**11. Intervention & follow up**

After treatment of the acute problems and sobering up, the multiple alcohol-use related problems mentioned above should be attended to in an evaluation.

Many treatments for alcohol use disorders can be applied to decrease alcohol use. Among them are family treatment, (short) motivational enhancement therapy and behavioral therapy, which all seem to have a significant positive effect on alcohol and substance use (41).

After receiving information in the hospital setting, the patients visit a pediatrician and a pediatric psychologist at the outpatient clinic. The program consists of several appointments.

At the appointment with the pediatrician, the patient's general alcohol and drug use, school problems and social issues are addressed. By means of a presentation several alcohol related problems are addressed, such as epidemiology, metabolism, neurological and physical consequences, case reports, peer pressure (for example at sport facilities), media attention and marketing strategies of alcohol industries. The role of the parents is emphasized as well; alcohol-specific rules are pointed out, such as; rules on vacation are the same as those at home, parents are not supposed to drink in front of their children, not to mention invite them to try. To optimize the effect of the intervention, these issues can be individualized depending on the patient's interest.

The child psychologist performs a psychological interview to screen for underlying problems. The patient is also evaluated based on behavioral questionnaires (Youth Self Report (YSR), Child Behavior Checklist (CBCL) and Teacher Report Form (TRF), to be filled in by patient as well as parents and teachers), and earlier and recent educational performance. The interaction between parents and adolescent is taken into account, and life events and psychosocial history also are important issues for discussion. Once again the dangers of alcohol use are explained.

When indicated, psychological, social, medical or addiction-related treatment is offered. Some services can be offered within the setting of the outpatient clinic, for others, the patient can be referred elsewhere. Although treatment is not always necessary, follow-up is done at all times. After the first appointments the patient will be contacted within 6 months after the event to discuss alcohol use and general well-being. However, often the pediatrician or child psychologist finds it necessary to see the patient in the mean time because of related issues.

In conclusion, underlying social and neuropsychological problems can come to light during psychological and pediatric screening and can be treated when indicated. The dangers of alcohol are being explained extensively to patients as well as parents. Help can consist of psychological treatment or referral to detox clinics or other youth care institutions.

Preliminary results of the project are promising. At follow-up, 84-88 % of the patients had stopped binge drinking and 61% had stopped the consumption of alcohol. Awareness of the parents was another factor of interest; at follow up 82,5 % of the parents applied specific alcohol rules, including prohibition of alcohol under 16 years of age. Behavioral questionnaires were filled in by 89% of the study population. Neuropsychological screening was done in 72% of the patients for whom it was indicated.
