Li, L., Zhu, S., Tse, N., Tse, S., Wong, P.

Effectiveness of motivational interviewing to reduce illicit drug use in adolescents: a systematic review and meta-analysis

AIMS: Motivational interviewing (MI) is a commonly used intervention approach to promote reduction or cessation of substance abuse. Effects may be different for adolescents, so it is useful to assess the state of the evidence in this subpopulation. This paper aimed to assess evidence for MI effectiveness in adolescents. METHOD: EBSCOhost, ProQuest and Digital Dissertation Consortium were searched using keywords. Ten randomized trials from the United Kingdom, United States and Taiwan, including 1466 participants, were identified and analysed using a random effects model. Primary outcome measures captured were: the extent of drug use, intention to use drugs and readiness to change. Each study received a high-quality score based on the Miller Quality Scoring Coding System. Moderator analyses were also conducted to examine the impacts of follow-up period, delivery setting and study design on the effectiveness of MI. RESULTS: No statistically significant effect of MI on was found change of drug use behaviours [d = 0.05, 95% confidence interval (CI) = -0.06, 0.17, P = 0.36]. A significant effect was found on attitude change (d = 0.44, 95% CI = 0.20, 0.67, P = 0.0002). The funnel plot was asymmetrical, suggesting publication bias favouring small studies with higher effect sizes. CONCLUSION: Motivational interviewing has not been found thus far to reduce adolescent use of illicit drugs. It may influence intentions to change, but evidence of publication bias weakens confidence in this conclusion. Copyright © 2015 Society for the Study of Addiction.

Addiction, 111(5) : 795-805

Patton, G. C., Sawyer, S. M., Santelli, J. S., Ross, D. A., Afifi, R., Allen, N. B., Arora, M., Azzopardi, P., Baldwin, W., Bonell, C., Kakuma, R., Kennedy, E., Mahon, J., McGovern, T., Mokdad, A. H., Patel, V., Petroni, S., Reavley, N., Taiwo, K., Waldfogel, J., Wickremarathne, D., Barroso, C., Bhutta, Z., Fatusi, A. O., Mattoo, A., Diers, J., Fang, J., Ferguson, J., Ssewamala, F., Viner, R. M.

Our future: a Lancet commission on adolescent health and wellbeing

Lancet, 387(10036) : 2423-78

Onrust, S. A., Otten, R., Lammers, J., Smit, F.

School-based programmes to reduce and prevent substance use in different age groups: What works for whom? Systematic review and meta-regression analysis

Background: Findings from systematic reviews and meta-analyses about the effectiveness of school-based programmes to prevent or reduce substance abuse are inconclusive. We hypothesise that in order to be effective, programmes have to be aligned with the developmental stages of the intended target group (childhood, early, middle, or late adolescence). The present study provides an overview of universal and targeted programmes, while distinguishing four age groups and examining which intervention characteristics are the effective components for the respective groups. Methods: Databases were searched for controlled studies of school-based programmes, evaluating their effectiveness on either smoking, alcohol or drug use. Multivariate meta-regression analysis was used to analyse the associations between effects and programme characteristics. Results: Our meta-analysis evaluates 288 programmes with a total of 436,180 participants. The findings support our hypothesis that specific aspects of the school-based programmes are effective in some developmental stages, but not for other age groups. The differences in effectiveness are systematically related to psychological and cognitive needs and capacities. Discussion: Our findings highlight the importance of considering a developmental perspective when designing and offering school-based prevention programmes. The various developmental stages offer different possibilities and opportunities for the reduction and prevention of substance use. Copyright © 2015 The Authors.

Clinical Psychology Review, 44 : 45-59

Wippert, Pia-Maria, Flieser, Michael

National doping prevention guidelines: Intent, efficacy and lessons learned-A 4-year evaluation

Background: Doping presents a potential health risk for young athletes. Prevention programs are intended to prevent doping by educating athletes about banned substances. However, such programs have their limitations in practice. This led Germany to introduce the National Doping Prevention Plan (NDPP), in hopes of ameliorating the situation among young elite athletes. Two studies examined 1) the degree to which the NDPP led to improved prevention efforts in elite sport schools, and 2) the extent to which newly developed prevention activities of the national anti-doping agency (NADA) based on the NDPP have improved knowledge among young athletes within elite sports schools. Methods: The first objective was investigated in a longitudinal study (Study I: t0 = baseline, t1 = follow-up 4 years after NDPP introduction) with N = 22 teachers engaged in doping prevention in elite sports schools. The second objective was evaluated in a cross-sectional comparison study (Study II) in N = 213 elite sports school students (54.5 % male, 45.5 % female, age M = 16.7 +/- 1.3 years (all students had received the improved NDDP measure in school; one student group had received additionally NADA anti-doping activities and a control group did not). Descriptive statistics were calculated, followed by McNemar tests, Wilcoxon tests and Analysis of Covariance (ANCOVA). Results: Results indicate that 4 years after the introduction of the NDPP there have been limited structural changes with regard to the frequency, type, and scope of doping prevention in elite sport schools. On the other hand, in study II, elite sport school students who received further NADA anti-doping activities performed better on an anti-doping knowledge test than students who did not take part (F(1, 207) = 33.99, p < 0.001), although this difference was small. Conclusion: The integration of doping-prevention in elite sport schools as part of the NDPP was only partially successful. The results of the evaluation indicate that the introduction of the NDPP has contributed more to a change in the content of doping prevention activities than to a structural transformation in anti-doping education in elite sport schools. Moreover, while students who did receive additional education in the form of the NDPP"booster sessions" had significantly more knowledge about doping than students who did not receive such education, this difference was only small and may not translate to actual behavior. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Substance Abuse Treatment, Prevention, and Policy Vol 11 2016, ArtID 35, 11 :

Tucker, J. S., D'Amico, E. J., Ewing, B. A., Miles, J. N. V., Pedersen, E. R.

A brief group-MI intervention reduces alcohol use among homeless young adults [conference abstract]

Purpose: Homeless young adults between the ages of 18 and 25 exhibit high rates of alcohol use, as well as drug use and sexual risk behaviors. Yet few risk reduction programs exist for this at-risk population, particularly ones that are both effective and can be easily incorporated into settings serving this population (e.g., drop-in centers). This study addresses an important gap in prevention services for homeless emerging adults by conducting a pilot cluster cross-over randomized controlled trial of AWARE, a group-MI (Motivational Interviewing) brief risk reduction intervention focusing on reducing both substance use and sexual risk behavior. Methods: AWARE consists of four 45-min sessions. Rolling admission is used so that youth can join the program at any time, regardless of session. The evaluation took place in two drop-in centers for homeless young adults in the Los Angeles area. Homeless young adults ages 18-25 (mean age = 21.8) received the AWARE program (n = 100) or usual care (n = 100). The sample was 73% male, 79% heterosexual, and 31%non-Hispanic white. Surveys were completed at baseline and 3 months after program completion. The 3-months follow-up rate for the sample was 91%. Results: Satisfaction with the program was high and nearly half (48%) of AWARE participants completed all four sessions. At follow-up, AWARE participants reported a lower frequency of alcohol use over the past 3 months (p = 0.01), were less likely to be classified as a frequent heavy drinker (compared to a non-drinker) in the past 30 days (p = 0.05), and showed a marginally significant positive difference in their confidence that they could reduce/quit their drinking (p = 0.09), compared to control participants. In addition, AWARE participants showed significant increases in both their readiness (p = 0.02) and confidence (p = 0.02) to change their drug use, compared to control participants. In terms of sex-related outcomes, AWARE participants reported greater condom use self-efficacy than the control group at follow-up (p = 0.05), but intervention effects were not found for number of partners or condomuse. Conclusion: Results from this pilot evaluation are promising, suggesting that a brief group-MI intervention can be effective in helping homeless young adults make positive changes in their alcohol use, as well as strengthen their motivation to reduce their drug use and their condom use self-efficacy.

Alcoholism: Clinical and Experimental Research, 40 : 311A

Veronneau, M.-H., Dishion, T. J., Connell, A.M., Kavanagh, K.

A randomized, controlled trial of the family check-up model in public secondary schools: Examining links between parent engagement and substance use progressions from early adolescence to adulthood

Objective: Substance use in adulthood compromises work, relationships, and health. Prevention strategies in early adolescence are designed to reduce substance use and progressions to problematic use by adulthood. This report examines the long-term effects of offering Family Check-up (FCU) at multiple time points in secondary education on the progression of substance use from age 11 to 23 years. Method: Participants (N = 998; 472 females) were randomly assigned individuals to intervention or control in Grade 6 and offered a multilevel intervention that included a classroom-based intervention (universal), the FCU (selected), and tailored family management treatment (indicated). Among intervention families, 23% engaged in the selected and indicated levels during middle school. Results: Intention to treat analyses revealed that randomization to the FCU was associated with reduced growth in marijuana use (p < .05), but not alcohol and tobacco use. We also examined whether engagement in the voluntary FCU services moderated the effect of the intervention on substance use progressions using complier average causal effect (CACE) modeling, and found that engagement in the FCU services predicted reductions in alcohol, tobacco, and marijuana use by age 23. In comparing engagers with nonengagers: 70% versus 95% showed signs of alcohol abuse or dependence, 28% versus 61% showed signs of tobacco dependence, and 59% versus 84% showed signs of marijuana abuse or dependence. Conclusion: Family interventions that are embedded within public school systems can reach high-risk students and families and prevent progressions from exploration to problematic substance use through early adulthood. (PsycINFO Database Record (c) 2016 APA, all rights reserved) Impact Statement What is the public health significance of this article?-This study suggests that family centered interventions designed to be embedded within the public school service system can have long-term preventive effects on reducing risk for marijuana use especially, but also tobacco and alcohol. By actively and respectfully encouraging at-risk families to participate, those most likely to benefit will engage and have motivation to change; thus, optimizing the use of resources while maintaining the significant impact of the intervention. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Journal of Consulting and Clinical Psychology, 84(6) : 526-543

Voloshyna, D., Walton, M. A., Zucker, R. A., Cunningham, R. M., Polshkova, S.

Prevention of alcohol and other drug use using motivational interviewing among youth in the Ukraine [conference abstract]

Despite WHO data showing alarming rates of alcohol consumption and consequences among age 15+ in the Ukraine, evidenced-based, brief alcohol interventions are currently lacking in this country. Of particular concern, are emerging adults, age 18-25, who may be at particularly high risk for alcohol problems, potentially as a result of recent political and economic events. This study examined the feasibility and initial efficacy a brief intervention on reducing risky drinking among emerging adults in the Ukraine. Youth presenting to two settings were screened for risky drinking: (i) Railway Clinical Hospital; and, (ii) Kiev National Medical University. Emerging adults screening positive on the AUDIT-C for risky drinking (>4) were enrolled in the study: 59 participants from the hospital setting (mean age = 22.6 (2.1), 54.2%male) and 61 participants from the university setting (mean age = 20.1(2.3), 55.7%male). In each setting, participants were randomized to receive a brief intervention (consisted of a 45-min session with a clinician) or to a control condition (included an informational brochure), with a follow-up assessment at 3 months. As compared to participants in the hospital setting, participants from the university setting were significantly younger, and single (as opposed to married), with fewer children. Regression analyses were conducted, separately for each setting, predicting alcohol outcomes (consumption and consequences); models controlled for baseline alcohol levels and condition assignment (brief intervention or control). In both settings, the brief intervention group showed significantly less alcohol consumption and consequences at 3-months as compared to the control group (p's < 0.001). However, when examining other drug use (DAST-10 score), the brief intervention groups were not significantly different from the control groups. Findings suggest that brief motivational interventions are promising for reducing risky drinking among emerging adults in the Ukraine in both inpatient hospital and university settings. Additional research is needed to extend these effects to reduce other drug use among Ukrainian youth.

Alcoholism: Clinical and Experimental Research, 40 : 71A

Wang, L. J., Lu, S. F., Chong, M. Y., Chou, W. J., Hsieh, Y. L., Tsai, T. N., Chen, C., Lee, Y. H.

A family-oriented therapy program for youths with substance abuse: Long-term outcomes related to relapse and academic or social status

Objective: The abuse of illegal substances by youths in Taiwan has become a major public health issue. This study explores the outcomes (relapse rate and academic or social status) of a family-oriented therapy program conducted for substance-using youths who were referred by a judge to participate in it. Methods: The present study includes 121 participants categorized into three groups: 36 youths underwent a weekly ten-session outpatient motivational enhancement psychotherapy (MEP) group program; 41 youths participated in a program that combined the aforementioned MEP program with an additional weekly ten-session parenting skill training (PST) program for their guardians (MEP + PST group); and 44 adolescents who received standard supervision by the court served as the control group. All participants were followed-up for a maximum of 2 years. Results: Of the 121 participants (mean age: 16.1+/-1.1 years), 33.1% relapsed into substance use during the follow-up period. The probability of relapse did not differ significantly between the MEP group (36.1%) and the control group (40.9%), but the youths in the MEP + PST group (22.0%) were at a lower risk of relapse than the control group participants (adjusted hazard ratio =0.48, 95% confidence interval [CI] =0.21-1.09). By the end of the study follow-up period, participants in both the MEP group and the MEP + PST group were more likely to be attending school (MEP group: adjusted odds ratio [aOR] =6.61, 95% CI =1.60-27.35; MEP + PST group: aOR =8.57, 95% CI =1.94-37.82) or employed (MEP group: aOR =7.75, 95% CI =1.95-30.75; MEP + PST group: aOR =7.27, 95% CI =1.76-29.97), when compared to the control group. Conclusion: This study revealed that a family-oriented treatment approach may be a more effective option for preventing youths' relapsing into substance abuse. In comparison to individuals who received standard supervision by the court, those who received MEP experienced a better school attendance or social outcome over the follow-up period. Copyright © 2016 Du et al.

Neuropsychiatric Disease and Treatment, 12 : 699-706

Stockings, E., Hall, W. D., Lynskey, M., Morley, K. I., Reavley, N., Strang, J., Patton, G., Degenhardt, L.

Prevention, early intervention, harm reduction, and treatment of substance use in young people

We did a systematic review of reviews with evidence on the effectiveness of prevention, early intervention, harm reduction, and treatment of problem use in young people for tobacco, alcohol, and illicit drugs (eg, cannabis, opioids, amphetamines, or cocaine). Taxation, public consumption bans, advertising restrictions, and minimum legal age are effective measures to reduce alcohol and tobacco use, but are not available to target illicit drugs. Interpretation of the available evidence for school-based prevention is affected by methodological issues; interventions that incorporate skills training are more likely to be effective than information provision-which is ineffective. Social norms and brief interventions to reduce substance use in young people do not have strong evidence of effectiveness. Roadside drug testing and interventions to reduce injection-related harms have a moderate-to-large effect, but additional research with young people is needed. Scarce availability of research on interventions for problematic substance use in young people indicates the need to test interventions that are effective with adults in young people. Existing evidence is from high-income countries, with uncertain applicability in other countries and cultures and in subpopulations differing in sex, age, and risk status. Concerted efforts are needed to increase the evidence base on interventions that aim to reduce the high burden of substance use in young people. Copyright © 2016 Elsevier Ltd.

The Lancet Psychiatry, 3(3) : 280-296

Rotheram-Borus, M. J., Tomlinson, M., Durkin, A., Baird, K., DeCelles, J., Swendeman, D.

Feasibility of using soccer and job training to prevent drug abuse and HIV

Many young, South African men use alcohol and drugs and have multiple partners, but avoid health care settings-the primary site for delivery of HIV intervention activities. To identify the feasibility of engaging men in HIV testing and reducing substance use with soccer and vocational training programs. In two Cape Town neighborhoods, all unemployed men aged 18-25 years were recruited and randomized by neighborhood to: (1) an immediate intervention condition with access to a soccer program, random rapid diagnostic tests (RDT) for alcohol and drug use, and an opportunity to enter a vocational training program (n = 72); or (2) a delayed control condition (n = 70). Young men were assessed at baseline and 6 months later by an independent team. Almost all young men in the two neighborhoods participated (98 %); 85 % attended at least one practice (M = 42.3, SD = 34.4); 71 % typically attended practice. Access to job training was provided to the 35 young men with the most on-time arrivals at practice, drug-free RDT, and no red cards for violence. The percentage of young men agreeing to complete RDT at soccer increased significantly over time; RDTs with evidence of alcohol and drug use decreased over time. At the pre-post assessments, the frequency of substance use decreased; and employment and income increased in the immediate condition compared to the delayed condition. HIV testing rates, health care contacts, sexual behaviors, HIV knowledge, condom use and attitudes towards women were similar over time. Alternative engagement strategies are critical pathways to prevent HIV among young men. This feasibility study shows that soccer and job training offer such an alternative, and suggest that a more robust evaluation of this intervention strategy be pursued. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

AIDS and Behavior, 20(9) : 1841-1850

Salam, R. A., Das, J. K., Lassi, Z. S., Bhutta, Z. A.

Adolescent Health Interventions: Conclusions, Evidence Gaps, and Research Priorities

Adolescent health care is challenging compared to that of children and adults, due to their rapidly evolving physical, intellectual, and emotional development. This paper is the concluding paper for a series of reviews to evaluate the effectiveness of interventions for improving adolescent health and well-being. In this paper, we summarize the evidence evaluated in the previous papers and suggest areas where there is enough existing evidence to recommend implementation and areas where further research is needed to reach consensus. Potentially effective interventions for adolescent health and well-being include interventions for adolescent sexual and reproductive health, micronutrient supplementation, nutrition interventions for pregnant adolescents, interventions to improve vaccine uptake among adolescents, and interventions for substance abuse. Majority of the evidence for improving immunization coverage, substance abuse, mental health, and accidents and injury prevention comes from high-income countries. Future studies should specifically be targeted toward the low- and middle-income countries with long term follow-up and standardized and validated measurement instruments to maximize comparability of results. Assessment of effects by gender and socioeconomic status is also important as there may be differences in the effectiveness of certain interventions. It is also important to recognize ideal delivery platforms that can augment the coverage of proven adolescent health-specific interventions and provide an opportunity to reach hard-to-reach and disadvantaged population groups. Copyright © 2016 Society for Adolescent Health and Medicine

Journal of Adolescent Health, 59(2 Supplement) : S88-S92

Skorka-Brown, J., Andrade, J., Whalley, B., May, J.

Playing Tetris decreases drug and other cravings in real world settings

Most research on cognitive processes in craving has been carried out in the laboratory and focuses on food craving. This study extends laboratory findings to real world settings and cravings for drugs or activities as well as food. Previous laboratory research has found that playing Tetris reduces craving strength. The present study used an ecological momentary assessment protocol in which 31 undergraduate participants carried iPods for a week and were prompted 7 times each day, by SMS message, to use their iPod to report craving. Participants reported craving target and strength (0-100), whether they indulged their previous craving (yes/no), and whether they were under the influence of alcohol (yes/no). Those randomly assigned to the intervention condition (n=15) then played Tetris for 3min and reported their craving again. Those in the monitoring-only control condition (n=16) provided baseline craving data to test if Tetris reduced the incidence and strength of spontaneous cravings across the week. Playing Tetris decreased craving strength for drugs (alcohol, nicotine, caffeine), food and drink, and activities (sex, exercise, gaming), with a mean reduction of 13.9 percentage points, effect size f(2)=0.11. This effect was consistent across the week. This is the first demonstration that visual cognitive interference can be used in the field to reduce cravings for substances and activities other than eating.; Copyright © 2015 Elsevier Ltd. All rights reserved.

Addictive Behaviors, 51 : 165-170