Study 1
D’Amico and colleagues (2013) conducted a randomized controlled trial to determine the impact of the Free Talk program on recidivism, delinquency, alcohol and other drug use and consequences, and alcohol and other drug use before sex, 3 months after completion of the program. Participants included 187 adolescents aged 14–18 who had been referred to the Santa Barbara [California] Teen Court diversion program for a first-time alcohol or marijuana offense. Eligible youths who are not in need of more intensive intervention, as determined by the probation department, can participate in this program instead of going through formal processing in the juvenile justice system. Each group of five teens was randomized using a 3:2 ratio, with three teens assigned to the Free Talk group and two teens to the control group. Using the 3:2 ratio ensured a sufficient number of participants in the Free Talk group to allow the group to run successfully.
Teens in the intervention group (n=109) were assigned to the six-session Free Talk motivational interviewing group. Teens in the comparison group (n=78) received usual care, which consisted of six group sessions that followed an abstinence-based Alcoholics Anonymous approach, and included discussion of personal triggers, consequences of alcohol and other drug use, educational videos, discussion of personal experiences with alcohol and other drug use, and myths about alcohol and other drug use. Attendees of these sessions also included teens who were not eligible for the study because they did not meet study criteria (e.g., they were younger than 14, had a medical marijuana prescription card, or had a different offense); however, all youths in the usual care group, whether in the study or not, reported alcohol and other drug problems.
Participants were mostly male (67 percent) with a mean age of 16.6 years (range 14–18). Race/ethnicity was evenly split between those reporting Hispanic race/ethnicity (45 percent) and those reporting white (non-Hispanic) race/ethnicity (45 percent). An additional 10 percent reported being of mixed or other race/ethnicity. There were no statistically significant between-group differences on these demographic variables. More teens in the intervention group reported lifetime alcohol use, alcohol consequences, and being drunk, compared with teens in the comparison group. These differences were controlled for in the outcome analyses.
Youths were assessed at baseline and 3 months after program completion. The primary outcomes of interest were past month frequency of alcohol and marijuana use, heavy drinking in the past month, and alcohol and marijuana consequences. Past month frequency of alcohol and marijuana use were assessed using measures from the RAND Adolescent/Young Adult Panel Study, based on established items and scales from Monitoring the Future and DSM-IV criteria. Participants were asked, “During the past month, how many times [or days] have you tried alcohol [marijuana]?” Heavy drinking was assessed by a question about how frequently in the past month they had drunk “five or more drinks of alcohol in a row, that is, within a couple of hours.” Items based on DSM-IV criteria addressed whether adolescents had experienced consequences due to alcohol (six items, which included missed school or work, or passed out) or marijuana use (five items such as got into trouble at school or home, had difficulty concentrating). Additional outcomes included recidivism, delinquency, and alcohol and other drug use before sex. Recidivism data were obtained from the Santa Barbara County Probation Department and included the total number of youths who recidivated 1 year after their first offense, by study condition. Delinquency was assessed by a 10-item scale that asked teens how often they participated in undesirable behaviors (e.g., cheated on a test at school, were drunk or high in a public place) in the past year or since the last survey. Finally, teens were asked one item obtained from the Youth Risk Behavior Surveillance System (YRBSS) regarding whether they had used alcohol and other drug before sex. Responses were: “I have never had sexual intercourse,” “yes,” or “no”.
For alcohol and other drug use and consequences, delinquency, and alcohol and other drug use before sex, between-group comparisons were conducted, to control for baseline covariates and baseline measure of the variable of interest. Recidivism data were analyzed using a chi-square test to determine whether the percentages who recidivated were different between groups. Recidivism rates were examined for a subgroup of youths in each condition who completed all six group sessions.
