Brief telephone interventions for reducing future alcohol use and related harm in young people accessing emergency departments

Participants are randomized to receive a 1x30 minute telephone session of Assessment Feedback and Information (AF), 2x30 minute telephone sessions of Quik-Fix motivational interviewing (MI) or 2x30 minute telephone sessions of a Personality-Targeted Intervention (PI). The two telephone sessions in the MI and PI groups occur one week apart. i) Quik-Fix MI: The Quik-Fix MI comprises a number of components. First AF delivered in a MI style (i.e. empathically, amplifying the person’s own concerns). MI about alcohol is then provided to: (a) build readiness and commitment to make a change (including pros and cons of current use and change), (b) negotiate change goals, and (c) develop a plan for change. Individuals do not progress to Step b or c unless they are ready to change (i.e. rating > 7/10 on importance of change & confidence to change likert scales). Homework (cued by emailed session summaries) for MI after Session 1 comprises review of their pros/cons balance sheet, and after Session 2, review of alcohol change plan or harm minimization strategies (if not ready to make a change). Brief post session SMSs remind the young person about the benefits of alcohol change they identified and any alcohol-related goals and plans. Four reminder SMSs with the same content are sent at 2, 4, 8 and 10 months post-baseline. ii) Brief Personality-Targeted Intervention (PI): PI incorporates personality specific AF, MI and cognitive-behavioural coping skills training components. The intervention targets how individuals with specific personality risk factors cope with their vulnerability to alcohol misuse. In Session 1, the young person is given personalised AF, that includes psychoeducation about their dominant personality trait (anxiety proneness, depression proneness, impulsivity, or sensation seeking), associated problematic, personality-specific coping behaviors (e.g. avoidance, aggression, risky behaviors), and how this may affect their alcohol and other substance use. Participants are given information on alcohol harm minimization strategies and are encouraged to think about how they could have used some of these strategies to prevent the recent alcohol-related injury or illness which resulted in their ED admission. In contrast to standard MI, PI does not restrict discussion of potential change strategies to participants who elect to change their drinking. Instead, it encourages them to develop implementation intentions, which are specific hypothetical or actual plans for change, which take the form “if situation Y is encountered, I could use Z coping behaviour, in order to achieve my alcohol use goal”. Young people are guided to develop an implementation intention for future alcohol use situations. They are asked to identify an alcohol use situation in which they could test this alcohol plan in the next week and are asked to rate their level of confidence (1-10) in implementing the plan. They are emailed a session summary and a brief SMS message as a reminder. In Session 2, the young person’s success in implementing their alcohol use plan is reviewed and if necessary, the plan is revised. Young people then receive personality-specific training in two cognitive behavioural coping skills. Those predominantly with anxiety proneness are given training in mindful breathing and thought awareness and acceptance training for anxious thoughts. Young people high in depression proneness receive behavioural activation and thought awareness and acceptance training for depressive thoughts. Sensation seekers receive training in savouring techniques to increase their awareness and ability to focus on and experience positive feelings from everyday activity (e.g. mindful eating) and are encouraged to identify and schedule natural highs from functional activities (e.g. exercise, skateboarding, rock climbing) and daily experiences (food, sex, music). Young people with high levels of impulsivity receive mindfulness training to increase awareness of their thoughts and are encouraged to apply the Stop-Think-Do rubric to help them slow down their decision-making processes sufficiently to consider likely outcomes of behavioural alternatives. Session 2 concludes with the young person developing an implementation intention for future alcohol-related situations, which incorporates their personality-specific coping skills. A session summary and a SMS reminder of their alcohol use plan is subsequently sent. As in MI, SMSs are sent at 2, 4, 8 and 10 months post-baseline to remind the participant of their alcohol use plan.