Disorders - Substance Use Disorders
Teesson, M., Newton, N., Slade, T., Chapman, C., Birrell, L., Mewton, L., Mather, M., Hides, L., McBride, N., Allsop, S., Andrews, G.
Introduction and Aims: Mental health and
substance use disorders are leading causes of disability among young people globally [1]. Research has highlighted the comorbidity of these disorders
[2], yet few existing prevention programs concurrently target these issues. Furthermore, many programs are hampered by poor implementation fidelity.
The Climate Schools Combined (CSC) Study was the first trial to test the effectiveness of an online prevention model targeting both mental health and
substance use disorders among adolescents. Design and Methods: A four-arm cluster RCT involving 6386 students from 71 schools was conducted from
2014-2016. Schools were randomised to one of the following conditions; 1) \"Control,\" 2) \"Climate Schools-Substance Use,\" 3) \"Climate Schools-
Mental Health,\" or 4) the \"CSC\" intervention. Result(s): Compared to Controls, the Combined intervention increased knowledge related to alcohol
and cannabis at 12, 24 and 30 months (30 months: alcohol SMD 0.26, 95% CI 0.14 - 0.39, cannabis SMD 0.17, 95% CI 0.06 - 0.28), increased knowledge
related to mental health at 24 months (SMD 0.17, 95% CI 0.08 - 0.27), less growth in their odds of drinking and heavy episodic drinking at 12, 24 and
30 months (30 months: drinking OR 0.25, 95% CI 0.12 - 0.51, heavy episodic drinking OR 0.15, 95% CI 0.04 - 0.58), and reduced increases in anxiety
symptoms at 12 and 30 months (30 months: SMD -0.12, 95% CI -0.22 - -0*01). No difference was found in symptoms or probable diagnosis of depression.
The Combined intervention also showed evidence of improvement on some outcomes compared to the Substance Use and Mental Health interventions.
Discussions and Conclusion(s): For the first time, there is evidence of the effectiveness of a universal school-based preventive intervention
concurrently targeting substance use, depression and anxiety. It provides educators with an easy to implement and scalable approach to prevention.
Disclosure of Interest Statement: MT and NN are developers of the Climate Schools programs, as well as the Directors of Climate Schools Pty Ltd,
which distributes the Climate Schools programs on a not-for-profit basis.
Alcoholism: Clinical and Experimental Research, 45
(SUPPL 1) : 75A
- Year: 2021
- Problem: Anxiety Disorders (any), Depressive Disorders, Substance Use Disorders (any), Alcohol
Use, Cannabis Use
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Other Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
Suto, M., Miyazaki, C., Yanagawa, Y., Takehara, K., Kato, T., Gai, R., Ota, E., Mori, R.
BACKGROUND: Universal prevention approaches that target the general population can
be effective for promoting children's health. This overview aims to summarize evidence presented in existing reviews of school-based interventions.
METHOD(S): We present an overview of evidence sourced from Campbell and Cochrane systematic reviews. These reviews examined randomized controlled
trials concerning school-based health-promotion programs for children (mostly aged 4-18years) in the general population. RESULT(S): We identified 56
high-quality reviews. The reviews focused on emotional and behavioral outcomes, infectious diseases, injury reduction, mental health, nutrition
intake, oral health, physical and developmental changes, sense-organ diseases, sexual-health outcomes, and substance use/abuse. Positive evidence-
such as vision screening plus provision of free spectacles for spectacle wear increase and a combination of social competence and social-influence
approaches for preventing illicit drug use-were considered high certainty. CONCLUSION(S): Of the various interventions implemented in school settings
that involved people from various occupations, some positive effects were found. In most cases, evidence certainty was negatively affected by a high
risk of bias within studies, inconsistencies within the estimates, and insufficient sample sizes. Further primary studies in these areas would be
helpful for accumulating evidence to promote stronger cooperation between health and education stakeholders. Copyright © 2021, American School Health
Association.
The Journal of school health, 91
(6) : 499-517
- Year: 2021
- Problem: Substance Use Disorders (any)
- Type: Systematic reviews
-
Stage: Universal prevention
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any)
Sheidow, A. J., Zajac, K., Chapman, J. E., McCart, M. R., Drazdowski, T. K.
Most adolescents presenting to community mental health centers have one or more comorbidities (internalizing, externalizing, and substance
use problems). We evaluated an integrated family-based outpatient treatment for adolescents (OPT-A) that can be delivered in a community mental
health center by a single therapist. A sample of 134 youth/families were randomized to receive OPT-A or usual services, delivered at the same public
sector mental health center. Repeated, multi-informant assessments occurred through 18-months post-baseline. At baseline, the sample displayed low
internalizing symptoms, moderate substance use, and high externalizing problems. Compared to usual services, OPT-A had effects on abstinence rates,
retention, motivation, parent involvement, and satisfaction, but not on internalizing or externalizing problems. While OPT-A achieved some key
improvements for youth who present to community mental health centers, and families were satisfied with treatment, continued work is necessary to
examine treatments for comorbidity while balancing treatment feasibility and complex strategies to boost treatment effectiveness.
Community mental health journal, 57(6) : 1094-
1110
- Year: 2021
- Problem: Substance Use Disorders (any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Other Psychological Interventions, Other service delivery and improvement
interventions
Schwinn, T. M., Fang, L., Hopkins,
J., Pacheco, A. R.
OBJECTIVE: This trial tested the efficacy of a smartphone application (app) designed to prevent drug
use among Hispanic youth. METHOD(S): Participants were recruited through online advertising and youth service agencies. The baseline sample (N = 644)
had a mean age of 14.1 years, was primarily female (60%), and resided in 31 U.S. states and Puerto Rico. Youth assented to study participation and
received parental permission to participate. Youth were randomly assigned to an intervention arm or a measurement-only control arm. Intervention-arm
youth completed 10 prevention program sessions via a smartphone app. Following intervention delivery, all youth completed posttest and 1-, 2-, and 3
-year follow-up measures. RESULT(S): Analyzed within an Arm by Time interaction model, follow-up data showed that compared with control-arm youth,
intervention-arm youth reported (a) less increase in alcohol use from baseline to 2-year follow-up; (b) less increase in marijuana use from baseline
to 2- and 3-year follow-ups; and (c) less increase in polydrug use from baseline to 1-, 2-, and 3-year follow-ups. Compared with youth in the control
arm, intervention-arm youth reported (a) less depressed mood and improved skills for refusing offers of alcohol and tobacco at posttest; (b) higher
self-efficacy and social self-efficacy at 1-, 2-, and 3-year follow-ups; (c) improved skills for refusing offers of marijuana at 2- and 3-year
follow-ups; (d) higher media literacy at 2- and 3-year follow-ups; and (e) better coping skills at 3-year follow-up. CONCLUSION(S): These
longitudinal findings suggest that Hispanic youth can profit from tailored, skills-based content delivered via a smartphone app to prevent drug
use.
Journal of studies on alcohol and drugs, 82(5) : 668-
677
- Year: 2021
- Problem: Substance Use Disorders (any)
- Type: Randomised controlled trials
-
Stage: Universal prevention, At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Skills training, Technology, interventions delivered using technology (e.g. online, SMS)
Sanchez, Z. M., Valente, J. Y., Galvao, P. P., Gubert, F. A., Melo, M. H. S., Caetano, S. C., Mari, J.
J., Cogo-Moreira, H.
AIMS: The study aimed to evaluate the effectiveness of the government school-based program #Tamojunto2.0, the third Brazilian version of the
European drug prevention program, Unplugged, in preventing the use of alcohol and other drugs. DESIGN: A parallel, two-arm cluster randomized
controlled trial was conducted in 205 classes in 73 public schools (37 intervention and 36 control) with a baseline assessment and follow-up after 9
months. SETTING: Schools in the cities of Sao Paulo, Fortaleza and Eusebio in Brazil. PARTICIPANTS: A total of 5208 students in the 8th grade with a
mean age of 13.2 years (standard deviation = 0.8 years) and an equal gender ratio. INTERVENTION: In 2019, the intervention group attended 12 classes
of the program #Tamojunto2.0, under the supervision of a team from the Ministry of Health. The control group did not receive any intervention to
prevent alcohol and drug use. MEASUREMENTS: The primary outcome measured was prevalence of binge drinking (five or more doses of alcohol in an
occasion) within the past month. Secondary outcomes were prevalence of initiation and use of alcohol, tobacco, inhalants, marijuana and cocaine
within the past month. FINDINGS: A statistically significant difference was not found in the prevalence of binge drinking within the past month
between intervention and control groups [odds ratio (OR) = 0.934; 95% confidence interval (CI) = 0.761-1.146]. However, students who were exposed to
the program were less likely to initiate alcohol use than those in the control group (OR = 0.782; 95% CI = 0.636-0.961). The Bayes factor for
reduction in binge drinking was 0.01, providing evidence in favor of the null hypothesis for this variable. CONCLUSION(S): The drug prevention
program #Tamojunto 2.0 reduced alcohol initiation, but appeared not to reduce past-month binge drinking among 8th grade students in Brazil. Copyright
© 2020 Society for the Study of Addiction.
Addiction (Abingdon, England), 116(6) : 1580-
1592
- Year: 2021
- Problem: Substance Use Disorders (any)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any), Psychoeducation, Skills training, Other Psychological Interventions
Sanchez, Z. M., Valente, J. Y., Gusmoes, J. D. P., Ferreira-Junior, V., Caetano, S. C., Cogo-
Moreira, H., Andreoni, S.
Background: The Drug and Violence Resistance Educational Program (PROERD)
is widely disseminated and implemented as a public policy in Brazil. PROERD's current curricula are the translation of the North American program
DARE-Keepin'it REAL, based on the theories of socio-emotional learning and resistance training. The present study aims to evaluate the effectiveness
of PROERD in the prevention of drug use. Method(s): Two PROERD curricula were analyzed through two cluster randomized controlled trials conducted
with 4030 students (1727 5th graders and 2303 7th graders) in 30 public schools in Sao Paulo. The intervention group received ten PROERD classes
delivered by trained police officers, and the control group received no intervention. Data collection was performed using self-administered
questionnaires on smartphones at two points in time (baseline pre-intervention and nine months follow-up). The outcomes evaluated were initiation and
recent drug use. Two different paradigms were used in a multilevel analysis: an analysis of complete cases (CC) and an intention to treat missing
data through full information maximum likelihood and selection model. Result(s): We found no evidence of the effectiveness of PROERD as an
intervention for the prevention of drug use. For the conditional transition analysis, we found that 7th graders in the PROERD group who were already
binge drinking at baseline had a significantly higher chance of maintaining this consumption pattern when compared to the control group. Conclusion
(s): The lack of preventive effects found here suggests that a process evaluation may address concrete implementation and cultural adaptation issues.
Copyright © 2021 Elsevier B.V.
International Journal of Drug Policy, 98 (no
pagination) :
- Year: 2021
- Problem: Substance Use Disorders (any)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Rushing, S. C., Kelley, A., Bull, S., Stephens, D., Wrobel, J., Silvasstar,
J., Peterson, R., Begay, C., Dog, T. G., McCray, C., Brown, D. L., Thomas, M., Caughlan,
C., Singer, M., Smith, P., Sumbundu, K.
Background: Culturally relevant interventions are needed to help American Indian and Alaska
Native (AI/AN) teenagers and young adults navigate common risky situations involving family and friends, including drug and alcohol misuse, dating
violence, and suicidality. Leveraging We R Native, a multimedia health resource for Native teenagers and young adults, staff of the Northwest
Portland Area Indian Health Board designed the BRAVE intervention for Native youth. The program is delivered via SMS text messaging and includes role
model videos, mental wellness strategies, links to culturally relevant resources, and social support from family and friends. Objective(s): We aim to
conduct a randomized controlled trial of the BRAVE intervention among AI/AN teenagers and young adults (aged 15-24 years) to assess its impact on
their physical, mental, and spiritual health; their resilience and self-esteem; and their coping and help-seeking skills. Method(s): From October to
December 2019, we recruited 2334 AI/AN teenagers and young adults nationwide via social media channels and SMS text messages and enrolled 1044
participants. AI/AN teenagers and young adults enrolled in the study received either BRAVE SMS text messages, designed to improve mental health,
help-seeking skills, and cultural resilience, or 8 weeks of science, technology, engineering, and math (STEM) SMS text messages, designed to elevate
and reaffirm Native voices in STEM and medicine and then received the BRAVE SMS text messages. The impacts of the BRAVE intervention were tested
using linear mixed-effect models and linear regressions. Result(s): A total of 833 AI/AN teenagers and young adults were included in the analysis.
Individuals in the BRAVE and STEM arms showed significant positive trends over the course of the study for all outcomes, except cultural identity and
help-seeking behavior. Mean scores were significantly different for health (P<.001), resilience (P<.001), negative coping (P=.03), positive coping
(P<.001), self-efficacy (P=.02), and self-esteem (P<.001). Changes in help-seeking self-efficacy were significant in those exhibiting risky behaviors
at baseline to exit (P=.01). Those who reported positive coping scores at baseline also reported better health on average; however, no difference was
found in risky drug and alcohol use (P<.001). The number of participants who used SMS text messages to help themselves increased from 69.1% (427/618)
at 3 months to 76% (381/501; P<.001) at 8 months. Similarly, the number of participants who used SMS text messages to help friends or family members
increased from 22.4% (138/616) at 3 months to 54.6% (272/498) at 8 months. Conclusion(s): This is the first national randomized controlled trial of a
mobile health intervention among AI/AN teenagers and young adults to test the efficacy of a mental wellness intervention in relation to STEM career
messages. This study provides new insights for supporting the next generation of AI/AN changemakers. ,,. Copyright © 2021 JMIR Publications Inc. All
right reserved.
JMIR Mental Health, 8(9) (no
pagination) :
- Year: 2021
- Problem: Substance Use Disorders (any)
- Type: Randomised controlled trials
-
Stage: Universal prevention, At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Other Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
Moltrecht, B., Deighton, J., Patalay, P., Edbrooke-Childs, J.
Background: Research
investigating the role of emotion regulation (ER) in the development and treatment of psychopathology has increased in recent years. Evidence
suggests that an increased focus on ER in treatment can improve existing interventions. Most ER research has neglected young people, therefore the
present meta-analysis summarizes the evidence for existing psychosocial intervention and their effectiveness to improve ER in youth. A systematic
review and meta-analysis was conducted according to the PRISMA guidelines. Twenty-one randomized-control-trials (RCTs) assessed changes in ER
following a psychological intervention in youth exhibiting various psychopathological symptoms. We found moderate effect sizes for current
interventions to decrease emotion dysregulation in youth (g = - 0.46) and small effect sizes to improve emotion regulation (g = 0.36). Significant
differences between studies including intervention components, ER measures and populations studied resulted in large heterogeneity. This is the first
meta-analysis that summarizes the effectiveness for existing interventions to improve ER in youth. The results suggest that interventions can enhance
ER in youth, and that these improvements correlate with improvements in psychopathology. More RCTs including larger sample sizes, different age
groups and psychopathologies are needed to increase our understanding of what works for who and when. Copyright © 2020, The Author(s).
European Child and Adolescent Psychiatry, 30(6) : 829
-848
- Year: 2021
- Problem: Anxiety Disorders (any), Depressive Disorders, Substance Use Disorders (any)
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any)
Kulis, S. S., Marsiglia, F. F., Medina-Mora, M. E., Nuno-Gutierrez, B. L., Corona, M. D., Ayers, S. L.
This study assesses the efficacy of a version of the keepin' it REAL (kiREAL)
substance use prevention curriculum for middle school students that was culturally adapted for Mexico, renamed Mantente REAL (MREAL), and tested in a
cluster randomized controlled trial in Mexico's three largest cities. Student participants were in 7th grade in public middle schools (N = 5523, 49%
female, mean age = 11.9). A representative sample of 12 schools from each city, stratified by whether they held morning or afternoon sessions, was
randomized to three conditions: culturally adapted MREAL, original kiREAL translated into Spanish, or a treatment-as-usual control group. Regular
classroom teachers were trained to deliver the adapted MREAL or the kiREAL manualized curricula. Students with active parental consent completed
pretest and post-test questionnaires, 7-8 months apart, at the beginning and end of the 2017-2018 academic year. We assessed the MREAL intervention,
relative to kiREAL and controls, with general linear models adjusted for baseline, attrition (24%), non-normal distributions, stratification by city,
and school-level clustering. Among students already using the substance more often at pretest, MREAL students had relatively more desirable outcomes,
compared to kiREAL and/or to controls, in recent use of alcohol, cigarettes, \"hard drugs,\" heavy episodic drinking, and intoxication. MREAL
students reported relatively less violence victimization and perpetration of bullying and relatively more use of three of the intervention's REAL
drug resistance strategies (Explain, Avoid, Leave). The adapted version of kiREAL for Mexico showed numerous desired outcomes in areas deliberately
targeted in the cultural adaptation. Full protocol can be accessed through Clinical Trials.gov. ID: NCT03233386, \"'Keepin' It REAL in Mexico: An
adaptation and multisite RCT\".
Prevention science : the
official journal of the Society for Prevention Research, 22(5) : 645-657
- Year: 2021
- Problem: Substance Use Disorders (any)
- Type: Randomised controlled trials
-
Stage: Universal prevention, At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Skills training
Kulis, S. S., Garcia-Perez, H., Marsiglia, F. F., Ayers, S. L.
Background: This article reports on a test of a youth substance use prevention program conducted in Nogales-Sonora, a Mexican city on the
US border. Objective: The study tested the efficacy of a version of the keepin' it REAL curriculum for middle school students that was culturally
adapted for Mexico and renamed Mantente REAL. Methods: Students in 7th grade classrooms in four public schools participated in the study (N = 1,418,
49% female, mean age = 11.9). Using a clustered randomized design, two schools received the intervention and two served as a treatment-as-usual
control group. Regular classroom teachers were trained to deliver the twelve-lesson Mantente REAL manualized curriculum. Parents provided active
consent and students gave written assent to collect pretest and posttest questionnaire data, 7 months apart, at the beginning and end of the 2017-
2018 academic year. We assessed the Mantente REAL intervention with general linear models adjusted for baseline, attrition, non-linear distributions,
and school-level clustering. Results: Students who participated in Mantente REAL reported relatively less frequent use of alcohol and illicit drugs
other than marijuana, compared to students in control schools. Males alone reported desirable intervention effects for marijuana use. These desirable
effects were especially strong among students who reported higher initial levels of involvement in risky behaviors. Among students more at risk, both
females and males receiving the program reported relative reductions in the frequency of use of alcohol and illicit drugs. Conclusions: These
promising results within the Mexico-US border context support a further dissemination of the intervention and additional youth prevention research in
the region.
, 56(2) : 245-257
- Year: 2021
- Problem: Substance Use Disorders (any)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any), Skills training
Kuklinski, M. R., Oesterle,
S., Briney, J. S., Hawkins, J. D.
This
study estimated sustained impacts and long-term benefits and costs of the Communities That Care (CTC) prevention system, implemented and evaluated in
a longitudinal cluster-randomized trial involving 24 communities in seven states. Analyses utilized reports from a longitudinal panel of 4407
participants, followed since the study's baseline in grade 5, with most recent follow-up 12 years later at age 23. Impacts on lifetime abstinence
from primary outcomes of substance use and antisocial behavior were estimated using generalized linear mixed Poisson regression analysis, adjusted
for individual and community-level covariates. Possible cascading effects on 4-year college completion, major depressive disorder, and generalized
anxiety disorder through age 23 were evaluated as secondary outcomes. CTC had a statistically significant global effect on primary outcomes and also
on combined primary and secondary outcomes. Among primary outcomes, point estimates suggested absolute improvements in lifetime abstinence of 3.5 to
6.1% in the intervention arm and relative improvements of 13 to 55%; 95% confidence intervals revealed some uncertainty in estimates. Among secondary
outcomes, 4-year college completion was 1.9% greater among young adults from intervention communities, a 20% relative improvement. Mental health
outcomes were approximately the same across trial arms. Although CTC had small sustained effects through age 23, benefit-cost analyses indicated CTC
was reliably cost beneficial, with a net present value of $7152 (95% credible interval: $1253 to $15,268) per participant from primary impacts and
$17,919 ($306 to $39,186) when secondary impacts were also included. It remained cost beneficial even when impacts were adjusted downward due to the
involvement of CTC's developer in the trial. Findings suggest that broader dissemination of CTC could improve public health and individual lives in
the long term and generate positive net benefits to society.
Prevention science : the official journal of the Society for Prevention Research, 22(4) : 452-
463
- Year: 2021
- Problem: Substance Use Disorders (any)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement
interventions
Hesse, M., Thylstrup, B., Karsberg, S., Mulbjerg Pedersen, M., Pedersen, M. U.
Objective: This multicenter, parallel
randomized, open study examined the effect of using vouchers and session reminders as an added element to outpatient treatment for drug use disorders
in youth. It was hypothesized that being randomly assigned to a contingency management condition would lead to a reduction of psychiatric symptoms,
and that this reduction would be mediated through abstinence and treatment completion. Method(s): A total of 460 participants aged 15 to 25 years
from nine outpatient sites were randomized to one of four treatment conditions (standard treatment alone [STD], i.e., 12 sessions using motivational
interviewing and cognitive behavioral therapy, STD plus vouchers for attendance [VOU], STD plus text reminders [REM], or STD plus vouchers and text
reminders [REM + VOU]). Participants' symptoms of psychological distress were assessed using the YouthMap 12 instrument at intake, and at 3, 6, and
9 months post-treatment initiation. Interviewers were blinded to interventions. Result(s): 114 participants were randomized to STD, 112 to REM, 113
to VOU, and 121 to VOU + REM. 69 clients were never interviewed for follow-up, leaving 391 for analysis (n = 90, n = 94, n = 99, n = 108). The mean
age was 20.5 years (SD = 2.6), 23% were female, and 34% reported having a psychiatric diagnosis. Random effects regression showed that participants
randomized to one of the two voucher-based conditions experienced significantly steeper declines in symptoms compared with STD (p <.01). Structural
equation modeling results indicated that the effects of contingency management on symptoms were mediated through abstinence, but not sessions
attended. Conclusion(s): Adding contingency management to interventions for drug use disorders can reduce symptoms of psychological and emotional
distress among populations of treatment-seeking youth, in part due to indirect effects through abstinence at follow-up. The data is collected from a
clinical trial registered as ISRCTN27473213, at https://www.isrctn.com/. Copyright © 2021 Taylor & Francis Group, LLC.
, 17
(3) : 257-266
- Year: 2021
- Problem: Substance Use Disorders (any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Motivational interviewing, includes Motivational Enhancing Therapy, Contingency
management