Evidence Rating for Outcomes
Drugs & Substance Abuse | Alcohol |
Drugs & Substance Abuse | Marijuana |
Date:
This practice consists of time-limited, low-dose therapeutic programs delivered in a school or educational setting that teach skills and encourage motivation to change or prevent substance use in youth participants. This practice is rated Effective for reducing alcohol use but was rated No Effects for reducing marijuana use.
Practice Goals/Target Population
Brief substance use interventions are time-limited, low-dose therapeutic programs that teach skills and encourage motivation to change or prevent risky substance-use behaviors in youth participants. School-based, brief substance-use interventions are delivered to youths in a middle, high, or secondary school setting or vocational education and training setting. The interventions can be used as universal, selective, or indicated prevention (CSAT, 1999).
Practice Theory
Brief interventions were developed on the assumption that people are not always ready to change their patterns of substance use (Carey et al., 2016). The theoretical basis for this practice is grounded in the transtheoretical model of behavior change. The transtheoretical model of behavior change argues that readiness for change develops along a series of stages rather than as a fixed event that either occurs or does not occur. These steps are precontemplation, contemplation, preparation, action, and maintenance. Individuals usually move through these stages before reaching termination (Prochaska, 1993). From this perspective, motivation is seen as a state that can be altered rather than as a fixed trait in an individual.
Practice Components
Brief interventions are targeted, time-limited, low-threshold services that aim to reduce substance use and its associated risks and to prevent progression to more severe levels of use and potential negative consequences (Babor et al., 2007). Interventions are delivered in person and provide information or advice, increase motivation not to use substances, and teach behavior change skills with the aim of reducing substance use.
Brief interventions vary in length and delivery format but typically last from one to five sessions (Moyer et al., 2002; Tevyaw and Monti, 2004). Although most brief interventions include a screening of potential participants, this element is typically not included in school-based interventions (Hallfors et al., 2006). In addition to advice-giving, the common elements of a successful intervention are referred to by the acronym FRAMES, which stands for the following:
- Feedback on behavior and its consequences to the client
- Responsibility for change as the responsibility of the individual
- Advice for change
- Menu of options for change
- Empathy
- Self-efficacy for change (Bien, Miller, and Tonigan, 1993)
Brief interventions are offered through a variety of modalities. The most common brief intervention program modalities for substance use involve cognitive–behavioral/skills training, motivational enhancement, and/or psychoeducational therapy. Cognitive–behavioral/skills training modalities focus on how individuals’ cognitions affect their actions and might involve, for instance, teaching and practicing skills for identifying and dealing with risky drinking situations. Motivational enhancement modalities use a motivational interviewing approach to concentrate on enhancing participants’ motivations to self-evaluate and self-regulate their behavior and often involve goal-setting or contracting and decisional balance exercises. Psychoeducational prevention modalities, in contrast, tend to be less interactive, and are typically didactic presentations focused on providing information and education about alcohol and alcohol-related harmful behavior.
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Drugs & Substance Abuse | Alcohol
Hennessy and Tanner–Smith (2015) analyzed effect sizes from 17 studies (that included randomized controlled trials and quasi-experimental designs) and found statistically significant improvements in alcohol use among youths who participated in school-based, brief substance-use interventions, compared with youths who did not participate. Specifically, participants of school-based, brief substance-use interventions reduced their alcohol use by 1.4 days a month (average 3.7 days in the past month), compared with youths who did not participate (average 5.1 days in the past month). In contrast, Carney and colleagues (2016) analyzed the effects from two randomized controlled trials and found no statistically significant difference in the frequency of alcohol use (number of days used) among youths who participated in school-based, brief substance-use interventions, compared with youths who received information provision only. However, the result should be interpreted with caution, given that only two studies were included in the analysis. |
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Drugs & Substance Abuse | Marijuana
Carney and colleagues (2016) analyzed the effects from two studies and found no statistically significant difference in the frequency of marijuana use (number of days used) among youths who participated in school-based, brief substance-use interventions, compared with youths who received information provision only. However, the result should be interpreted with caution, given that only two studies were included in the analysis. |
Literature Coverage Dates | Number of Studies | Number of Study Participants | |
---|---|---|---|
Meta Analysis 1 | 1980-2012 | 17 | 2877 |
Meta Analysis 2 | 1970-2015 | 6 | 1176 |
Hennessy and Tanner–Smith (2015) conducted a meta-analysis evaluating the effectiveness of school-based, brief alcohol interventions on substance use among youth. This analysis used data collected from studies identified in a larger systematic review of brief substance-use interventions for adolescents and young adults (Tanner–Smith and Lipsey, 2015). Studies were included in the review if they met the following eligibility criteria: The study 1) evaluated a school-based brief intervention in either an individually or group-delivered format, 2) had no more than 5 hours of total intervention contact time and no more than 4 weeks in duration between the first and last session, 3) used a randomized or quasi-experimental research design that included a comparison condition of no treatment, waitlist control, or some form of treatment as usual, 4) assessed the effects of the intervention on at least one alcohol-related outcome, 5) included adolescents in middle, high, or secondary schools, and 6) was conducted in 1980 or later. A comprehensive literature search was conducted to detect all relevant published and unpublished studies current through December 2012. The electronic databases searched included Clinical Trials Register, Dissertation Abstracts International, ERIC, PsycARTICLES, PsycINFO, and PubMed. Bibliographies were reviewed from all screened and eligible studies and from prior narrative reviews and meta-analyses. Several additional gray literature sources were searched.
Twenty-eight documents that reported findings for 17 unique study samples were identified for inclusion from the literature search. Studies were conducted in North America (nine studies), Latin America (three studies), Europe (three studies), Asia (one study), and South America (one study). The majority of studies (11 studies) were randomized controlled designs, and the others (6 studies) used controlled quasi-experimental research designs. Nine studies involved interventions delivered to a group, and eight were delivered individually. All the individually delivered interventions used motivational enhancement therapy (MET). The group-delivered interventions used psychoeducational therapy (four studies), cognitive–behavioral therapy/skills training (three studies), MET (one study), and cognitive–behavioral and motivational enhancement therapy combined (one study). Ten studies implemented school-based brief substance use interventions in a single session (the range of sessions was 1–4). Participants across the studies were predominately male (53 percent), and the average age was 15.6 years. Among the studies that reported participant ethnicity, most study participants were white (41 percent) or Black (21 percent).
Outcomes were measured with standardized mean difference effect sizes and were adjusted with the small-sample correction factor (Hedges’ g). Random effects statistical models were used, implemented with weighted analyses using inverse variance weights.
Meta Analysis 2Carney and colleagues (2016) conducted a meta-analysis evaluating the effectiveness of brief school-based interventions on substance use among youths. Studies were included if they were randomized controlled trials that evaluated the effects of brief school-based interventions for substance-using adolescents and included a comparison or control group (i.e., no intervention, placebo, assessment only, or other types of education). The primary outcome was reduction or cessation of substance use. Participants were required to 1) be under age 19, 2) be attending high school, secondary school, or a further education training college, and 3) have used alcohol or other substances without meeting the criteria for dependence. Studies were excluded if the intervention was conducted among youths in any setting other than educational.
A comprehensive literature search was conducted from March 2013 through February 2015, which included 10 electronic databases and 6 websites on evidence-based interventions. Databases searched included the Cochrane Central Register of Controlled Trials, PubMed, EMBASE, PsycINFO, ERIC, the Social Science Index, Academic Search Premier, the Alcohol and Alcohol Problems Science Database, and the Web of Science Social Science Citation Index. Reference lists of included studies and reviews were also searched from 1966 through February 2015.
Six studies published between 2004 and 2015, which included 1,176 youths, were eligible for inclusion. Comparison groups consisted of either an information-only group, in which youths received general health promotion materials and harm-reduction information (three studies; 732 youths), or an assessment-only group, in which youths received no intervention or informational material (three studies; 444 youths). The CrimeSolutions review of this meta-analysis looked at the comparison between the treatment group and the information-only comparison group. The included studies in the meta-analysis assessed alcohol and marijuana use outcomes. The average youth age was 16.9 years. Studies were conducted in the United States or the United Kingdom. Interventions were delivered on an individual face-to-face basis in high schools and alternative education/vocational training colleges. The interventions of the included studies consisted of a single session (three studies) or two sessions (three studies). Participants received some or all the following: screening, motivational interviewing, information provision and discussion, brochures, and follow-up appointments.
Alcohol use frequency was assessed in two studies at 4- to 6-month follow-up by self-report questionnaires. Marijuana use frequency was assessed in two studies at 1- to 3-month follow-up by self-report questionnaires. Substance use was assessed using established tools such as the Global Appraisal of Individual Needs Interview, the Alcohol Use Disorders Identification Test, the Timeline Followback interview, the Severity of Dependence Scale, the Substance Use Disorder Manual of the Adolescent Diagnostic Interview, and the Alcohol Beverage Youth Survey. Standardized mean differences were calculated for outcomes, and random-effects models were used to account for the variability in duration of intervention and different follow-up measures.
Hennessy and Tanner–Smith (2015) conducted moderator analyses to examine the delivery format of school-based brief substance-use interventions on youth alcohol use. Delivery format was measured as individually-delivered (individual with provider) or group delivered (group with provider). The results showed that individually delivered, school-based, brief substance-use interventions had a statistically significant effect on reducing youth alcohol use, compared with group format interventions, which did not have a statistically significant effect on reducing alcohol use with youth.
These sources were used in the development of the practice profile:
Carney, Tara, Bronwyn J. Myers, Johann J. Louw, and Charles I. Okwundu. 2016. “Brief School-Based Interventions and Behavioural Outcomes for Substance-Using Adolescents.” Cochrane Database of Systematic Reviews Issue 1. Art.No.: CD008969
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7119449/Hennessy, Emily A., and Emily E. Tanner–Smith. 2015. “Effectiveness of Brief School-Based Interventions for Adolescents: A Meta-Analysis of Alcohol Use Prevention Programs.” Prevention Science: The Official Journal of the Society for Prevention Research 16(3):463–74.
These sources were used in the development of the practice profile:
Babor, Thomas F., Bonnie G. McRee, Patricia A. Kassebaum, Paul L. Grimaldi, Kazi Ahmed, Jeremy W. Bray. 2007. “Screening, Brief Intervention, and Referral to Treatment (SBIRT).” Substance Abuse 28(3):7–30.
Bien, Thomas H., William R. Miller, and J. Scott Tonigan. 1993. “Brief Interventions for Alcohol Problems: A Review. Addiction 88(3):315–36.
(CSAT) Center for Substance Abuse Treatment. 1999. Brief Interventions and Brief Therapies for Substance Use. Treatment Improvement Protocol (TIP) Series 34. Rockville, Md.: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment. DHHS Publication No. SMA 99–3353.
https://www.ncbi.nlm.nih.gov/books/NBK64947Hallfors, Denise Dion, Hyunsan Cho, Paul Henry Brodish, Robert L. Flewelling, and Shereen Khatapoush. 2006. “Identifying High School Students ‘At Risk’ for Substance Use and Other Problems: Implication for Prevention.” Substance Use and Misuse 41:1–15.
Miller, William R., and Stephen Rollnick. 2002. Motivational Interviewing: Preparing People to Change Addictive Behavior, Second Edition. New York, N.Y.: Guilford Press.
Moyer, Anne, John W. Finney, Carolyn E. Swearingen, and Pamela Vergun. 2002. “Brief Interventions for Alcohol Problems: A Meta-Analytic Review of Controlled Investigations in Treatment-Seeking and Nontreatment Seeking Populations.” Addiction 97:279–92.
Prochaska, James O., Carlo C. DiClemente, and John C. Norcross. 1993. “In Search of How People Change: Applications to Addictive Behaviors.” Journal of Addictions Nursing 15(1):2–16.
Tanner-Smith, Emily E., and Mark W. Lipsey. 2015. “Brief Alcohol Interventions for Adolescents and Young Adults: A Systematic Review and Meta-Analysis.” Journal of Substance Abuse Treatment 51:1–18.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4346408Tevyaw, Tracy O’Leary, and Peter M. Monti. 2004. “Motivational Enhancement and Other Brief Interventions for Adolescent Substance Abuse: Foundations, Applications, and Evaluations.” Addiction 99:63–75.
Following are CrimeSolutions-rated programs that are related to this practice:
Age: 13 - 19
Gender: Male, Female
Race/Ethnicity: White, Black
Setting (Delivery): School
Practice Type: Alcohol and Drug Prevention, Cognitive Behavioral Treatment, Conflict Resolution/Interpersonal Skills, Individual Therapy
Unit of Analysis: Persons
151 Merrimac St.
Emily Hennessy
Recovery Research Institute, Massachusetts General Hospital; Harvard Medical School
6th Floor
Boston, MA 02114
United States
Website
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