We evaluated the 12-month outcomes of a brief intervention, enhanced by a consistent support person, which aimed to facilitate referral attendance for substance use treatment following a hospital alcohol or other drug (AOD) presentation. Outcomes were assessed as: attendance for substance use treatment; the number of hospital AOD ED presentations; change in AOD consumption and psychological wellbeing (GHQ-12). We recruited 127 adolescents, with 60 randomised to the intervention and 67 receiving usual care. At 12 months, 87 (69%) were re-interviewed. Significantly more of the intervention than the usual care group (12 versus 4) had attended a treatment agency. Excluding the index presentations, there were 66 AOD hospital presentations post intervention, with the proportion of AOD events falling for the intervention group, whilst no change occurred for the usual care group. Irrespective of randomisation, those who attended for substance use treatment had a greater decline in total self-reported drug use than the remainder. Both intervention and usual care groups had improved GHQ-12 scores by 12 months, with reduction in GHQ scores correlated with reduced drug use. In conclusion, while brief intervention in ED only has limited success in facilitating adolescents to attend for subsequent AOD treatment, it can significantly reduce the number of AOD related ED presentations. (c) 2005 Elsevier Ireland Ltd. All rights reserved.