Short-term effects of a brief motivational intervention to reduce alcohol and drug risk among homeless adolescents.

The short-term results of a randomized trial testing a brief feedback and motivational intervention for substance use among homeless adolescents are presented. Homeless adolescents ages 14-19 (N = 285) recruited from drop-in centers at agencies and from street intercept were randomly assigned to either a brief motivational enhancement (ME) group or 1 of 2 control groups. The 1-session motivational intervention presented personal feedback about patterns of risks related to alcohol or substance use in a style consistent with motivational interviewing. Follow-up interviews were conducted at 1 and 3 months postintervention. Youths who received the motivational intervention reported reduced illicit drug use other than marijuana at 1-month follow-up compared with youths in the control groups. Treatment effects were not found with respect to alcohol or marijuana. Post hoc analyses within the ME group suggested that those who were rated as more engaged and more likely to benefit showed greater drug use reduction than did those rated as less engaged. Limitations of the study are discussed as are implications for development of future substance use interventions for this high-risk group. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term effects of a personality-targeted intervention to reduce alcohol use in adolescents.

Objective: To examine the long-term effects of a personality-targeted intervention on drinking quantity and frequency (QF), problem drinking, and personality-specific motivations for alcohol use in early adolescence. Method: A randomized control trial was carried out with 364 adolescents (median age 14) recruited from 13 secondary schools with elevated scores in Hopelessness, Anxiety-Sensitivity (AS), Impulsivity, and Sensation-Seeking. Participants were randomly assigned to a control no-intervention condition or a 2-session group coping skills intervention targeting 1 of 4 personality risk factors. The effects of the intervention on quantity/frequency (QF) of alcohol use, frequency of binge drinking, problem drinking, and motives were examined at 6, 12, 18, and 24 months postintervention. Results: Intent-to-treat repeated measures analyses revealed a significant overall intervention effect in reducing problem drinking symptoms, and a Time × Intervention effect on drinking QF and binge drinking frequency. Relative to the control group, the intervention group showed significantly reduced drinking and binge drinking levels at 6 months postintervention and reduced problem drinking symptoms for the full 24-month follow-up period (Cohen's d = 0.33). A significant Time × Intervention × Personality interaction was demonstrated for coping and enhancement drinking motives. In addition to an overall effect of intervention on coping motives, the AS group who received that intervention reported fewer coping motives compared with the AS control group at 12 and 24 months postintervention. Conclusions: This study provides further evidence showing that personality-targeted interventions reduce drinking behavior in adolescents in the short term. Novel findings were that the interventions were shown to produced long-term effects on drinking problems and personality-specific effects on drinking motives. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Brief motivational intervention with homeless adolescents: Evaluating effects on substance use and service utilization.

A brief motivational intervention with 117 homeless adolescents was evaluated using a randomized design and 3-month follow-up. The intervention was designed to raise youths' concerns about their substance use, support harm reduction, and encourage greater service utilization at a collaborating agency. The study was designed to strengthen initial promising results of an earlier study (P. L. Peterson, J. S. Baer, E. A. Wells, J. A. Ginzler, & S. B. Garrett, 2006). Several modifications in the clinical protocol were included to enhance engagement with the intervention. Analyses revealed no significant benefits for intervention participants when homeless youths' substance use rates were compared with those of control participants. Service utilization during the intervention period increased for those receiving the intervention but returned to baseline levels at follow-up. Participants reported overall reductions in substance use over time. Differences between sampling methods for the current and previous study are discussed, as are the limitations of brief interventions with this population. Future research needs to elucidate mechanisms of change and service engagement for highly vulnerable youth. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Site matters: Multisite randomized trial of motivational enhancement therapy in community drug abuse clinics.

[Correction Notice: An erratum for this article was reported in Vol 77(2) of Journal of Consulting and Clinical Psychology (see record 2009-03774-013). There are two errors in the means and standard deviations reported in Table 1 (p. 561). The mean (and standard deviation) for the Total sample % positive urine drug tests (28 days) in the motivational enhancement therapy (MET) column is not 0.21 (SD = 0.35) as reported, but rather 0.28 (SD = 0.40). The mean (and standard deviation) for the Total sample % positive urine drug tests (28 days) in the counseling as usual (CAU) column is not 0.28 (SD = 0.40) as reported, but rather 0.31 (SD = 0.41). These corrections do not change any of the values reported for the d, F, or p statistics in this table.] The effectiveness of motivational enhancement therapy (MET) in comparison with counseling as usual (CAU) for increasing retention and reducing substance use was evaluated in a multisite randomized clinical trial. Participants were 461 outpatients treated by 31 therapists within 1 of 5 outpatient substance abuse programs. There were no retention differences between the 2 brief intervention conditions. Although both 3-session interventions resulted in reductions in substance use during the 4-week therapy phase, MET resulted in sustained reductions during the subsequent 12 weeks whereas CAU was associated with significant increases in substance use over this follow-up period. This finding was complicated by program site main effects and higher level interactions. MET resulted in more sustained substance use reductions than CAU among primary alcohol users, but no difference was found for primary drug users. An independent evaluation of session audiotapes indicated that MET and CAU were highly and comparably discriminable across sites. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

“Site matters: Multisite randomized trial of motivational enhancement therapy in community drug abuse clinics”: Correction.

Reports an error in "Site matters: Multisite randomized trial of motivational enhancement therapy in community drug abuse clinics" by Samuel A. Ball, Steve Martino, Charla Nich, Tami L. Frankforter, Deborah Van Horn, Paul Crits-Christoph, George E. Woody, Jeanne L. Obert, Christiane Farentinos and Kathleen M. Carroll (Journal of Consulting and Clinical Psychology, 2007[Aug], Vol 75[4], 556-567). There are two errors in the means and standard deviations reported in Table 1 (p. 561). The mean (and standard deviation) for the Total sample % positive urine drug tests (28 days) in the motivational enhancement therapy (MET) column is not 0.21 (SD = 0.35) as reported, but rather 0.28 (SD = 0.40). The mean (and standard deviation) for the Total sample % positive urine drug tests (28 days) in the counseling as usual (CAU) column is not 0.28 (SD = 0.40) as reported, but rather 0.31 (SD = 0.41). These corrections do not change any of the values reported for the d, F, or p statistics in this table. (The following abstract of the original article appeared in record 2007-11558-005.) The effectiveness of motivational enhancement therapy (MET) in comparison with counseling as usual (CAU) for increasing retention and reducing substance use was evaluated in a multisite randomized clinical trial. Participants were 461 outpatients treated by 31 therapists within 1 of 5 outpatient substance abuse programs. There were no retention differences between the 2 brief intervention conditions. Although both 3-session interventions resulted in reductions in substance use during the 4-week therapy phase, MET resulted in sustained reductions during the subsequent 12 weeks whereas CAU was associated with significant increases in substance use over this follow-up period. This finding was complicated by program site main effects and higher level interactions. MET resulted in more sustained substance use reductions than CAU among primary alcohol users, but no difference was found for primary drug users. An independent evaluation of session audiotapes indicated that MET and CAU were highly and comparably discriminable across sites. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use of monetary reinforcement to reduce the cigarette smoking of persons with schizophrenia: A feasibility study.

The feasibility of using monetary reinforcement to promote abstinence from substance use in adult individuals with schizophrenia was addressed. Cigarette smoking was studied as an exemplar of drug use in 11 individuals with schizophrenia by use of a within-subject experimental design. The study duration was 3 weeks, with weeks 1 and 3 serving as baseline conditions and week 2 serving as the intervention condition; in the latter, patients could earn money by abstaining from cigarette smoking. Abstinence was significantly greater during the intervention condition than during the baseline conditions. These results illustrate the potential sensitivity of drug use in this population to reinforcement contingencies, suggesting that contingency-management interventions are a feasible option for treating the substance abuse of individuals with schizophrenia (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of motivational interviewing interventions for adolescent substance use behavior change: A meta-analytic review.

Objective: This study was designed to quantitatively evaluate the effectiveness of motivational interviewing (MI) interventions for adolescent substance use behavior change. Method: Literature searches of electronic databases were undertaken in addition to manual reference searches of identified review articles. Databases searched include PsycINFO, PUBMED/MEDLINE, and Educational Resources Information Center. Twenty-one independent studies, representing 5,471 participants, were located and analyzed. Results: An omnibus weighted mean effect size for all identified MI interventions revealed a small, but significant, posttreatment effect size (mean d = .173, 95% CI [.094, .252], n = 21). Small, but significant, effect sizes were observed at follow-up suggesting that MI interventions for adolescent substance use retain their effect over time. MI interventions were effective across a variety of substance use behaviors, varying session lengths, and different settings, and for interventions that used clinicians with different levels of education. Conclusions: The effectiveness of MI interventions for adolescent substance use behavior change is supported by this meta-analytic review. In consideration of these results, as well as the larger literature, MI should be considered as a treatment for adolescent substance use. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Preventing substance abuse with children and adolescents.

Reviews research, from 1977 to 1984, on the prevention of tobacco, alcohol, and drug abuse with children and adolescents. The review is organized according to an intervention focus on the agent, environment, and host. A study, involving 193 6th graders and skills and attention-placebo interventions, examined methods and results of host-oriented skills intervention to prevent cigarette smoking. Results suggest that attention-placebo interventions (e.g., oral quizzes, games, debates) were insufficient to prevent smoking. Based on the review, conceptual and methodological progress in substance abuse prevention research is noted. Suggestions for future research include technological improvements necessary to implement preventive interventions on a wide scale. Highlighted are the importance of careful designs: manipulation checks on independent variables; process data collection; multimodal measures of self-report, behavioral, and physiological variables; and multivariate statistical analyses in studies on interventions to prevent tobacco, alcohol, and drug abuse with children and adolescents. (75 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personality and substance dependence symptoms: Modeling substance-specific traits.

Personality traits related to neuroticism and disinhibition have been consistently associated with substance use disorders (SUDs). It is unclear, however, whether different personality traits predict distinct forms of substance dependence. Additionally, it is unclear whether personality traits continue to predict alcohol, drug, and tobacco dependence after controlling for comorbid antisociality and other SUDs. The current study addresses these questions by characterizing relations between personality traits and substance dependence symptoms in a longitudinal sample of 3,720 college students. Results revealed that antisociality and certain core personality traits predicted multiple types of substance pathology. In addition, several personality traits were differentially associated with alcohol, drug, and tobacco symptomatology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mutual attachment, personality, and drug use: pathways from childhood to young adulthood

Young adult drug use stemming from childhood aggression, the parent-child mutual attachment relationship, and the effect of unconventionality were studied. Youngsters and their mothers were interviewed when the former were early adolescents, late adolescents, and young adults. Additional data were collected from the mothers when their youngsters were children. The analysis was conducted on youngsters who had complete data at all 4 points in time. The findings were in accord with the family interactional model; that is, the parent-child mutual attachment relationship affects unconventionality in the youngster, which, in turn, affects young adult drug use. The results indicate that the parent-child mutual attachment relationship does so through (a) the stability of the attachment relationship from childhood to young adulthood, (b) the stability of unconventional personality and behavioral attributes from early adolescence to young adulthood, and (c) the stability of drug use from early adolescence to young adulthood. The findings imply that (a) early intervention with respect to aggression, (b) interventions that focus on strengthening the parent-child bond and conventional behavior, and (c) interventions aimed at early drug use should be most effective in reducing young adult drug use.     

A multisite randomized effectiveness trial of motivational enhancement therapy for Spanish-speaking substance users.

Hispanic individuals are underrepresented in clinical and research populations and are often excluded from clinical trials in the United States. Hence, there are few data on the effectiveness of most empirically validated therapies for Hispanic substance users. The authors conducted a multisite randomized trial comparing the effectiveness of 3 individual sessions of motivational enhancement therapy with that of 3 individual sessions of counseling as usual on treatment retention and frequency of substance use; all assessment and treatment sessions were conducted in Spanish among 405 individuals seeking treatment for any type of current substance use. Treatment exposure was good, with 66% of participants completing all 3 protocol sessions. Although both interventions resulted in reductions in substance use during the 4-week therapy phase, there were no significant Treatment Condition × Time interactions nor Site × Treatment Condition interactions. Results suggest that the individual treatments delivered in Spanish were both attractive to and effective with this heterogeneous group of Hispanic adults, but the differential effectiveness of motivational enhancement therapy may be limited to those whose primary substance use problem is alcohol and may be fairly modest in magnitude. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Two brief alcohol interventions for mandated college students.

Encouraging but limited research indicates that brief motivational interventions may be an effective way to reduce heavy episodic drinking in college students. At 2 campuses, students (83% male) mandated to a substance use prevention program were randomly assigned to 1 of 2 individually administered conditions: (a) a brief motivational interview (BMI; n = 34) or (b) an alcohol education session (AE; n = 30). Students in the BMI condition reported fewer alcohol-related problems than the AE students at 3-and 6-month assessments. Trends toward reductions in number of binge drinking episodes and typical blood alcohol levels were seen in both groups. Process measures confirmed the integrity of both interventions. The findings demonstrate that mandated BMIs can reduce alcohol problems in students referred for alcohol violations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Peer enhancement of a brief motivational intervention with mandated college students.

In this pilot study, the authors evaluated whether incorporating a peer in a brief motivational intervention would lead to significant reductions in alcohol use and problems in students mandated to receive treatment after violating campus alcohol policy. Thirty-six participant-peer dyads (66% male) were randomly assigned to receive either two 45-min sessions of an individual motivational intervention (IMI, n = 18) or a peer-enhanced motivational intervention (PMI, n = 18). The IMI included exploration of motivation to change alcohol use, perceived positive and negative effects of drinking, personalized feedback, and goals for changing alcohol consumption and related behaviors. The PMI included all elements of the IMI plus the presence of a supportive peer of the participant during both sessions. Although both groups significantly reduced number of drinking days and heavy drinking days at 1-month follow-up, the magnitude of within-group reductions in alcohol use and problems was 3 times larger on average for the PMI group than for the IMI group, based on effect-size calculations. Peers and participants endorsed high satisfaction ratings on the PMI. Findings indicate the promise of including peers in brief motivational interventions for mandated students. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized control trial examining the effect of acceptance and commitment training on clinician willingness to use evidence-based pharmacotherapy.

This study evaluated the effectiveness of acceptance and commitment training (ACT) for increasing drug and alcohol counselors' willingness to use evidence-based agonist and antagonist pharmacotherapy. Fifty-nine drug and alcohol counselors were randomly assigned to either a 1-day ACT workshop or a 1-day educational control workshop. Both groups then attended a 2-day workshop on empirically supported treatments for substance abuse. Measures were taken at pre- and posttraining and 3-month follow-up on reported use of pharmacotherapy, willingness to use pharmacotherapy, perceived barriers to implementing new treatments, and general acceptance. As compared with those in the education alone condition, participants in the ACT condition showed significantly higher rates of referrals to pharmacotherapy at follow-up, rated barriers to learning new treatments as less believable at posttraining and follow-up, and showed greater psychological flexibility at posttraining and follow-up. Mediational analyses indicated that reduced believability of barriers and greater psychological flexibility mediated the impact of the intervention. Results support the idea that acceptance-based interventions may be helpful in addressing the psychological factors related to poor adoption of evidence-based treatments. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Increasing Substance Abuse Treatment Compliance for Persons With Traumatic Brain Injury.

This study compared 3 methods of increasing participation in substance abuse treatment for clients with traumatic brain injury. Participants (N = 195) were randomly assigned to 4 conditions: (a) motivational interview, (b) reduction of logistical barriers to attendance, (c) financial incentive, and (d) attention control. Four interviewers conducted structured, brief telephone interventions targeting the timeliness of signing an individualized service plan. Participants assigned to the barrier reduction (74%) and financial incentive (83%) groups were more likely to sign within 30 days compared with the motivational interview (45%) and attention control (45%) groups. Similar results were observed for time to signing, perfect attendance at appointments, and premature termination during the following 6 months. Extent of psychiatric symptoms was the only significant covariate. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Longitudinal substance initiation outcomes for a universal preventive intervention combining family and school programs.

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 (SlI) 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. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of coping skills training on adolescents at risk for substance use.

279 high-risk secondary school students completed one of the following treatment conditions: (1) coping skills school intervention, (2) coping skills school plus parent intervention, or (3) comparison control. Ss in the coping skills conditions improved on a measure of coping skills acquisition, whereas those in the control group did not. All Ss improved on a variety of personality and school behavior variables. There were some modest increases in self-report of substance use; however, these were smaller than would be expected in a high-risk population over the study period. The findings suggest that preventive intervention with high-risk youth has some positive effect on risk factors, although the differential efficacy of coping skills training with high-risk youth was not supported. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Access conditions are crucial: Comment on Lynch and Carroll (2001).

W. J. Lynch and M. E. Carroll (see record 2001-06653-001) sought to identify factors that control drug intake, that is, factors that decrease the avidity of drug seeking and drug taking while drug is obviously available. The review provides updated information about factors that regulate drug intake and a heuristic framework for future studies of regulatory processes throughout the natural history of a substance abuse disorder. In particular, the review suggests a productive framework for studies of transitions from early drug use to later abusive use. Forceful identification of factors that control the avidity of drug seeking and drug taking under the controlled conditions of the laboratory may encourage development of therapeutic interventions that capitalize on these factors for successful treatment of human drug abuse. Extending the analysis of regulation of intake include factors that can be manipulated to reorganize behavior may improve the design of interventions to treat drug abuse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using Behavioral Theories of Choice to Predict Drinking Outcomes Following a Brief Intervention.

Behavioral theories of choice predict that substance use is partly a function of the relative value of drugs in relation to other available reinforcers. This study evaluated this hypothesis in the context of predicting drinking outcomes following an alcohol abuse intervention. Participants (N=54, 69% female, 31% male) were college student heavy drinkers who completed a single-session motivational intervention. Students completed a baseline measure of substance-related and substance-free activity participation and enjoyment. Only women showed a significant reduction in drinking at the 6-month follow-up, and the ratio of substance-related to substance-free reinforcement accounted for unique variance in their drinking outcomes. Women who at baseline derived a smaller proportion of their total reinforcement from substance use showed lower levels of follow-up drinking, even after the authors controlled for baseline drinking level. Male and female participants who reduced their drinking showed increased proportional reinforcement from substance-free activities. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Some models and mechanisms for explaining the impact of maternal and adolescent characteristics on adolescent stage of drug use.

Examined the impact of interrelationship models and interactive mechanisms involving maternal and adolescent variables on the adolescent's stage of drug use in 356 mothers and their youngsters (aged 13–18 yrs). Ss completed questionnaires assessing maternal personality attributes, mother–child relationship, adolescent personality attributes, and stage of drug use. Results indicate that domains (i.e., sets of related variables) of adolescent personality and mother–child relationship variables each had an independent impact on drug use. Thus, conventional adolescents with strong mutual attachments to mothers were at lower drug stages. The maternal personality domain had an indirect impact on drug use via the other 2 domains. A psychologically stable and conventional mother was associated with a positive mother–child relationship and conventionality in the adolescent, which led to lower drug stages. The interactive effects on drug stage of individual maternal and adolescent measures were also examined. Results show that the impact on drug use of maternal risk (drug-prone) and protective (non-drug prone) characteristics could be altered by certain adolescent traits. (42 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)