Disorders - Substance Use Disorders
Harris, S. K., Sherritt, L., Grubb, L., Samuels, R., Silva, T., Vernacchio, L., Wornham, W., Erdem, G., Knight, J. R.
Purpose: Substance use (SU) can harm the developing adolescent brain, making delaying its initiation or decreasing its frequency among youth an important public health goal. National guidelines recommend primary care providers screen all adolescents for SU and give brief advice, but studies show that adherence to this recommendation is suboptimal. Often cited barriers to screening include lack of time and training. To ameliorate these barriers, we developed a computer-facilitated Screening and Brief Advice (cSBA) system consisting of computerized pre-visit screening and psychoeducation for patients, and point-of-care decision support and advice guidance for providers. We tested the system's effects, compared to treatment as usual (TAU), on adolescent receipt of provider advice to avoid SU, and on SU prevention during a 12-month follow-up, as indicated by time to first substance use post-visit. Methods: Patients ages 11-20 years with upcoming well-visits at 5 Boston-area pediatric primary care practices (54 participating providers) were consecutively recruited in 2015-2016 through mailed informational letters, or upon arrival for their visit. Participants (N = 1011) provided informed assent (18 years), with an IRB-approved waiver of parent consent. Before seeing their provider, participants completed the CRAFFT 2.0 screen on a tablet computer, and then were randomized within site (1:2.5) to receive either TAU (n = 279) or cSBA (n = 732). The computer program then presented cSBA participants with immediate personalized feedback about their screen results, brief psychoeducation on substance use risks to health and development, and gave providers the screening results, "talking points" (guiding 2-3 minutes of brief discussion), and recommended follow-up plan. We assessed advice receipt with a patient questionnaire immediately post-visit, and substance use days at baseline and through the 12 months post-visit using a Timeline Follow-Back calendar completed confidentially online or by phone at 3-month intervals. We used Cox proportional hazards regression analysis in SPSS to compare days-to-first-use post-visit, controlling for age and baseline use. Results: The participation rate was 89%; 89% of baseline completers had at least one follow-up assessment, with no significant difference in retention or baseline substance use rates between groups. Participants had mean age+SD 15.0 + 2.3 years, and were comprised of 51% girls, 44% White non-Hispanic, 77% from two-parent homes, and 65% had college-graduate parents. Most (85%) saw a pediatrician (vs. NP/PA), and 93% had >1 prior visit with that provider. Twenty-nine percent reported any baseline past-12-month alcohol or drug use, with alcohol, cannabis, and other drug use rates 27%, 15%, and 2%, respectively; 9% were CRAFFT+ (score >2). cSBA increased patient-reported receipt of provider advice to avoid use (90% vs. 71%, chi-square p <.001). Adjusted hazard ratios (AHR) for days-to-first-use of any substance in cSBA compared to TAU was.77 (95%CI.61-.98), indicating longer time until use post-visit in the intervention group; the AHR for alcohol was.75 (.59-.96), and for cannabis.61 (.44-.86). Conclusions: Computer-facilitated adolescent screening and provider brief advice significantly delayed, compared to usual care, time to first substance use following the pediatric well-visit. Sources of Support: NIAAA grants 1R01AA021904 and 1R34AA023026; HRSA/MCHB Leadership Education in Adolescent Health T71 MC00009 (SKH).
Journal of Adolescent Health, 62 (2 Supplement 1) : S13
- Year: 2018
- Problem: Substance Use Disorders (any)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Psychoeducation, Personalised feedback, normative feedback
Schwinn, T. M., Schinke, S. P., Hopkins, J., Keller, B., Liu, X.
Early adolescent girls' rates of drug use have matched, and in some instances, surpassed boys' rates. Though girls and boys share risk factors for drug use, girls also have gender-specific risks. Tailored interventions to prevent girls' drug use are warranted. This study developed and tested a web-based, drug abuse prevention program for adolescent girls. The nationwide sample of 13- and 14-year-old girls (N = 788) was recruited via Facebook ads. Enrolled girls were randomly assigned to the intervention or control condition. All girls completed pretest measures online. Following pretest, intervention girls interacted with the 9-session, gender-specific prevention program online. The program aimed to reduce girls' drug use and associated risk factors by improving their cognitive and behavioral skills around such areas as coping with stress, managing mood, maintaining a healthy body image, and refusing drug use offers. Girls in both conditions again completed measures at posttest and 1-year follow-up. At posttest, and compared to girls in the control condition, girls who received the intervention smoked fewer cigarettes and reported higher self-esteem, goal setting, media literacy, and self-efficacy. At 1-year follow-up, and compared to girls in the control condition, girls who received the intervention reported engaging in less binge drinking and cigarette smoking; girls assigned to the intervention condition also had higher alcohol, cigarette, and marijuana refusal skills, coping skills, and media literacy and lower rates of peer drug use. This study's findings support the use of tailored, online drug abuse prevention programming for early adolescent girls. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Journal of Youth and Adolescence, 47(3) : 490-500
- Year: 2018
- Problem: Substance Use Disorders (any)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Other Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
Shin, Y. J., Miller-Day, M., Hecht, M. L., Krieger, J. L.
Based on social cognitive theory and narrative engagement theory, the current study examined hypothesized indirect effects of engagement with keepin'it REAL (kiR) curriculum entertainment-education (E-E) videos on youth alcohol use via youth drug offer refusal efficacy. Students in 7th grade (N = 1,464) at 25 public schools in two Midwestern states were randomly assigned to one of the two versions of the kiR curriculum, the kiR urban version and the kiR rural version. Each version had their own set of five culturally-grounded E-E videos depicting communicative skills to refuse drug offers. Differential effects for engagement components were expected depending on the degree of cultural matching. Pre/post surveys were administered at the beginning and the end of 7th grade. Structural equation modeling analysis resulted in partial support for the research hypotheses. Rural youth receiving the urban curriculum who reported higher interest in the E-E videos were more likely to report having higher refusal efficacy, and in turn, less likely to use alcohol. Rural youth receiving the rural curriculum who identified with the E-E video main characters were more likely to report having higher refusal efficacy, and in turn, less likely to use alcohol. Implications for E-E health promotion are discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Health Communication, 33(7) : 896-906
- Year: 2018
- Problem: Substance Use Disorders (any)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Hogue, A., Henderson, C. E., Becker, S. J., Knight, D. K.
This article updates the evidence base on outpatient behavioral treatments for adolescent substance use (ASU) since publication of the previous review completed for this journal by Hogue, Henderson, Ozechowski, and Robbins (2014). It first summarizes the Hogue et al. findings along with those from recent literature reviews and meta-analytic studies of ASU treatments. It then presents study design and methods criteria used to select 11 comparative studies subjected to Journal of Clinical Child and Adolescent Psychology level of support evaluation. These 11 studies are detailed in terms of their sample characteristics, methodological quality, and substance use outcomes. Cumulative level of support designations are then made for each identified treatment approach. These cumulative designations are virtually identical to those of the previous review: ecological family-based treatment, individual cognitive-behavioral therapy, and group cognitive-behavioral therapy remain well-established; behavioral family-based treatment and motivational interviewing remain probably efficacious; drug counseling remains possibly efficacious; and an updated total of 5 multicomponent treatments combining more than 1 approach (3 of which include contingency management) are deemed well-established or probably efficacious. Treatment delivery issues associated with evidence-based approaches are then reviewed, focusing on client engagement, fidelity and mediator, and predictor and moderator effects. Finally, to help accelerate innovation in ASU treatment science and practice, the article outlines promising horizons in improving youth identification and access, specifying and implementing pragmatic treatment in community settings, and leveraging emerging lessons from implementation science. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Journal of Clinical Child and Adolescent Psychology, 47(4) : 499-526
- Year: 2018
- Problem: Substance Use Disorders (any)
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Family therapy, Motivational interviewing, includes Motivational Enhancing Therapy, Other Psychological Interventions, Case management
Melendez-Torres, G., Tancred, T., Fletcher, A., Thomas, J., Campbell, R., Bonell, C.
Background: Prevention of substance (alcohol, tobacco, illegal/legal drug) use in adolescents is a public health priority. As the scope for school-based health education is constrained in school timetables, interventions integrating academic and health education have gained traction in the UK and elsewhere, though evidence for their effectiveness remains unclear. We sought to synthesize the effectiveness of interventions integrating academic and health education for the prevention of substance use. Methods: We searched 19 databases between November and December 2015, among other methods. We included randomized trials of interventions integrating academic and health education targeting school students aged 4-18 and reporting substance use outcomes. We excluded interventions for specific health-related subpopulations (e.g., children with behavioural difficulties). Data were extracted independently in duplicate. Outcomes were synthesized by school key stage (KS) using multilevel meta-analyses, for substance use, overall and by type. Results: We identified 7 trials reporting substance use. Interventions reduced substance use generally in years 7-9 (KS3) based on 5 evaluations (d = -0.09, 95% CI [-0.17, -0.01], I2 = 35%), as well as in years 10-11 (KS4) based on 3 evaluations (-0.06, [-0.09, -0.02]; I2 = 0%). Interventions were broadly effective for reducing specific alcohol, tobacco, and drug use in both KS groups. Conclusions: Evidence quality was highly variable. Findings for years 3-6 and 12-13 could not be meta-analysed, and we could not assess publication bias. Interventions appear to have a small but significant effect reducing substance use. Specific methods of integrating academic and health education remain poorly understood. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Child: Care, Health and Development, 44(4) : 516-530
- Year: 2018
- Problem: Substance Use Disorders (any)
- Type: Systematic reviews
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Psychoeducation, Other Psychological Interventions
Mewton, L., Visontay, R., Chapman, C., Newton, N., Slade, T., Kay-Lambkin, F., Teesson, M.
ISSUES: This overview of reviews will synthesise information from existing reviews to provide a summary of the evidence for universal alcohol and illicit drug prevention strategies across different intervention settings.
APPROACH: Academic databases, including Medline, EMBASE and PsycInfo were searched on 1 August 2016. All reviews and meta-analyses of universal alcohol and drug prevention conducted since 2006 were included. The reviews included in this overview were grouped according to the different settings where prevention strategies have been applied (i.e. family, school, college, workplace, leisure, healthcare, community, media and policy).
KEY FINDINGS: Fifty-two reviews met the inclusion criteria and were included in this report. There is sufficient evidence to support universal preventive interventions for alcohol in family and school settings. In terms of reducing drug use, there is sufficient evidence to support the use of school- and leisure-based universal primary prevention strategies. Based on evidence published in the last 10 years, mass media campaigns to do not appear to be effective in reducing drug use. More evidence is needed to support preventive interventions in college, workplace, healthcare and community settings.
IMPLICATIONS: Through the identification of settings where preventive interventions are effective, this overview can be used to guide alcohol and drug policy and the allocation of resources.
CONCLUSION: The evidence base for universal prevention in several settings could be strengthened, guiding priorities for future research.
Drug & Alcohol Review, 37 Suppl 1 : S435-S469
- Year: 2018
- Problem: Substance Use Disorders (any), Alcohol Use
- Type: Systematic reviews
-
Stage: Universal prevention
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Service Delivery & Improvement, Psychological Interventions (any)
, Other Psychological Interventions, Physical activity, exercise, Technology, interventions delivered using technology (e.g. online, SMS)
Pandey, A., Hale, D., Das, S., Goddings, A. L., Blakemore, S. J., Viner, R. M.
IMPORTANCE Childhood and adolescence self-regulation (SR) is gaining importance as a target of intervention because of mounting evidence of its positive associations with health, social and educational outcomes. OBJECTIVE To conduct a systematic review and meta-analysis of rigorously evaluated interventions to improve self-regulation in children and adolescents. DATA SOURCES Keyword searches of the PsycINFO, PubMed, EMBASE, CINAHL Plus, ERIC, British Education Index, Child Development and Adolescent Studies, and CENTRAL were used to identify all studies published through July 2016. STUDY SELECTION To be eligible for this review, studies had to report cluster randomized trials or randomized clinical trials, evaluate universal interventions designed to improve self-regulation in children and adolescents aged 0 to 19 years, include outcomes associated with self-regulation skills, and be published in a peer-reviewed journal with the full text available in English. DATA EXTRACTION AND SYNTHESIS A total of 14 369 published recordswere screened, of which 147 were identified for full-text review and 49 studies reporting 50 interventions were included in the final review. Results were summarized by narrative review and meta-analysis. MAIN OUTCOMES AND MEASURES Self-regulation outcomes in children and adolescents. RESULTS This review identified 17 cluster randomized trials and 32 randomized clinical trials evaluating self-regulation interventions, which included a total of 23 098 participants ranging in age from 2 to 17 years (median age, 6.0 years). Consistent improvement in self-regulation was reported in 16 of 21 curriculum-based interventions (76%), 4 of the 8 mindfulness and yoga interventions (50%), 5 of 9 family-based programs (56%), 4 of 6 exercise-based programs (67%), and 4 of 6 social and personal skills interventions (67%), or a total of 33 of 50 interventions (66%). Ameta-analysis evaluating associations of interventions with self-regulation task performance scores showed a positive effect of such interventions with pooled effect size of 0.42 (95%CI, 0.32-0.53). Only 24 studies reported data on distal outcomes (29 outcomes). Positive associations were reported in 11 of 13 studies (85%) on academic achievement, 4 of 5 studies on substance abuse (80%), and in all studies reporting on conduct disorders (n = 3), studies on social skills (n = 2), studies on depression (n = 2), studies on behavioral problems (n = 2), and study on school suspensions (n = 1). No effect was seen on 2 studies reporting on academic achievement, 1 study reporting on substance abuse, and 1 additional study reporting on psychological well-being. CONCLUSIONS AND RELEVANCE A wide range of interventions were successful in improving self-regulation in children and adolescents. There was improvement in distal academic, health, and behavioral outcomes in most intervention groups compared with controls. Copyright © 2018 American Medical Association. All rights reserved.
JAMA Pediatrics, 172(6) : 566-575
- Year: 2018
- Problem: Depressive Disorders, Substance Use Disorders (any)
- Type: Systematic reviews
-
Stage: Universal prevention
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Psychological Interventions (any)
, Skills training, Other Psychological Interventions, Mindfulness based therapy, Mind-body exercises (e.g. yoga, tai chi, qigong)
, Physical activity, exercise
Richardson, L. P., McCarty, C. A., Radovic, A., Suleiman, A. B.
Despite the recognition that behavioral and medical health conditions are frequently intertwined, the existing health care system divides management for these issues into separate settings. This separation results in increased barriers to receipt of care and contributes to problems of underdetection, inappropriate diagnosis, and lack of treatment engagement. Adolescents and young adults with mental health conditions have some of the lowest rates of treatment for their conditions of all age groups. Integration of behavioral health into primary care settings has the potential to address these barriers and improve outcomes for adolescents and young adults. In this paper, we review the current research literature for behavioral health integration in the adolescent and young adult population and make recommendations for needed research to move the field forward. Copyright © 2016 Society for Adolescent Health and Medicine
Journal of Adolescent Health, 60(3) : 261-269
- Year: 2017
- Problem: Depressive Disorders, Substance Use Disorders (any)
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Other service delivery and improvement interventions
Schleider, J. L., Weisz, J. R.
Objective Despite progress in the development of evidence-based interventions for youth psychiatric problems, up to 75% of youths with mental health needs never receive services, and early dropout is common among those who do. If effective, then single-session interventions (SSIs) for youth psychiatric problems could increase the accessibility, scalability, completion rates, and cost-effectiveness of youth mental health services. This study assessed the effects of SSIs for youth psychiatric problems. Method Using robust variance estimation to address effect size (ES) dependency, findings from 50 randomized-controlled trials (10,508 youths) were synthesized. Results Mean postintervention ES showed a Hedges g value equal to 0.32; the probability that a youth receiving SSI would fare better than a control-group youth was 58%. Effects varied by several moderators, including target problem: ESs were largest for anxiety (0.56) and conduct problems (0.54) and weakest for substance abuse (0.08; targeted in >33% of studies). Other problems yielded numerically promising but nonsignificant ESs (e.g., 0.21 for depression), potentially from low representation across trials. ESs differed across control conditions, with larger ESs for studies with no treatment (0.41) versus active controls (0.14); developmental periods, with greater ESs for children (0.42) than adolescents (0.19); intervention types, with largest ESs for youth-focused cognitive-behavioral approaches (0.74); and follow-up lengths, with smaller ESs for follow-ups exceeding 13 weeks. ESs did not differ for self- versus therapist-administered interventions or for youths with diagnosable versus subclinical problems. Conclusion Findings support the promise of SSIs for certain youth psychiatric problems and the need to clarify how, to what degree, and for whom SSIs effect lasting change. Copyright © 2016 American Academy of Child and Adolescent Psychiatry
Journal of the American Academy of Child & Adolescent Psychiatry, 56(2) : 107-115
- Year: 2017
- Problem: Anxiety Disorders (any), Depressive Disorders, Substance Use Disorders (any)
- Type: Systematic reviews
-
Stage: Universal prevention
, At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
Steinka-Fry, K. T., Tanner-Smith, E E., Dakof, G. A., Henderson, C.
This systematic review and meta-analysis synthesized findings from studies examining culturally sensitive substance use treatment for racial/ethnic minority youth. An extensive literature search located eight eligible studies using experimental or quasi-experimental designs. The meta-analysis quantitatively synthesized findings comparing seven culturally sensitive treatment conditions to seven alternative conditions on samples composed of at least 90% racial/ethnic minority youth. The results from the meta-analysis indicated that culturally sensitive treatments were associated with significantly larger reductions in post-treatment substance use levels relative to their comparison conditions (g = 0.37, 95% CI [0.12, 0.62], k = 7, total number participants = 723). The average time between pretest and posttest was 21 weeks (SD = 11.79). There was a statistically significant amount of heterogeneity across the seven studies (Q = 26.5, p = 0.00, tau2 = 0.08, I2 = 77.4%). Differential effects were not statistically significant when contrasts were active generic counterparts of treatment conditions (direct "bona fide" comparisons; g = -0.08, 95% CI [-0.51, 0.35]) and 'treatment as usual' conditions (g = 0.39, 95% CI [-0.14, 0.91]). Strong conclusions from the review were hindered by the small number of available studies for synthesis, variability in comparison conditions across studies, and lack of diversity in the adolescent clients served in the studies. Nonetheless, this review suggests that culturally sensitive treatments offer promise as an effective way to address substance use among racial/ethnic minority youth. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Journal of Substance Abuse Treatment, 75 : 22-37
- Year: 2017
- Problem: Substance Use Disorders (any)
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Family therapy
Newton, N. C., Champion, K. E., Slade, T., Chapman, C., Stapinski, L., Koning, I., Tonks, Z., Teesson, M.
Issues: Alcohol and other drug use among adolescents is a serious concern, and effective prevention is critical. Research indicates that expanding school-based prevention programs to include parenting components could increase prevention outcomes. This paper aims to identify and describe existing combined student- and parent-based programs for the prevention of alcohol and other drug use to evaluate the efficacy of existing programs. Approach: The PsycINFO, Medline, Central Register of Controlled trials and Cochrane databases were searched in April 2015 and additional articles were obtained from reference lists. Studies were included if they evaluated a combined universal intervention for students (aged 11-18 years old) and their parents designed to prevent alcohol and/or other drug use, and were delivered in a school-based setting. Risk of bias was assessed by two independent reviewers. Because of the heterogeneity of the included studies, it was not possible to conduct a meta-analysis and a qualitative description of the studies was provided. Key Findings: From a total of 1654 screened papers, 22 research papers met inclusion criteria, which included 13 trials of 10 programs. Of these, nine programs demonstrated significant intervention effects in terms of delaying or reducing adolescent alcohol and/or other drug use in at least one trial. Conclusion: This is the first review of combined student- and parent-based interventions to prevent and reduce alcohol and other drug use. Whilst existing combined student- and parent-based programs have shown promising results, key gaps in the literature have been identified and are discussed in the context of the development of future prevention programs. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Drug & Alcohol Review, 36(3) : 337-351
- Year: 2017
- Problem: Substance Use Disorders (any)
- Type: Systematic reviews
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Liddell, J., Burnette, C. E.
Purpose: Given the disproportionately high levels of alcohol and other drug abuse among Indigenous youth in the United States, the purpose of this systematic review was to explicate the current state of empirically-based and culturally-informed substance abuse prevention and intervention programs for Indigenous youth (ages 9-18). Method: The 14 articles that met inclusion criteria for this review were analyzed both in terms of the cultural intervention itself (primary population, intervention, core tenants, focus of intervention, intervention goals, location, intervention location, and program length) and their evaluation approach. Results: Results indicate variable integration of cultural components with the majority of interventions taking place in schools and treatment facilities, targeting primarily individuals. Discussion: There is a current gap in research on culturally-informed substance abuse interventions for Indigenous youth, which this review begins to address. Promising areas of future research and interventions include bringing communities and families into treatment and prevention. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Journal of Evidence-Informed Social Work, 14(5) : 329-359
- Year: 2017
- Problem: Substance Use Disorders (any)
- Type: Systematic reviews
-
Stage: Universal prevention
, At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions