Disorders - Substance Use Disorders
Eisen, Marvin, Zellman, Gail L., Murray, David M.
Thirty-four schools (n=7426 consented sixth graders, 71% of the eligible population) were randomized to conditions to test the hypothesis that Skills for Adolescence (SFA), a widely used comprehensive life skills training curriculum with a dedicated drug education unit, is more effective than standard care in deterring and delaying substance use through middle school. Two-year posttest (1-year post-intervention) data were collected from 5691 eighth graders (77% of those who completed the sixth-grade survey and 87% of those who completed the seventh-grade survey). Lifetime and recent (last 30 days) use of five substances or combinations of substances was compared using mixed-model regression to control for school clustering. There were two significant treatment main effects at the end of the eighth grade: lifetime (P=.05) and recent (P<.03) marijuana use were lower in SFA than control schools with pretest usage and salient demographic and psychosocial variables controlled. There was also one significant Treatment x Pretest Usage interaction around binge drinking. Baseline binge drinkers in SFA schools were less likely to report recent binge drinking than students in control schools (P<.01); there were no treatment differences among baseline nonbinge drinkers. Analyses of potential mediators of SFA treatment effects on eighth-grade binge drinking and marijuana use suggested that SFA increased self-efficacy around drug refusal skills, but did not affect behavioral intentions, perceptions of harm, or perceived peer norms. These 2-year (1-year post-intervention) outcomes offer some additional support for SFA effectiveness and the general thrust of school-based, life skills-based prevention programs. The promising sixth- through eighth-grade findings for SFA, a commercially available program, provide a further step in bridging a major gap in the "research to practice" literature: theory-based interventions that have documented behavioral effects have not enjoyed large-scale implementation, while intuition-based programs that have no documented effects still enjoy wide exposure.
Addictive Behaviors, 28(5) : 883-97
- Year: 2003
- Problem: Substance Use Disorders (any)
- Type: Randomised controlled trials
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Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Skills training
he Multicultural Interventions for Adolescent Substance Use, referred to as The Shadow Project, was a 3-year, NIAAA-funded pilot study involving 60 American Indian families who had a youth entering alcohol and drug inpatient treatment. Participation was voluntary and involved comparison of two different treatment modalities: treatment as usual and a brief family-enhanced intervention. In adapting this family-based intervention specifically for American Indian families, a cultural approach to assessment and intervention was integrated into the process, with the intervention focusing on building support around the youth to attain abstinence and assuring the youth that their family, community, and substance abuse counselor were motivating influences. Five areas were assessed in the family observation tasks: relationship building, positive reinforcement, limit setting, monitoring, problem solving, and communication. Cultural adaptation was made for two of the five tasks. Two legends were used to assess the families' skill level in relationship building, problem solving, and communication as a family unit. By incorporating Indian stories, families were encouraged to respond in a culturally appropriate manner. Preliminary findings show that these stories were linked to child prosocial behavior and the percentage of days abstinent from individual drug use. This pilot project also adapted culturally responsive instruments, tasks, and validity to this population. The first year required adaptation of recruitment methods, tribal and treatment center agreements, referral contacts, and implementation of intervention and follow-up with adolescents and their families. The second year was composed of intervention implementation and follow-up assessments. To determine the intervention program's long-term effect on reducing adolescent alcohol and other drug use, all families were followed up and assessed 11 months after they left treatment. The third and final year of the study included follow-up, data entry, and data analysis.
Alcoholism: Clinical & Experimental Research, 27(8) : 1356-1360
- Year: 2003
- Problem: Substance Use Disorders (any)
- Type: Controlled clinical trials
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Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Motivational interviewing, includes Motivational Enhancing Therapy, Other Psychological Interventions
Tait, Robert J., Hulse, Gary K.
The aim of this paper is to evaluate the effectiveness of brief interventions (BI) with adolescents (mean age <20) in reducing alcohol, tobacco or other drug (ATOD) use by means of a systematic review of BI for adolescent substance use in the English language literature up to 2002. We identified 11 studies involving 3734 adolescents. Follow-up ranged from 6 weeks to 24 months. Motivational interviewing was the predominant approach, underpinning eight studies: the remaining three provided personalized health information. Seven papers reported outcomes for alcohol interventions and four involved other substances (including one with separate alcohol outcomes). The overall effect size was d=0.126 with borderline homogeneity (Q=14.9, df=9, p=0.09). The effect size from the eight alcohol interventions (n=1,075) was classified as significant but "small" (d=0.275). The remaining non-alcohol studies were considered separately as interventions involving tobacco or multiple substance use. The two interventions with tobacco involved a substantial sample (n=2,626) but had a very small effect (d=0.037), while the two interventions addressing multiple substances involved few participants (n=110) but had a medium-large effect (d=0.78). Across a diverse range of settings (dental clinic, schools, universities, substance treatment centres) and, therefore, probably diverse clients, BI conferred benefits to adolescent substance users. BI had a small effect on alcohol consumption and related measures. The data for tobacco interventions suggested a very small reduction, particularly with general community interventions. The effect of BI with multiple substances appears substantial but the small sample cautions against expansive generalization. [References: 59]
Drug & Alcohol Review, 22(3) : 337-46
- Year: 2003
- Problem: Substance Use Disorders (any)
- Type: Systematic reviews
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Stage: Disorder established (diagnosed disorder)
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Treatment and intervention: Psychological Interventions (any)
Skara, Silvana, Sussman, Steve
BACKGROUND: Although the initial effectiveness of psychosocial strategies programming in preventing smoking and other drug abuse among adolescents has been well established through literature reviews and meta-analyses, much less evidence exists for the long-term follow-up success of these interventions. The primary goal of this paper, therefore, is to summarize the effectiveness of published program evaluation studies that have followed adolescents across the transitional period between junior high and high school for a period of at least 2 years. METHODS: Studies for inclusion in this review were accessed primarily through a computerized search of Medline, Healthstar, and PsychINFO databases. Intervention studies that met five core criteria were retained for review. Two authors independently abstracted data on study characteristics, methodology, and program outcomes. RESULTS: Search results yielded 25 studies suitable for examination. The majority of these studies reported significant program effects for long-term smoking, alcohol, and marijuana outcomes, while indicating a fairly consistent magnitude of program effects. CONCLUSIONS: This review provides long-term empirical evidence of the effectiveness of social influences programs in preventing or reducing substance use for up to 15 years after completion of programming. However, this conclusion is still somewhat tenuous given the lack of significant program effects reported in several studies and the great variability that existed in the level of internal and external validity across all studies. [References: 68]
Preventive Medicine, 37(5) : 451-74
- Year: 2003
- Problem: Substance Use Disorders (any)
- Type: Systematic reviews
-
Stage: Universal prevention
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Treatment and intervention: Psychological Interventions (any)
Santisteban, Daniel A., Coatsworth, J. Douglas, Perez-Vidal, Angel, Kurtines, William M., Schwartz, Seth J., LaPerriere, Arthur, Szapocznik, Jose
This study investigated the efficacy of brief strategic family therapy (BSFT) with Hispanic behavior problem and drug using youth, an underrepresented population in the family therapy research literature. One hundred twenty-six Hispanic families with a behavior problem adolescent were randomly assigned to 1 of 2 conditions: BSFT or group treatment control (GC). Results showed that, compared to GC cases, BSFT cases showed significantly greater pre- to post-intervention improvement in parent reports of adolescent conduct problems and delinquency, adolescent reports of marijuana use, and observer ratings and self reports of family functioning. These results extend prior findings on the efficacy of family interventions to a difficult to treat Hispanic adolescent sample.
Journal of Family Psychology, 17(1) : 121-33
- Year: 2003
- Problem: Substance Use Disorders (any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Family therapy
Spoth, Richard L., Redmond, Cleve, Trudeau, Linda, Shin, Chungyeol
This study evaluated the substance initiation effects of an intervention combining family and school-based competency-training intervention components. Thirty-six rural schools were randomly assigned to 1 of 3 conditions: (a) the classroom-based Life Skills Training (LST) and the Strengthening Families Program: For Parents and Children 10-14, (b) LST only, or (c) a control condition. Outcomes were examined 1 year after the intervention posttest, using a substance initiation index (SII) measuring lifetime use of alcohol, cigarettes, and marijuana and by rates of each individual substance. Planned intervention-control contrasts showed significant effects for both the combined and LST-only interventions on the SII and on marijuana initiation. Relative reduction rates for alcohol initiation were 30.0% for the combined intervention and 4.1% for LST only.
Psychology of Addictive Behaviors, 16(2) : 129-34
- Year: 2002
- Problem: Substance Use Disorders (any)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Skills training, Other Psychological Interventions
Wolchik, Sharlene A., Sandler, Irwin N., Millsap, Roger E., Plummer, Brett A., Greene, Shannon M., Anderson, Edward R., Dawson-McClure, Spring R.
CONTEXT: Compared with their peers with nondivorced parents, adolescents with divorced parents are more likely to have mental health problems, drop out of school, and become pregnant. The long-term effects of intervention programs for this population are unknown. OBJECTIVE: To evaluate the long-term effectiveness of 2 programs designed to prevent mental health problems in children with divorced parents. DESIGN AND SETTING: Six-year follow-up of a randomized controlled trial of 2 intervention programs (mother program: 11 group and 2 individual sessions; mother plus child program: mother program and 11 group sessions for children) and a control condition (books on postdivorce adjustment), which was conducted in a large metropolitan US city from April 1998 through March 2000. PARTICIPANTS: A total of 218 families (91% of the original sample) with adolescents aged between 15 and 19 years were reinterviewed. MAIN OUTCOME MEASURES: Externalizing and internalizing problems, diagnosed mental disorders, drug and alcohol use, and number of sexual partners. RESULTS: Eleven percent of adolescents in the mother plus child program (95% confidence interval [CI], 3.8%-18.2%) had a 1-year prevalence of diagnosed mental disorder compared with 23.5% (95% CI, 13.8%-33.2%) of adolescents in the control program (P =.007). Adolescents in the mother plus child program had fewer sexual partners (mean [SE], 0.68 [0.16]) compared with adolescents in the control program (1.65 [0.37]; P =.01). Adolescents with higher initial mental health problems whose families were in the mother plus child program had lower externalizing problems (P =.007) and fewer symptoms of mental disorder (P =.02) compared with those in the control program. Compared with controls, adolescents whose mothers participated in the mother program and who had higher initial mental health problems had lower levels of externalizing problems (P<.001); fewer symptoms of mental disorder (P =.005); and less alcohol (P =.005), marijuana (P =.02), and other drug use (P =.01). CONCLUSIONS: In adolescents of divorced parents, the mother program and the mother plus child program reduced symptoms of mental disorder; rates of diagnoses of mental disorder; levels of externalizing problems; marijuana, alcohol, and other drug use; and number of sexual partners.
JAMA, 288(15) : 1874-81
- Year: 2002
- Problem: Substance Use Disorders (any)
- Type: Randomised controlled trials
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Stage: At risk (indicated or selected prevention)
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Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Sussman, Steve, Dent, Clyde W., Stacy, Alan W.
OBJECTIVE: To provide a review of the evidence from 3 experimental trials of Project Towards No Drug Abuse (TND), a senior-high-school-based drug abuse prevention program. METHODS: Theoretical concepts, subjects, designs, hypotheses, findings, and conclusions of these trials are presented. A total of 2,468 high school youth from 42 schools in southern California were surveyed. RESULTS: The Project TND curriculum shows reductions in the use of cigarettes, alcohol, marijuana, hard drugs, weapon carrying, and victimization. Most of these results were replicated across the 3 trials. CONCLUSION: Project TND is an effective drug and violence prevention program for older teens, at least for one-year follow-up.
American Journal of Health Behavior, 26(5) : 354-65
- Year: 2002
- Problem: Substance Use Disorders (any)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Wu, Zunyou, Detels, Roger, Zhang, Jiapeng, Li, Virginia, Li, Jianhua
OBJECTIVES: This study evaluated a community-based program in China to prevent initiation of drug use in young men. METHODS: Similar intervention and control areas were selected. Village leaders, teachers, and women and youth leaders were recruited to participate in the program. Community activities were organized and intervention activities in schools were implemented. Incidence of new drug users was estimated. RESULTS: There was a 2.7-fold greater reduction in drug use initiation in the intervention area (1.59% vs 0.60%). Reduction was highest among males aged 15 to 19, single men, illiterate men, and the Jingpo minority. HIV/AIDS knowledge and attitudes and recognition of drug problems were all significantly better in the intervention area. CONCLUSIONS: Community-based intervention programs to prevent drug use can be successful in rural areas of China.
American Journal of Public Health, 92(12) : 1952-7
- Year: 2002
- Problem: Substance Use Disorders (any)
- Type: Controlled clinical trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Psychoeducation
Dishion, Thomas J., Kavanagh, Kathryn, Schneiger, Alison, Nelson, Sarah, Kaufman, Noah K.
The Adolescent Transitions Program (ATP) promotes student adjustment and reduces risk within a public school setting, focusing primarily on parenting practices using a tiered, multilevel prevention strategy. A description is given of the program, levels of engagement, and intervention effects. Within each school, multiethnic students (N = 672) and their families were randomly assigned at the individual level to a control condition or the ATP intervention. Analyses focus on the longitudinal effects of the ATP intervention on self-reported substance use through middle school and the 1st year of high school (Grades 6, 7, 8, and 9). Levels of engagement in the selected and indicated interventions were somewhat less than expected. Despite relatively low levels of engagement, the intervention reduced initiation of substance use in both at-risk and typically developing students. These findings are discussed with respect to lessons learned about parent engagement, optimizing strategies for schoolwide implementation, and the promise of embedding family interventions within the public school ecology.
Prevention Science, 3(3) : 191-201
- Year: 2002
- Problem: Substance Use Disorders (any)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Eisen, Marvin, Zellman, Gail L., Massett, Holly A., Murray, David M.
Thirty-four schools (n=7426 consented sixth graders, 71% of the eligible population) were randomized to conditions to test the hypothesis that "Skills for Adolescence" (SFA) is more effective than standard care in deterring and delaying substance use through middle school. One-year posttest data were collected from 6239 seventh graders (84% of those eligible). Initiation of "ever" and "recent" use of five substances for baseline nonusers and changes in recent use for baseline users by experimental condition were compared using mixed model regression to control for school clustering. For pretest nonusers, recent cigarette smoking was lower for SFA than controls (P<.05), as was lifetime marijuana use (P<.06). There were also three Treatment x Ethnicity interactions around drinking behaviors. Hispanics in SFA were less likely to ever and recently drink, and to recently binge drink than Hispanic controls; there were no treatment differences among non-Hispanics. For baseline users, there were three significant SFA delays in transition to experimental or recent use of more "advanced" substances: drinking to smoking, drinking to marijuana use, and binge drinking to marijuana.
Addictive Behaviors, 27(4) : 619-32
- Year: 2002
- Problem: Substance Use Disorders (any)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Skills training
Cuijpers, Pim
Several studies have suggested that peer-led drug prevention programs are more effective than adult-led programs, but the evidence is not conclusive. In this article the results are presented of a meta-analysis of studies that compare drug prevention programs led by peers to the same programs led by adults. Twelve studies were identified in a systematic literature search. The quality of these studies was not optimal, and the interventions and target groups differed considerably among studies. Overall, peer-led programs were found to be somewhat more effective than adult-led programs (standardized difference d: 0.24). Large differences between studies were found, with some studies indicating greater effects for peer-led programs and other studies showing greater effects for adult-led programs. It is concluded that the effectiveness of a prevention program is determined by several characteristics of the programs. The leader may constitute one of those characteristics.
Journal of Drug Education, 32(2) : 107-19
- Year: 2002
- Problem: Substance Use Disorders (any)
- Type: Controlled clinical trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions