Psychological outpatient follow-up after hospitalization for adolescent acute alcohol intoxication

Abstract

Alcohol-related emergency department attendance in adolescents should be considered as a valuable opportunity to address and mitigate future alcohol consumption. Therefore, a paediatric department of a major district hospital in the Netherlands developed an outpatient preventive program targeting adolescents admitted for acute alcohol intoxication. The primary aim of this study is to evaluate how adolescent drinking patterns participating in the preventive program developed over time. This retrospective observational study involved 310 patients from the Reinier de Graaf Hospital, Delft, the Netherlands (years 2014–2022). The outpatient preventive program consists of three main components: an initial intervention, subsequent an extended counselling session and psychological interventions. The alcohol consumption was compared at three time points: before the admission for acute alcohol intoxication(T = 0), 4–6 weeks after hospital admission (T = 1) and 6–12 months after the hospital admission (T = 2). Moreover, sociodemographic variables, adolescent risk-taking behaviour and family and pedagogical factors were included in secondary analysis. Adolescents who experienced an alcohol intoxication exhibited more adolescent risk-taking behaviour (higher rates of lifetime smoking, substance use and sexual intercourse) compared to the Dutch average. Initially, these adolescents had significantly higher rates of alcohol consumption and drunkenness. Alcohol use decreased significantly in the month following intoxication, even below the Dutch average. Though 6–12 months later, their alcohol consumption increased but remained statistically lower and involved less binge drinking than the Dutch average.

Conclusions: The findings of this study demonstrate that a preventive program following acute alcohol intoxication contributes to the reduction of adolescent alcohol use and associated risk-taking behaviours.

What is Known: • Earlier studies showed that adolescents with problematic alcohol use reported reduced alcohol consumption and fewer alcohol-related problems after participating in a motivational interviewing intervention compared to standard care. • During the follow-up assessment of adolescents with acute alcohol intoxication it is possible to signalize mental disorders and to determine whether the patient requires referral to specialized mental healthcare.

What is New: • These findings suggest that the preventive program had a short-term impact in reducing alcohol consumption among adolescents with acute alcohol intoxication, as well as a long-term impact in reducing binge-drinking behaviours. • The program’s success in mitigating binge-drinking behaviours aligns with its goals of promoting safer drinking habits among adolescents.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00431-024-05856-1.

Introduction

Increasing numbers of youth in need of emergency medical treatment following acute alcohol intoxication (AAI) have been a major public health concern in Europe [1]. This while alcohol consumption between the age of 10 and 24 is the most important risk factor to disability-adjusted life years [2]. Moreover, AAI can result in a variety of immediate medical complications, including decreased consciousness, hypothermia, electrolyte disturbances and secondary injuries [3]. Also, alcohol in adolescence impacts brain development and leads to impairment of the brain and cognitive and behavioural dysfunctions [4]. Negative effects on social well-being and behaviour can encompass various aspects, such as susceptibility to peer influence, engaging in risky sexual behaviour, participation in criminal activities and decline in academic achievement [5–7].

Common mental health issues in adolescents, including anxiety, depression, impulsive behaviour and feelings of shame or guilt, can serve as a trigger for alcohol consumption or emerge as a consequent of alcohol consumption [8–10]. Disadvantaged and especially vulnerable populations have higher rates of alcohol-related hospitalization and even death [11]. Thus, excessive alcohol use in adolescents continues to be a major public health problem [12] and indicated preventive interventions as early as in adolescence are essential [13, 14].

Alcohol-related emergency department attendance should be considered as a valuable opportunity to address and mitigate future alcohol consumption [1]. Earlier studies showed that adolescents with problematic alcohol use reported reduced alcohol consumption and fewer alcohol-related problems after participating in a motivational interviewing intervention compared to standard care [15–17]. Follow-up assessment of adolescents who were admitted for AAI demonstrates a brief period of reduced alcohol consumption shortly after the incident [18]. Moreover, during the follow-up assessment of adolescents with AAI, it is possible to signalize mental disorders and to determine whether the patient requires referral to specialized mental healthcare [19].

In 2007, the Paediatric Department of a major district hospital in the Netherlands developed an outpatient preventive program targeting adolescents admitted for AAI. The program consists of three main components: an initial intervention, subsequent an extended counselling session and psychological interventions.

The primary aim of this retrospective cohort study is to evaluate how drinking patterns of adolescents participating in the preventive program developed over time. Secondary aims were to evaluate risk factors of adolescent alcohol use: substance use patterns, development, positive family history of substance use disorders, parental awareness and alcohol-specific parental rule setting.

Materials and methods

Study design and setting

This retrospective observational study was conducted in the Reinier de Graaf hospital, Delft, the Netherlands, whereas prevention-intervention program at the ‘Outpatient Department for Adolescents and Alcohol’ was implemented in 2007. Adolescents < 18 years of age were invited to the follow-up program after emergency department presentation or hospital admission related to alcohol consumption. Alcohol consumption was defined as reported alcohol use or a blood alcohol concentration > 0.0 g/l. Both the psychological follow-up program and the paediatric alcohol questionnaire are standard care for this population, no additional intervention was conducted because of this study.

The program consists of three main components: an initial intervention, subsequent an extended counselling session and psychological interventions. The initial intervention is conducted on the next day following admission by a trained nurse or pedagogical worker and aims to raise awareness. This includes an introduction to our outpatient clinic, an informative talk and e-learning about alcohol. In total, this initial intervention takes about 1–2 h and parents are only involved in the introduction of the outpatient clinic. The extended counselling session with the paediatrician occurring 3 to 6 weeks after hospital admission focuses on providing a detailed understanding of how alcohol affects adolescents. In this session, the paediatrician with alcohol expertise makes use of visual and verbal information and tries to alter his information provided based on the relevance for the specific patient. Parents are also invited to join during this session. The psychological interventions consist of a screening consultation aiming to identify psychological risk factors for the continuation of binge drinking, signalizes mental disorders or psychosocial problems and incorporates motivational interviewing. This consultation is done by the child psychologist and takes place approximately 4 to 6 weeks after hospital admission. Finally, the child psychologist does a final consultation that takes place 6 to 12 months after the emergency department attendance to evaluate how it has been going with the adolescent since their last consultation. Prior research demonstrated follow-up rates of this outpatient clinic were 91% for the consultation at the paediatrician and 67% at the follow-up by a child psychologist [19]. This specific study targets the adolescents that completed the consultation(s) with the child psychologist. The psychological consultation was split in three different sections: one with the adolescent alone, one with the parents and one with all the family members together.

Data collection

Cases were identified using a search engine in the hospital’s electronic health record (Chipsoft HiX, Amsterdam, the Netherlands). The files were extracted by the hospital’s data warehouse based on the presence of a diagnosis and treatment combination code ‘intake alcohol intoxication’, which is used by the child medical psychology department to register all initial consultations related to alcohol intoxication. This registration format at the psychological outpatient clinic was used from 2014 onwards, and therefore, data was extracted since 2014. Demographical data were extracted from the health record. All other data were extracted from the medical records of the semi-structured consultation with the child psychologist which took place 4 to 6 weeks after hospital admission and final consultation 6 to 12 months after hospital admission. Pseudonymized data was stored in an online database (Castor Electronic Data Capture, Ciwit BV, Amsterdam, the Netherlands).

Variables primary outcomes

The primary aim was to determine how alcohol consumption patterns developed during the follow-up program. Alcohol consumption before the admission for AAI (T = 0) was assessed during the intake consultation with the adolescent alone by the child psychologist. Secondly, alcohol consumption 4–6 weeks after hospital admission was assessed during the psychological intake at that time point (T = 1). Lastly, alcohol consumption 6–12 months after the hospital admission was reassessed during the follow-up session at that time point with the child psychologist (T = 2).

At T = 0, alcohol consumption before the hospital admission, was assessed by three different outcome measures: lifetime prevalence, lifetime drunkenness and lifetime binge drinking. At T = 1 and T = 2 assessed last month alcohol use and binge drinking. Lifetime prevalence was assessed by asking whether the adolescent had ever consumed alcohol before the hospital admission. Last month prevalence was assessed by asking if the adolescent consumed alcohol in the last month. Binge drinking was assessed by asking if the adolescent consumed more than 4 (for girls) or more than 5 drinks (for boys) on a single occasion.

The results of these specific outcome measures were compared to a reference group from a nationally representative sample based on year of admission, sex and age [20–25]. Detailed comparisons are provided in Table A and B in the appendix. The reference group were sourced from the Health Behaviour in School-aged Children (HBSC) and Peilstations research project, who performed validated questionnaires in the Dutch school-going children in the years 2013, 2015, 2017, 2019 and 2021. The values used for matching study to reference group data includes adolescents’ alcohol use parameters (Lifetime alcohol use, lifetime drunkenness, last month alcohol use, last month binge drinking) and risk-taking behaviour parameters (lifetime prevalence smoking, last month smoking, lifetime cannabis use, lifetime sexual intercourse). These parameters of the reference group were collected via standardized digital questionnaires of the HBSC/Peilstation, while in this study these same parameters were collected verbally. Patients in the study were matched based on their year of admission to the same or previous year of the reference group. If exact matching was not possible due to missing information in the reference group, the closest available year was used.

Measures

Sociodemographic variables such as year of hospital admission, age and sex were extracted from the electronic health records.

Adolescent risk-taking behaviour was assessed by the following measures: age at first alcohol use, lifetime prevalence of smoking, lifetime prevalence of substance use and lifetime prevalence of sexual intercourse. Smoking was defined as categorical variables with three categories: never smoked, stopped smoking, currently smoking. Furthermore, internalizing and externalizing behaviour were assessed using the validated Child Behaviour Checklist (CBCL), which includes three questionnaires: CBCL/6–18 by parents, the Teacher’s Report Form (TRF) and the Youth Self Report (YSR). The CBCL evaluates two scales: internalizing problems (including anxious/depressed, withdrawn-depressed and somatic complaints) and externalizing problems (including rule-breaking and aggressive behaviour). This outcome measure is expressed as the percentage of adolescents clinical score on one of the two scales or total score.

Family and pedagogical factors were assessed using the semi-structured intake consultation, conducted separately with the adolescent and with the parents. Family history was assessed by determining the prevalence of alcohol or substance use disorder among first-, second- or third-degree family members. Exposure to parental alcohol use was assessed by asking whether the adolescent had ever seen a parent drunk. Alcohol-specific parental rule setting was assessed during the session with the adolescent alone and during the session with parents alone. Alcohol-specific parental rule setting was defined as a categorical variable ranging from 1 to 3: no rules or approval (1), rules (2), strict alcohol-specific parental rule setting/not allowed (3) and was asked to the parents and adolescent separately. Parental awareness was assessed by comparing the adolescent’s self-reported lifetime prevalence and last month prevalence of alcohol use with those reported by the parents. Details are provided in Table 3.

Table 3.

Alcohol-specific parental rule setting and parental awareness

	T = 0	T = 1
Alcohol-specific parental rule setting
Strict alcohol-specific parental rule setting	34.6%	67.6%
Permission with rule setting	25.3%	15.2%
Approval or absent rule setting	40.1%	17.2%
Perceived rule setting
Rule-setting concordant	71.7%	82.0%
Parental awareness
Alcohol use concordant	76.7%
	Child	Parent
Lifetime prevalence alcohol use	89.2%	70.7%
Last month’s prevalence alcohol use (T = 1)	31.4%	23.3%

Data analyses

Descriptive statistics were used to present baseline characteristics of the study population. Categorical variables were expressed as proportions. The normality of continuous variables was assessed using the Kolmogorov–Smirnov test. Continuous variables were reported as medians with interquartile range (IQR) for non-normally distributed data or as means with standard deviation (SD) for normally distributed data. Development in drinking patterns were assessed using McNemar test for two-category paired data and the Wilcoxon signed-ranks test for paired ordinal data. Adolescent risk-taking behaviour and alcohol use parameters from the study population were compared to the reference population using a chi-square goodness of fit test. The significance level for all statistical tests was set at α = 0.05. Statistical analyses were performed using IBM SPSS Statistics for Windows, Version 28.0 (Armonk, NY, USA: IBM Corp.).

Ethics

Only patients who gave consent to the Youth and Alcohol department (data ≥ 2018) or to the former the Dutch Paediatric Surveillance System (data < 2017) for data collection for research purposes using the Paediatric Alcohol Questionnaire were included in this study. The data collection procedure was approved by the Medical Ethics Committee Leiden The Hague Delft, as well as by the research committee and board of directors of the Reinier de Graaf Hospital.

Results

Study population

Between 2014 and 2022, a total of 310 adolescents presented to the emergency department due to AAI and subsequently received outpatient follow-up care from a child psychologist. The characteristics of these patients are summarized in Table 1. The median age of the cohort was 16 years (interquartile range [IQR] 1.0 year), with no patients younger than 11 years. There was a slight female predominance, accounting for 57.7% of the cohort.

Table 1.

Population characteristics for total sample

Sociodemographic characteristics	Study population (n = 310)
Year of emergency department presentation
2014–2016	160 (51.6%)
2017–2019	98 (31.6%)
2020–2022	52 (16.8%)
Sex
Female	179 (57.7%)
Male	131 (42.3%)
Age
≤ 14 years	67 (21.6%)
15 years	83 (26.8%)
16 years	98 (31.6%)
17 years	62 (20.0%)
Adolescent risk-taking behaviour
Age at first alcohol use	14 (IQR 2)
Lifetime prevalence smoking	47.6%
Current smoking status
Never smoked	52.3%
Former smoker	24.0%
Current smoker	23.6%
Lifetime prevalence cannabis use	38.1%
Lifetime prevalence sexual intercourse	25.7%
Psychological factors
Psychological disorders	43.9%
AD(H)D	20.6%
Clinical score CBCL1,2	15.1%
Family and pedagogical factors
Family history of alcohol- and substance use disorders
Positive in the first degree	14.2%
Positive in the second or third degree	31.1%
Exposure to parental alcohol use
Seen parents drunk	41.5%

¹CBCL = child behaviour checklist

²Clinical score as a proportion of adolescents without history of psychological disorders

Adolescent risk-taking behaviour, family and pedagogical factors and psychological disorders

The median age at first alcohol use was 14.0 years (IQR 2.0 years). The lifetime prevalence of smoking was 47.6%, with 23.6% classified as current smokers at baseline. The lifetime prevalence of cannabis use was 38.1%. Additionally, 25.7% had engaged in sexual intercourse. A first-degree relative with a history of alcohol or substance use disorders was reported by 14.2% of the adolescents, while 31.1% reported a second- or third-degree relative with such a history. Exposure to parental drunkenness was noted in 41.5% of cases. An earlier diagnosed psychological disorder was present in 43.9% of the adolescents with AAI, with Attention-deficit/hyperactivity disorder (ADHD) being the most common diagnosis. Among those without a prior psychological disorder, 15.1% had clinical scores on the CBCL indicative of undiagnosed psychological disorders.

The chi-square goodness-of-fit test indicated that the lifetime prevalence of smoking was significantly higher in the study population (47.7%) compared to the general Dutch adolescent population (32.1%, χ²(2) = 28.7, p < 0.001). The lifetime prevalence of sexual intercourse in the study population (22.1%) did also differ significantly from that of the general Dutch adolescent population (16.3%, χ²(2) = 15.5, p < 0.001). Furthermore, the lifetime prevalence of cannabis use was significantly higher in the study population (38.1%) than in the general Dutch adolescent population (20.0%, χ²(2) = 54.6, p < 0.001).

Alcohol use parameters at baseline

The alcohol use parameters at baseline are presented in Table 2. At the initial assessment (T = 0), the majority of adolescents (89.2%) reported alcohol consumption prior to their alcohol-related emergency department visit. In 10.8% of cases, the emergency department visit was due to first-time alcohol use. The lifetime prevalence of alcohol use in the study population (89.2%) was significantly higher compared to the general Dutch adolescent population (65.8%, χ²(2) = 72.0, p < 0.001). Additionally, nearly two-thirds of the adolescents (64.7%) had experienced drunkenness at least once. The prevalence of drunkenness was significantly higher in the study population than in the general Dutch adolescent population (41.8%, χ²(2) = 64.5, p < 0.001). However, among those who had consumed alcohol prior to the emergency department visit, the prevalence of binge drinking was significantly lower in the study population (49.2%) compared to the general Dutch adolescent population (75.5%, χ²(2) = 98.4, p < 0.001).

Table 2.

Prevalence of alcohol use during the outpatient follow-up program

	Sex		Age				Total
	Male	Female	≤ 14	15	16	17
Lifetime prevalence alcohol use1
T = 0	90.4%	88.3%	77.4%	84.1%	96.8%	96.6%	89.2%*
Lifetime prevalence drunkenness
T = 0	63.3%	65.7%	46.9%	56.1%	74.2%	80.3%	64.7%*
Last month alcohol use
T = 1	36.0%	28.1%	18.0%	24.4%	36.6%	46.7%	31.4%*
T = 2	49.5%	33.1%	26.7%	41.0%	38.7%	55.1%	40.4%*
Last month binge drinking2
T = 0	52.2%	47.0%	31.3%	40.6%	57.8%	61.4%	49.2%*
T = 2	25.5%	25.0%	36.4%	25.0%	18.5%	28.0%	25.3%*

¹Lifetime prevalence of alcohol use before the emergency department presentation for AAI

²Last month binge drinking as a proportion of last month’s alcohol use

^*Significantly different than reference population based on chi-square goodness-of-fit test, p < 0.05

Alcohol use parameters over time

At the intake assessment (T = 1), two-thirds of the adolescents (68.6%) reported not consuming alcohol between the alcohol-related emergency department visit and the intake with the child psychologist. The last month prevalence of alcohol use at T = 1 was significantly lower in the study population (31.4%) than in the general Dutch adolescent population (47.7%, χ²(2) = 31.5, p < 0.001). An exact McNemar test was conducted to determine whether the proportion of alcohol abstinence was sustained over time. During the follow-up period, the prevalence of alcohol use in the last month significantly increased to 43.9% at T = 2 (McNemar p = 0.023). However, the last month prevalence of alcohol use at T = 2 (40.4%) remained significantly lower than that in the general Dutch adolescent population (47.7%, χ²(2) = 4.9, p = 0.027). Conversely, the proportion of binge drinking significantly decreased during the outpatient follow-up program (McNemar p < 0.001).

Development of alcohol-specific parental rule setting and parental awareness

Prior to the alcohol-related emergency department visit, a substantial proportion of parents either approved of alcohol use or did not have specific rules regarding it (40.1%). One-third of the adolescents (34.6%) reported having strict alcohol-specific parental rules. Following the emergency department visit, 37.6% of parents adopted stricter alcohol-specific rules (Wilcoxon p < 0.001). The outpatient follow-up program led to an increase in the concordance of perceived parental rule setting, from 71.7 to 82.0%. Parental awareness of lifetime and last month alcohol use (at T = 1) indicated that parents underestimated their children’s alcohol consumption by 23.3%, as shown in Table 3.

Discussion

The findings of this study provide significant insights into the drinking patterns and associated risk behaviours among adolescents participating in a preventive program following AAI. Our results indicate that these adolescents exhibit higher rates of lifetime smoking, substance use and sexual intercourse compared to national averages, suggesting a broader spectrum of risk-taking behaviours associated with early and excessive alcohol use. Moreover, nearly half of the patients had a positive family history of alcohol or substance use disorders among first-, second- or third-degree relatives. This aligns with existing literature indicating that a family history of substance use disorders significantly increases the risk of similar behaviours and psychiatric morbidity in offspring [26].

Additionally, exposure to parental drunkenness was reported in 41.5% of cases, which literature suggests increases the risk of adolescent binge drinking by approximately twofold [27]. Nearly half of the adolescents with AAI had a confirmed psychological disorder, with ADHD being the most prevalent. Prior studies have shown a strong association between alcohol exposure and the development of mental disorders, highlighting the need for comprehensive mental health assessments in this population [19, 28]. Among patients without a prior diagnosed psychological disorder, 15.1% had clinical scores on CBCL indicative of undiagnosed psychological disorders. It is crucial to identify these new mental health issues and determine the need for referral to specialized care to prevent recurrent hospital admissions and future regular alcohol consumption [19].

Initial alcohol consumption patterns

At baseline, the data revealed that adolescents with AAI had significantly higher instances of alcohol consumption and episodes of drunkenness before the AAI event compared to their peers. This finding is consistent with previous research indicating that early initiation and frequent alcohol use are predictors of more severe drinking problems and related risk behaviours in adolescence and later life [29]. However, the prevalence of binge drinking before alcohol intoxication was reported lower than the Dutch average, which is unexpected since binge drinking is associated with alcohol intoxication [29]. On the other hand, all these patients did eventually perform in binge drinking resulting in their alcohol intoxication.

Post-intoxication changes in drinking behaviour

Following the acute intoxication event, a notable decline in alcohol use was observed in the subsequent month. This reduction could be attributed to the immediate health scare and the subsequent intervention efforts, reflecting the known short-term efficacy of preventive programs in mitigating risky drinking behaviours [18]. Alcohol consumption rose at 6–12 months post-intoxication, compared to 4–6 weeks after AAI, still remaining to be below the Dutch average. Interestingly, binge drinking did not increase proportionately 6–12 months post-intoxication. This suggests a potential shift in drinking patterns towards less intensive drinking sessions. The prevention programs might therefore also be successful in curbing binge-drinking behaviours in the long run, which are often associated with acute health risks and long-term negative outcomes [29].

Alcohol-specific parental rule setting and parental awareness

Prior to the alcohol-related emergency department presentation, a substantial proportion of parents either approved of alcohol use or did not have specific rules regarding it. Only one-third of the adolescents reported having strict alcohol-specific parental rules. Following the emergency department visit, more than one-third of parents adopted stricter alcohol-specific rules. This is a positive sign since indulgent and negligent parenting styles are associated with a significant increase in prevalence of adolescent binge drinking with 2.51- and 2.82-fold, respectively [27]. Additionally, adolescents’ perception of high parental disapproval of substance use has been prospectively associated with a non-binge-drinking trajectory [30]. Parental awareness of lifetime and last-month alcohol use indicated that parents underestimated the presence of their children’s alcohol consumption by 23.3%. This research shows that parental monitoring and involvement is a protective factor for alcohol use among adolescents [31, 32].

Strengths and limitations

This study has several strengths that enhance the reliability and significance of its findings: the longitudinal design allows for the observation of changes in drinking patterns over time, providing a dynamic view of adolescent behaviour post-intervention. This design helps understand the long-term effects and sustainability of the preventive program. Additionally, by evaluating not only alcohol consumption but also related risk behaviours such as smoking, substance use, sexual activity, psychological disorders and family and pedagogical factors, the study offers a holistic understanding of the adolescent risk profile. The comprehensive assessment helps identify correlations and potential causal relationships between different risk behaviours. Furthermore, comparing the study population’s behaviours with Dutch national averages contextualizes the findings, highlighting the extent of risk behaviours in the studied group relative to broader trends. This comparison underscores the specific needs of the targeted population.

However, a limitation of this study is the lack of a control group of patients with alcohol intoxication who did not receive follow-up care, making it difficult to determine the extent to which the intervention program or the alcohol intoxication itself resulted in the observed decrease in alcohol use, though previous studies have shown that adolescents with problematic alcohol use reported reduced alcohol consumption and fewer alcohol-related problems after participating in motivational interviewing interventions compared to standard care [15–17]. Suggestion for further research would therefore be to perform a randomized controlled trial to test effectiveness of the outpatient clinic program with a group of adolescents with AAI with and without this follow-up care.

Furthermore, it is important to underscore that the same adolescent risk-taking behaviour measures were used in the reference group and the study population. Although in the reference group, they were collected via standardized digital questionnaires of the HBSC/Peilstation, while in this study these same parameters were collected verbally. This might result in an underestimation of the study population adolescent risk-taking behaviour because it is less anonymous and might be harder to admit in person.

Moreover, another limitation is the missing information of patients that were lost to follow-up. Prior research demonstrated follow-up rates of this outpatients clinic was 67% at the child psychologist [19]. During the study period, there might have been a shift in the consultation approach with the child psychologist from universal prevention (where every adolescent was referred) to indicated prevention (where referrals were based on initial assessments and concerns). This potential change was because of personnel shortage at the paediatric medical psychology department and the corona pandemic which made live appointments in the hospital more complex. This change introduced heterogeneity into the lost-to-follow-up population and might have led to a selection bias of the study population, potentially resulting in either overestimation or underestimation of the actual problems among participants. The missing outcome parameters of adolescents who did not visit the paediatric psychology department due to for instance continuation of pre-existing mental health care or direct referral to mental health care likely lead to underestimation of the prevalence of major outcomes in the study. Conversely, adolescents who were not referred to the psychology department due to indicated prevention might lead to overestimation of the prevalence of major outcomes among those that visited that paediatric psychology department. Moreover, patients with AAI who came from a different region were referred back to their own region for follow-up because of logistical reasons and to shorten travel time to the hospital. The effect of the adolescents that dropped out before visit to the paediatric psychology department could hypothetically influence the study results in both directions, making it challenging to precisely assess the overall impact (either underestimation or overestimation) of the findings. However, it is hypothesized that the true impact lies somewhere between these extremes.

In conclusion, these findings suggest that the preventive program had a short-term impact in reducing alcohol consumption among adolescents with acute alcohol intoxication (AAI), as well as a long-term impact in reducing binge-drinking behaviours. The program’s success in mitigating binge-drinking behaviours aligns with its goals of promoting safer drinking habits among adolescents.

Supplementary Information

Below is the link to the electronic supplementary material.

Abbreviations

AAI

Acute alcohol intoxication

ADHD

Attention-deficit/hyperactivity disorder

CBCL

Child Behaviour Checklist

HBSC

Health Behaviour in School-aged Children

TRF

Teacher’s Report Form of Child behaviour checklist

YSR

Youth Self Report of Child behaviour checklist

Authors’ contributions

All authors contributed to the study conception and design. Data entry was performed by AB. Data preparation and analysis were performed by LP and LdV. The first draft of the manuscript was written by LP and LdV and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Funding

The author declares that no funds, grants or other support were received during the preparation of this manuscript.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethical approval

Only patients who gave consent to the Youth and Alcohol Department (data ≥ 2018) or to the former the Dutch Paediatric Surveillance System (data < 2017) for data collection for research purposes using the Paediatric Alcohol Questionnaire were included in this study. The data collection procedure was approved by the Medical Ethics Committee Leiden The Hague Delft, as well as by the research committee and board of directors of the Reinier de Graaf Hospital. Moreover, this study was performed in line with the principles of the Declaration of Helsinki.

Competing interests

The authors declare no competing interests.