Practice Profile: School-Based Brief Interventions for Substance Use Among Youth

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 A comprehensive literature search was conducted to detect all relevant published and unpublished studies current through December 2012.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.

Carney 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.