Disorders - Substance Use Disorders
Young, M. M., Stevens, A., Galipeau, J., Pirie, T., Garritty, C., Singh, K.l Yazdi,
F., Golfam, M., Pratt, M., Turner, L., Porath-Waller, A., Arratoon, C., Haley, N., Leslie, K., Reardon, R., Sproule, B., Grimshaw, J., Moher, D.
The purpose of this systematic review is to assess the effectiveness of brief
interventions (BIs) as part of the Screening, Brief Intervention, and Referral to Treatment (SBIRT) model for reducing the nonmedical use of
psychoactive substances. Bibliographic databases (including MEDLINE, Embase, The Cochrane Library, CINAHL, and PsycINFO to April 2012) and gray
literature sources were searched. We included randomized controlled trials that opportunistically screened adolescents or adults and then provided a
one-to-one, verbal BI to those at risk of substance-use harm. Of interest was the nonmedical use of psychoactive substances (for example, drugs
prohibited by international law), excluding alcohol, nicotine, and caffeine. Interventions comprised four or fewer sessions and were compared with
no/delayed intervention or provision of information only. Studies were assessed for bias using the Cochrane risk of bias tool. Results were
synthesized narratively. Evidence was interpreted according to the GRADE framework. We identified 8,836 records. Of these, five studies met our
inclusion criteria. Two studies compared BI with no BI, and three studies compared BI with information only. Studies varied in characteristics such
as substances targeted, screening procedures, and BI administered. Outcomes were mostly reported by a single study, leading to limited or uncertain
confidence in effect estimates. Insufficient evidence exists as to whether BIs, as part of SBIRT, are effective or ineffective for reducing the use
of, or harms associated with nonmedical use of, psychoactive substances when these interventions are administered to nontreatment-seeking, screen-
detected populations. Updating this review with emerging evidence will be important. CRD42012002414.
Systematic
Reviews, 3 : 50
- Year: 2014
- Problem: Substance Use Disorders (any)
- Type: Systematic reviews
-
Stage: Universal prevention, At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Motivational interviewing, includes Motivational Enhancing Therapy, Other Psychological Interventions
Ward, C. L., Mertens, J. R., Bresick,
G. F., Little, F., Weisner, C. M.
Purpose: To explore whether reducing substance misuse through a brief motivational intervention also reduces aggression and HIV risk
behaviours.Methods: Participants were enrolled in a randomized controlled trial in primary care if they screened positive for substance misuse.
Substance misuse was assessed using the Alcohol, Smoking and Substance Involvement Screening Test; aggression, using a modified version of the
Explicit Aggression Scale; and HIV risk, through a count of common risk behaviours. The intervention was received on the day of the baseline
interview, with a 3-month follow-up.Results: Participants who received the intervention were significantly more likely to reduce their alcohol use
than those who did not; no effect was identified for other substances. In addition, participants who reduced substance misuse (whether as an effect
of the intervention or not) also reduced aggression but not HIV risk behaviours.Conclusions: Reducing substance misuse through any means reduces
aggression; other interventions are needed for HIV risk reduction.
Alcohol & Alcoholism, 50(3) : 302-309
- Year: 2014
- Problem: Substance Use Disorders (any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Motivational interviewing, includes Motivational Enhancing Therapy
Wagner, E. F., Hospital, M. M., Graziano, J. N., Morris, S. L., Gil, A. G.
Objective: Adolescent substance use and abuse is a pressing public health problem and is
strongly related to interpersonal aggression. Such problems disproportionately impact minority youth, who have limited access to evidence-based
interventions such as ecological family therapies, brief motivational interventions (BMIs), and cognitive behavioral therapies (CBTs). With a
predominantly minority sample, our objective was to rigorously evaluate the efficacy of a school-based BMI/CBT, Guided Self-Change (GSC), for
addressing substance use and aggressive behavior. Method: We conducted a school-based randomized, controlled trial with 514 high school students
(mean age 16.24 years, 41% female, 80% minority) reporting using substances and perpetrating aggression. We used structural equation modeling to
compare participants randomly assigned to receive GSC or standard care (SC; education/assessment/ referral-only) at posttreatment and at 3 and 6
months posttreatment on alcohol use, drug use, and interpersonal aggression outcomes as assessed by the Timeline Follow-Back. Results: Compared with
SC participants, GSC participants showed significant reductions (p < .05) in total number of alcohol use days (Cohen's d = 0.45 at posttreatment and
0.20 at 3 months posttreatment), drug use days (Cohen's d = 0.22 at posttreatment and 0.20 at 3 months posttreatment), and aggressive behavior
incidents (Cohen's d = 0.23 at posttreatment). Moreover, treatment effects did not vary by gender or ethnicity. Conclusions: With minority youth
experiencing mild to moderate problems with substance use and aggressive behavior, GSC holds promise as an early intervention approach that can be
implemented with success in schools.
Journal of Consulting & Clinical Psychology, 82(6) : 1128-
1139
- Year: 2014
- Problem: Substance Use Disorders (any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Motivational interviewing, includes Motivational Enhancing Therapy, Self-help
Vigna-
Taglianti, F. D., Galanti, M. R., Burkhart, G., Caria, M. P., Vadrucci, S., Faggiano, F.
The EU-Dap study aimed to develop and evaluate a school-based curriculum for the prevention of substance use among
young people. The school curriculum, \"Unplugged,\" is based on social influence approach and addresses social and personal skills, knowledge, and
normative beliefs. It consists of 12 one-hour interactive sessions delivered by teachers. Its effectiveness was evaluated through a randomized trial
involving 7,079 pupils of seven European countries. Unplugged was effective in reducing cigarette smoking, episodes of drunkenness, and the use of
cannabis at short term. This association, however, was confined to boys, with age and self-esteem as possible explanations of this difference.
Beneficial effects associated with the program persisted at fifteen-month follow-up for drunkenness, alcohol-related problems, and cannabis use, and
were stronger among adolescents in schools of average low socioeconomic level. These results are of scientific importance and may inform the adoption
of effective public health interventions at population level.; © WILEY PERIODICALS, INC.
New Directions For Youth
Development, 2014(141) : 67
- Year: 2014
- Problem: Substance Use Disorders (any)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Van-Horn, M. L., Fagan, A. A., Hawkins, J. D., Oesterle, S.
Introduction Adolescent substance use and delinquency are major public health problems. Although community-based prevention strategies have
been recommended to produce population-level reductions in rates of substance use and delinquency, few models show evidence of effectiveness. Purpose
To test the efficacy of a community-based prevention system, Communities That Care (CTC), in reducing community rates of problem behaviors,
particularly effects on specific profiles of adolescent substance use and delinquency in eighth- and tenth-graders. Methods Twenty-four communities
were randomized to CTC intervention or control groups. Data were collected from 14,099 8th- and 10th-grade students in these communities using
anonymous cross-sectional surveys in 2004 and 2010 and analyzed in 2012. Outcomes were four different profiles of self-reported substance use and
delinquency in 8th grade and five profiles in 10th grade. Results In the cross-sectional 2010 data, there was no intervention effect on the
probability of experimenting with substances or of substance use coupled with delinquent activities for either grade. However, tenth-graders in
intervention communities were significantly less likely to be alcohol users than those in control communities (OR=0.69, CI=0.48, 1.00). Conclusions
Cross-sectional population surveys showed evidence of CTC effects in reducing tenth-grade alcohol users but not experimenters. A community-wide
reduction in adolescent alcohol use is important because alcohol is the most commonly used illicit substance during adolescence, and early initiation
of alcohol use has been associated with alcohol-related disorders in adulthood. Failure to find hypothesized effects on experimenters qualifies these
results. © 2014 American Journal of Preventive Medicine.
American Journal of Preventive Medicine, 47(2) : 188-197
- Year: 2014
- Problem: Substance Use Disorders (any)
- Type: Controlled clinical trials
-
Stage: Universal prevention
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement
interventions
Faggiano, F., Minozzi, S., Versino, E., Buscemi, D.
BACKGROUND: Drug addiction
is a chronic, relapsing disease. Primary interventions should aim to reduce first use or to prevent the transition from experimental use to
addiction. School is the appropriate setting for preventive interventions.\rOBJECTIVES: To evaluate the effectiveness of universal school-based
interventions in reducing drug use compared to usual curricular activities or no intervention.\rSEARCH METHODS: We searched the Cochrane Drugs and
Alcohol Group's Trials Register (September 2013), the Cochrane Central Register of Controlled Trials (2013, Issue 9), PubMed (1966 to September
2013), EMBASE (1988 to September 2013) and other databases. We also contacted researchers in the field and checked reference lists of articles.
\rSELECTION CRITERIA: Randomised controlled trials (RCT) evaluating school-based interventions designed to prevent illicit drugs use.\rDATA
COLLECTION AND ANALYSIS: We used the standard methodological procedures expected by The Cochrane Collaboration.\rMAIN RESULTS: We included 51
studies, with 127,146 participants. Programmes were mainly delivered in sixth and seventh grade pupils. Most of the trials were conducted in the USA.
Social competence approach versus usual curricula or no intervention Marijuana use at < 12 months follow-up: the results favoured the social
competence intervention (risk ratio (RR) 0.90; 95% confidence interval (CI) 0.81 to 1.01, four studies, 9456 participants, moderate quality
evidence). Seven studies assessed this outcome (no data for meta-analysis): two showed a positive significant effect of intervention, three showed a
non-significant effect, one found a significant effect in favour of the control group and one found a trend in favour of the control group.Marijuana
use at 12+ months: the results favoured the social competence intervention (RR 0.86; 95% CI 0.74 to 1.00, one study, 2678 participants, high quality
evidence). Seven studies assessed this outcome (no data for meta-analysis): two showed a significant positive effect of intervention, three showed a
non-significant effect, one found a significant effect in favour of the control group and one a trend in favour of the control group.Hard drug use at
< 12 months: we found no difference (RR 0.69; 95% CI 0.40 to 1.18, one study, 2090 participants, moderate quality evidence). Two studies assessed
this outcome (no data for meta-analysis): one showed comparable results for the intervention and control group; one found a statistically non-
significant trend in favour of the social competence approach.Hard drug use at 12+ months: we found no difference (mean difference (MD) -0.01; 95% CI
-0.06 to 0.04), one study, 1075 participants, high quality evidence). One study with no data for meta-analysis showed comparable results for the
intervention and control group.Any drug use at < 12 months: the results favoured social competence interventions (RR 0.27; 95% CI 0.14 to 0.51, two
studies, 2512 participants, moderate quality evidence). One study with 1566 participants provided continuous data showing no difference (MD 0.02; 95%
CI -0.05 to 0.09, moderate quality evidence). Social influence approach versus usual curricula or no intervention Marijuana use at < 12 months: we
found a nearly statistically significant effect in favour of the social influence approach (RR 0.88; 95% CI 0.72 to 1.07, three studies, 10,716
participants, moderate quality evidence). One study with 764 participants provided continuous data showing results that favoured the social influence
intervention (MD -0.26; 95% CI -0.48 to -0.04).Marijuana use at 12+ months: we found no difference (RR 0.95; 95% CI 0.81 to 1.13, one study, 5862
participants, moderate quality evidence). One study with 764 participants provided continuous data and showed nearly statistically significant
results in favour of the social influence intervention (MD -0.22; 95% CI -0.46 to 0.02). Of the four studies not providing data for meta-analysis a
statistically significant protective effect was only found by one study.Hard drug use at 12+ months: one study not providing data for meta-analysis
found a significant protective effect of the social influence approach.Any drug use: no studies assessed this outcome. Combined approach versus usual
curricula or no intervention Marijuana use at < 12 months: there was a trend in favour of intervention (RR 0.79; 95% CI 0.59 to 1.05, three studies,
8701 participants, moderate quality evidence). One study with 693 participants provided continuous data and showed no difference (MD -1.90; 95% CI -
5.83 to 2.03).Marijuana use at 12+ months: the results favoured combined intervention (RR 0.83; 95% CI 0.69 to 0.99, six studies, 26,910
participants, moderate quality evidence). One study with 690 participants provided continuous data and showed no difference (MD -0.80; 95% CI -4.39
to 2.79). Two studies not providing data for meta-analysis did not find a significant effect.Hard drug use at < 12 months: one study with 693
participants provided both dichotomous and continuous data and showed conflicting results: no differenc for dichotomous outcomes (RR 0.85; 95% CI
0.63 to 1.14), but results in favour of the combined intervention for the continuous outcome (MD -3.10; 95% CI -5.90 to -0.30). The quality of
evidence was high.Hard drug use at 12+ months: we found no difference (RR 0.86; 95% CI 0.39 to 1.90, two studies, 1066 participants, high quality
evidence). One study with 690 participants provided continuous data and showed no difference (MD 0.30; 95% CI -1.36 to 1.96). Two studies not
providing data for meta-analysis showed a significant effect of treatment.Any drug use at < 12 months: the results favoured combined intervention (RR
0.76; 95% CI 0.64 to 0.89, one study, 6362 participants).Only one study assessed the effect of a knowledge-focused intervention on drug use and found
no effect. The types of comparisons and the programmes assessed in the other two groups of studies were very heterogeneous and difficult to
synthesise.\rAUTHORS' CONCLUSIONS: School programmes based on a combination of social competence and social influence approaches showed, on average,
small but consistent protective effects in preventing drug use, even if some outcomes did not show statistical significance. Some programmes based on
the social competence approach also showed protective effects for some outcomes.Since the effects of school-based programmes are small, they should
form part of more comprehensive strategies for drug use prevention in order to achieve a population-level impact.
Cochrane Database of Systematic
Reviews, 12 : CD003020
- Year: 2014
- Problem: Substance Use Disorders (any)
- Type: Systematic reviews
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Deady, M., Teesson, M., Kay-
Lambkin, F. J.
Background: Depression and problematic substance use represent two of the major
social and health problems facing young people internationally. Frequently, these conditions co-occur and this co-occurrence is associated with
greater functional impact, poorer treatment outcomes, and increased costs to both society and the individual. Objective: This review aims to identify
peer-reviewed published trials of interventions for co-occurring substance use and depression delivered to young people, describe these
interventions, and critique the methodological quality of the studies. Method: Eleven electronic databases were searched. The reference lists of
relevant review papers were searched manually for additional studies not identified by the electronic database search. Results: Initially, 1,976
studies were identified, of which 22 were classified as trial studies of youth-based treatment interventions for co-occurring substance use and
depression. Ten of these studies met criteria for review. The majority (60%) utilized a pharmacotherapy component, but found it to be generally no
better than placebo when both groups received adjunct counselling. Methodological quality of studies varied. Conclusions: There is a dearth of trials
of interventions for co-occurring depression and substance use disorders in young people. The limited data available is promising regarding the
overall effectiveness of a psychological counselling approach. Given the importance of early intervention, and the difficulties faced when engaging
youth in treatment, there is a need for further focused effort amongst this group. This may require more innovative techniques in intervention design
and implementation. Recent advances in Internet- and mobile phone-based therapies present a potential avenue for further research.
Current Drug Abuse Reviews, 7(1) : 3-
17
- Year: 2014
- Problem: Depressive Disorders, Substance Use Disorders (any)
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Psychological Interventions
(any)
Hunter, B. D., Godley, M. D., Godley, S. H.
Nationally, approximately 10% of adolescents in need of treatment for a substance use (SU) disorder receive
treatment. School-based treatment may provide an important opportunity to reduce the treatment gap by facilitating access to services. While some
school-based SU treatment exists, little is known about whether newer, evidence-based treatments (e.g. Adolescent Community Reinforcement Approach
[A-CRA]) can be well implemented in schools. The objectives of this study were to compare adolescents receiving A-CRA services in school-based versus
clinic-based settings in regard to (1) intake characteristics, (2) treatment implementation quality, and (3) clinical outcomes. Results suggest that
A-CRA in school-based settings was more likely to reach girls and youth with shorter SU histories; A-CRA was well implemented within school-based
settings and the school-based group had equivalent or better outcomes than the clinic-based group. (PsycINFO Database Record (c) 2015 APA, all rights
reserved) (journal abstract).
Advances in School Mental Health Promotion, 7(2) : 105-
122
- Year: 2014
- Problem: Substance Use Disorders (any)
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Other service delivery and improvement
interventions
Godley, M.
D., Godley, S. H., Dennis, M. L., Funk, R. R., Passetti, L. L., Petry, N. M.
Objective:
Most adolescents relapse within 90 days of discharge from residential substance use treatment. We hypothesized that contingency management (CM),
assertive continuing care (ACC), and their combination (CM + ACC) would each be more effective than usual continuing care (UCC). Method: Following
residential treatment, 337 adolescents were randomized to 4 continuing care conditions: UCC alone, CM, ACC, or CM + ACC. UCC was available across all
conditions. Outcome measures over 12 months included percentage of days abstinent from alcohol, heavy alcohol, marijuana, and any alcohol or other
drugs (AOD) using self-reports and toxicology testing and remission status at 12 months. Results: CM had significantly higher rates of abstinence
than UCC for heavy alcohol use, t(297) = 2.50, p <.01, d = 0.34; any alcohol use, t(297) = 2.58, p <.01, d = 0.36; or any AOD use, t(297) = 2.12, p
=.01, d = 0.41; and had a higher rate in remission, odds ratio (OR) = 2.45, 90% confidence interval (CI) [1.18, 5.08], p =.02. ACC had significantly
higher rates of abstinence than UCC from heavy alcohol use, t(297) = 2.66, p <.01, d = 0.31; any alcohol use, t(297) = 2.63, p <.01, d = 0.30; any
marijuana use, t(297) = 1.95, p =.02, d = 0.28; or any AOD use, t(297) = 1.88, p =.02, d = 0.30; and had higher rates in remission, OR = 2.31, 90% CI
[1.10, 4.85], p =.03. The ACC + CM condition was not significantly different from UCC on any outcomes. Conclusions: CM and ACC are promising
continuing care approaches after residential treatment. Future research should seek to further improve their effectiveness. © 2013 American
Psychological Association.
Journal of Consulting & Clinical
Psychology, 82(1) : 40-51
- Year: 2014
- Problem: Substance Use Disorders (any)
- Type: Randomised controlled trials
-
Stage: Relapse prevention
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions, Contingency
management
Gonzales, R., Ang, A., Murphy, D. A., Glik, D. C., Anglin, M. D.
Project ESQYIR (Educating & Supporting Inquisitive Youth in Recovery) is a pilot study
examining the feasibility of a 12-week mobile-based aftercare intervention for youth (ages 12 to 24) transitioning out of community-based substance
abuse treatment programs. From January 2012 through July 2013, a total of 80 youth were recruited from outpatient and residential treatment programs,
geographically dispersed throughout Los Angeles County, California. Results revealed that youth who participated in the texting mobile pilot
intervention were significantly less likely to relapse to their primary compared to the aftercare as usual control condition (OR = 0.52, p= 0.002)
over time (from baseline throughout the 12-week aftercare pilot program to a 90-day follow-up). Participants in the texting aftercare pilot program
also reported significantly less substance use problem severity (ß = - 0.46, p= 0.03) and were more likely to participate in extracurricular recovery
behaviors (ß = 1.63, p= 0.03) compared to participants in the standard aftercare group. Collectively, findings from this pilot aftercare study
suggest that mobile texting could provide a feasible way to engage youth in recovery after substance abuse treatment to aid with reducing relapse and
promoting lifestyle behavior change. © 2014 Elsevier Inc.
Journal of Substance Abuse Treatment, 47(1) : 20-
26
- Year: 2014
- Problem: Substance Use Disorders (any)
- Type: Randomised controlled trials
-
Stage: Relapse prevention
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Jensen, M. R., Wong, Jessie J., Gonzales, N. A., Dumka, L. E., Millsap, R., Coxe, S.
This randomized trial of a family-focused
preventive intervention for Mexican American middle schoolers examined internalizing, externalizing, and substance use outcomes in late adolescence,
5 years after completing the intervention. Parent-adolescent conflict was tested as a mediator of these effects. The role of parent and adolescent
acculturation in these pathways was also examined. There were 494 seventh-grade adolescents and their primary female caregivers randomized to receive
either a 9-week multicomponent intervention or a brief workshop control group. Assessments were conducted at pretest, 2-year follow-up (9th grade),
and 5-year follow-up (when most participants were in the 12th grade). The Bridges program significantly reduced mother-adolescent conflict measured
in the 9th grade, with conflict mediating program effects on internalizing and externalizing symptoms, adolescent substance use, and diagnosed
internalizing disorder in late adolescence. Mother and child acculturation were both significantly predictive of late adolescence outcomes. Contrary
to hypotheses, neither mother nor child acculturation emerged as a significant predictor of mother-adolescent conflict, and the interaction of mother
and adolescent acculturation was similarly not related to mother-adolescent conflict. Intervention effects were largely consistent across different
levels of acculturation. These findings provide support for the efficacy of family-focused intervention during early adolescence, both in reducing
mental health problems and substance use in the long term and in impacting parent-adolescent conflict processes that appear to play an important role
in the development of later adjustment problems.;
Journal of Clinical Child & Adolescent Psychology, 43(3) : 415-
427
- Year: 2014
- Problem: Substance Use Disorders (any)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Hogue, A., Henderson, C. E., Ozechowski, T. J., Robbins, M.
S.
This article updates the evidence base on outpatient behavioral treatments for
adolescent substance use (ASU) since publication of the previous review completed for this journal by Waldron and Turner ( 2008 ). It first
summarizes the Waldron and Turner findings as well as those from more recent literature reviews and meta-analytic studies of ASU treatment. It then
presents study design and methods criteria used to select 19 comparative studies subjected to Journal of Clinical Child & Adolescent Psychology level
of support evaluation. These 19 studies are grouped by study category (efficacy or effectiveness) and described for sample characteristics,
methodological quality, and substance use outcomes. Cumulative level of support designations are then made for each identified treatment approach:
ecological family-based treatment, group cognitive-behavioral therapy, and individual cognitive-behavioral therapy are deemed Well Established;
behavioral family-based treatment and motivational interviewing are deemed Probably Efficacious; drug counseling is deemed Possibly Efficacious; and
four integrated treatment models combining more than one approach are deemed Well Established or Probably Efficacious. The remainder of the article
(a) articulates fidelity, mediator, and moderator effects reported for evidence-based approaches since 2008 and (b) recommends four enhancements to
the prevailing business model of ASU outpatient services to accelerate penetration of evidence-based approaches into the underserved consumer base:
pursue partnerships with influential governmental systems, utilize web-based technology to extend reach and control costs, adapt effective methods
for linking services across sectors of care, and promote uptake and sustainability by emphasizing return on investment.
Journal of Clinical Child & Adolescent Psychology, 43(5) : 695-
720
- Year: 2014
- Problem: Substance Use Disorders (any)
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any)