The effectiveness of brief interventions in the clinical setting in reducing alcohol misuse and binge drinking in adolescents: a critical review of the literature

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Abstract
To investigate the effectiveness of brief interventions for adolescent alcohol misuse and to determine if these interventions are useful in reducing alcohol consumption. To determine if brief interventions could be used successfully by nurses in the clinical setting. Australian adolescents are consuming risky levels of alcohol in ever increasing numbers. The fiscal, health-related and social costs of this alcohol misuse are rising at an alarming rate and must be addressed as a matter of priority. Brief interventions have been used with some success for adult problem drinkers in the clinical setting. Brief interventions delivered in the clinical setting by nurses who are 'on the scene' are therefore a potential strategy to redress the epidemic of adolescent alcohol misuse. Literature review. Multiple databases were searched to locate randomised controlled trials published within the past 10 years, with participants aged 12-25 years. Included studies used brief intervention strategies specific to alcohol reduction. Fourteen studies met these criteria and were reviewed. A range of different interventions, settings, participant age-ranges and outcome measures were used, limiting generalisability to the studied populations. No trials were carried out by nurses and only one took place in Australia. Motivational interviewing (one form of brief intervention) was partially successful, with the most encouraging results relating to harm minimisation. Long-term follow-up trials using motivational interviewing reported significant reductions in alcohol intake and harmful effects, but this may be partially attributed to a normal maturation trend to a steady reduction in alcohol consumption. No single intervention could be confidently recommended due to confounding evidence. However, successful elements of past studies warrant further investigation. These include face-to-face, one-session, motivational interviewing-style brief interventions, focusing on harm minimisation and all with long-term follow-up. The introduction of brief interventions in the hospital setting has the potential to address the epidemic of adolescent alcohol misuse. Nurses are well placed to deliver these interventions, but a standardised approach is required to ensure consistency. Further research is urgently needed to ensure clinical practice is based on the best available evidence and to ensure findings are more relevant to Australian adolescents and to nurses in a clinical setting.