Promotionsprüfungsausschusses Vorsitzender: Prof. Dr. Martin Spieß Erstgutachter: Prof. Dr. Dr. Martin Härter Zweitgutachterin: PD Dr. Regine Klinger Erster Disputationsgutachter: Prof. Dr. Rainer Thomasius Zweiter Disputationsgutachter: PD Dr. Timur Sevincer Silke Diestelkamp: Effectiveness of a brief alcohol intervention iv T ABLE OF CONTENTS A B S T R A C T ………………………………………………………….. 1 Z USAMMENFASSUNG ……………………………………………… 2 L IST OF PUBLICATIONS ………………………………………….. 3 1 I NTRODUCTION ………………………………………………............... 5 1.1 Alcohol use in adolescence …………………………………………... 5 1.2 Consequences of underage drinking ..................................................... 5 1.3 Theoretical models of adolescent alcohol use....................................... 6 1.4 Brief Motivational Alcohol Interventions............................................. 8 1.5 The concept of the teachable moment................................................... 10 1.6 Evidence for the effectiveness of brief alcohol interventions in the emergency department………......……....................................... 10 1.7 Moderators of brief intervention effectiveness...................................... 12 1.7.1 Patient variables........................................................................... 12 1.7.2 Intervention variables................................................................... 14 1.7.3 Counsellor variables..................................................................... 15 2 R ESEARCH QUESTIONS ....................................................................... 17 2.1 The framework research project HaLT-Hamburg ................................ 17 2.2 Research questions and related hypotheses........................................... 19 2.2.1 Research question 1 …................................................................. 19 2.2.2 Research question 2 ..................................................................... 19 2.2.3 Research question 3 ..................................................................... 20 3 M ETHODS ................................................................................................... 23 3.1. Methodological background - Study protocol of the HaLT-Hamburg trial ............................................................................ 23 3.2 Conceptual background - The HaLT-Hamburg intervention manual.... 24 3.3 Empirical background - Systematic Review and Evidence Synthesis... 24 3.4 Effectiveness of the HaLT-Hamburg intervention ............................... 26 3.5 Latent class analysis of habitual drinking patterns ............................... 26 3.6 Analyses of moderators of intervention effectiveness........................... 27 4 O VERVIEW OF PUBLICATIONS ........................................................ 29 4.1 Publication I - The HaLT-Hamburg study protocol (Methodological background)................................................................. 29 4.2 Publication II - The HaLT-Hamburg intervention manual Silke Diestelkamp: Effectiveness of a brief alcohol intervention v (Conceptual background) ..................................................................... 29 4.3 Publication III - Systematic literature review (Empirical background) ........................................................................ 30 4.4 Publication IV - Effectiveness of the HaLT-Hamburg intervention (Research Question 1)........................................................................... 31 4.5 Publication V - Habitual drinking patterns in adolescents with acute alcohol intoxication (Research question 2)........................................... 32 4.6 Publication VI - Moderators of brief intervention effectiveness (Research question 3)............................................................................ 33 5 D ISCUSSION .............................................................................................. 36 5.1 Summary and discussion of overall results........................................... 36 5.2 Discussion of results regarding the effectiveness of the HaLT-Hamburg BMI ............................................................................ 38 5.3 Limitations ............................................................................................ 41 5.4 Implications for future research ............................................................ 42 5.5 Practical implications ............................................................................ 43 5.6 Conclusion ............................................................................................ 43 R EFERENCES .................................................................................................... 45 A P P E N D I X I ...................................................................................................... 61 Full-texts of publications for the dissertation ............................................. 61 Publication I. Brief motivational intervention for adolescents treated for acute alcohol intoxication in the emergency department – a randomized controlled trial (Study protocol) ................................. 62 Publication II. Brief In Person Interventions for Adolescents and Young Adults following Alcohol-related Events in Emergency Care: A Systematic Review and European Evidence Synthesis ............... 74 Publication III. Riskanter Alkoholkonsum bei Jugendlichen. Manual zur Durchführung einer motivierenden Kurzintervention ..................... 94 Publication IV. Short- to Midterm Effectiveness of a Brief Motivational Intervention to Reduce Alcohol Use and Related Problems for Alcohol Intoxicated Children and Adolescents in Pediatric Emergency Departments: A Randomized Controlled Trial ............ 126 Publication V. Drinking patterns of alcohol intoxicated adolescents in the emergency department: a latent class analysis ................................ 142 Silke Diestelkamp: Effectiveness of a brief alcohol intervention vi Publication VI. Einfluss von Berater/-innen- und Interventions- variablen auf die Veränderungsmotivation von Kindern und Jugendlichen nach einer motivierenden Kurzintervention zur Reduktion riskanten Alkoholkonsums ........................................... 152 A P P E N D I X II .................................................................................................... 169 Complete list of author´s publications ........................................................ 169 A P P E N D I X III ................................................................................................. 175 Curriculum vitae ......................................................................................... 175 Silke Diestelkamp: Effectiveness of a brief alcohol intervention 1 A BSTRACT Background. Brief interventions (BI) in the emergency department (ED) provide an opportunity to motivate children and adolescents with risky alcohol use to reduce consumption. However, evidence of effectiveness of this approach is inconclusive. Against the theoretical background of motivational interviewing and the dual process framework of adolescent risk behaviour, this cumulative dissertation examined effectiveness and differential effectiveness of a brief motivational intervention (BMI) delivered in the presumed teachable moment potentially associated with medical treatment as a result of an acute alcohol intoxication (AAI). Method. The methodological, conceptual, and empirical background for investigation of this research question were elaborated in a study protocol for a randomized controlled trial (RCT) testing the effectiveness of this approach, a systematic review on effectiveness of alcohol BIs for adolescent ED patients and an intervention manual for the delivery of a BMI for children and adolescents following an AAI. Characteristics of the target population with regard to habitual drinking and associated psychosocial problems were investigated using latent class analysis. Effectiveness of the BMI was tested in a RCT against treatment as usual (TAU), which comprised an information leaflet on alcohol-associated risks. Patient variables, counsellor variables and intervention content were examined as potential moderators of intervention effectiveness. Results. N = 316 ED patients aged 12 to 17 years participated in the RCT. Latent class analysis of habitual drinking identified 5 distinct classes with 61.2% habitually consuming at low-risk. At-risk and high-risk drinking classes showed heterogeneous patterns of habitual drinking with high-risk drinking being most strongly associated with psychosocial problems. Mixed-effects analysis of covariance of data from the RCT revealed that participants who received