Brief motivational enhancement intervention to prevent or reduce postpartum alcohol use: A single-blinded,randomized controlled effectiveness trial

Aims

The aim of this study is to assess the effect of brief motivational enhancement intervention postpartum alcohol use.

Design

This study is a single-blinded, randomized controlled effectiveness trial in which pregnant women were assigned to receive usual care or up to 5 face-to-face brief motivational enhancement sessions lasting 10–30 minutes each and occurring at study enrollment, 4 and 8 weeks after enrollment, 32 weeks of gestation, and 6 weeks postpartum.

Setting

The setting is in a large, urban, obstetrics clinic.

Participants

Participants were women who were ≥ 18 years old, < 20 weeks of gestation, and consumed alcohol during pregnancy. Of 3438 women screened, 330 eligible women were assigned to usual care (n = 165) or intervention (n = 165). Due to missing data, we analyzed 125 in the intervention group and 126 in the usual care group.

Measurements

The measurements were the proportion of women with any alcohol use and the number of drinks per day, reported via follow-up telephone interviews at 4 and 8 weeks after enrollment, 32 weeks of gestation, and 6 weeks, 6 months, and 12 months postpartum.

Findings

In random effects models adjusted for confounders, the intervention group was less likely to use any alcohol (odds ratio 0.50; 95% confidence interval [CI], 0.23–1.09; P = 0.08) and consumed fewer drinks per day (coefficient − 0.11; 95% CI − 0.23–0.01; P = 0.07) than, the usual care group in the postpartum period but these differences were non-significant. Missing data during the prenatal period prevented us from modeling prenatal alcohol use.

Conclusions

Brief motivational enhancement intervention delivered in an obstetrical outpatient setting did not conclusively decrease alcohol use during the postpartum period.     

Drinking motives for self and others predict alcohol use and consequences among college women: The moderating effects of PTSD

Although drinking motives have been shown to influence drinking behavior among women with trauma histories and PTSD, no known research has examined the influence of drinking motives on alcohol use and alcohol-related consequences for women with PTSD as compared to women with a trauma history but no PTSD and women with no trauma history. Therefore, the present study sought to examine the associations between drinking motives women held for themselves as well as their perception of the drinking motives of others and their own alcohol use and consequences, and whether this was moderated by a history of trauma and/or PTSD. College women (N = 827) were categorized as either having no trauma exposure (n = 105), trauma exposure but no PTSD (n = 580), or PTSD (n = 142). Results of regression analyses revealed that women with trauma exposure and PTSD consume more alcohol and are at greatest risk of experiencing alcohol-related consequences. A diagnosis of PTSD moderated the association between one's own depression and anxiety coping and conformity drinking motives and alcohol-related consequences. PTSD also moderated the association between the perception of others' depression coping motives and one's own consequences. These findings highlight the importance of providing alternative coping strategies to women with PTSD to help reduce their alcohol use and consequences, and also suggest a possible role for the perceptions regarding the reasons other women drink alcohol and one's own drinking behavior that may have important clinical implications.     

Phone-delivered brief motivational interventions for mandated college students delivered during the summer months

Objective

Across the United States, tens of thousands of college students are mandated to receive an alcohol intervention following an alcohol policy violation. Telephone interventions may be an efficient method to provide mandated students with an intervention, especially when they are away from campus during summer vacation. However, little is known about the utility of telephone-delivered brief motivational interventions.

Method

Participants in the study (N = 57) were college students mandated to attend an alcohol program following a campus-based alcohol citation. Participants were randomized to a brief motivational phone intervention (pBMI) (n = 36) or assessment only (n = 21). Ten participants (27.8%) randomized to the pBMI did not complete the intervention. Follow-up assessments were conducted 3, 6, and 9 months post-intervention.

Results

Results indicated the pBMI significantly reduced the number of alcohol-related problems compared to the assessment-only group. Participants who did not complete the pBMI appeared to be lighter drinkers at baseline and randomization, suggesting the presence of alternate influences on alcohol-related problems.

Conclusion

Phone BMIs may be an efficient and cost-effective method to reduce harms associated with alcohol use by heavy-drinking mandated students during the summer months.     

Single-session motivational intervention to decrease alcohol use during pregnancy

This randomized clinical trial tested the effectiveness of a single-session of motivational interviewing (MI) to decrease alcohol use during pregnancy, while examining theory-based mechanisms of the intervention. Eligible pregnant women who drank any amount of alcohol in the previous year (n = 122) were randomized to an intervention or comparison group. Drinking behaviors, basic psychological need satisfaction, and autonomous motivation to decrease prenatal alcohol use were measured at baseline, 30 day postbaseline, and 30 day postpartum follow-ups. Poisson and linear regression with generalized estimating equations were used to evaluate treatment effects over time. Although MI was not found effective in decreasing alcohol use, low levels of reported alcohol use by the women at baseline left little room for improvement due to the intervention. To prevent fetal alcohol spectrum disorders, future studies will use self-report and biomarkers to more accurately identify women in need of interventions to reduce their risk of alcohol-exposed pregnancies.     

Substance use and posttraumatic stress disorder symptoms in trauma center patients receiving mandated alcohol screening and brief intervention

In an effort to integrate substance abuse treatment at trauma centers, the American College of Surgeons has mandated alcohol screening and brief intervention (SBI). Few investigations have assessed trauma center inpatients for comorbidities that may impact the effectiveness of SBI that exclusively focuses on alcohol. Randomly selected SBI eligible acute care medical inpatients (N = 878) were evaluated for alcohol, illegal drugs, and symptoms consistent with a diagnosis of posttraumatic stress disorder (PTSD) using electronic medical record, toxicology, and self-report assessments; 79% of all patients had one or more alcohol, illegal drug, or PTSD symptom comorbidity. Over 70% of patients receiving alcohol SBI (n = 166) demonstrated one or more illegal drug or PTSD symptom comorbidity. A majority of trauma center inpatients have comorbidities that may impact the effectiveness of mandated alcohol SBI. Investigations that realistically capture, account for, and intervene upon these common comorbid presentations are required to inform the iterative development of college policy targeting integrated substance abuse treatment at trauma centers.     

Family smoking history moderates the effect of expectancies on smoking initiation in college students

Aims

This report was designed to test the hypothesis that family history of smoking (FH) would moderate the effects of positive and negative smoking expectancies on initiation in a college sample.

Design

Secondary analysis of a study of college freshmen never-smokers (n = 196; 46% male) who completed a baseline interview and quarterly online follow-up assessments for 15 months.

Findings

Analyses indicated that FH moderated the effect of negative outcome expectancies (p = .003) but not the effects of expectancies for positive or negative reinforcement on the probability of smoking initiation. Stronger negative expectancies were associated with a decreased risk of initiation for family history positive but not family history negative participants.

Conclusions

Findings are consistent with previous tobacco research indicating that FH + adolescents have more negative expectancies about cigarette smoking. This suggests that adolescents observing negative consequences or receiving negative messages from their parents about cigarettes may be less likely to experiment with smoking.     

Efficacy of ecologically-based treatment with substance-abusing homeless mothers: Substance use and housing outcomes

This randomized pilot study tested the efficacy of an integrative treatment targeting homeless substance abusing mothers with young children in their care. Sixty mothers with 2–6 year old children were recruited from a local family shelter. The mothers were randomly assigned to Ecologically-Based Treatment (n = 30) or treatment as usual (n = 30). The intervention group received 3 months of rental and utility assistance up to $600 per month, case management services, and substance abuse counseling (referred to as supportive services). The treatment as usual group received housing and services through the family shelter and community housing programs. All participants completed follow-up assessments at 3, 6, and 9 months post-baseline. Mothers receiving Ecologically-Based Treatment showed a quicker decline in alcohol frequency and a quicker increase in housing stability. Furthermore, with supportive services, two-thirds of women were successful in maintaining their apartments 6 months after rental assistance ended.     

Forced sexual intercourse,suicidality, and binge drinking among adolescent girls

Although sexual assault victimization has been shown to predict suicidality, little is known about the mechanisms linking these two factors. Using cross-sectional data (N = 6364) from the 2007 Youth Risk Behavior Survey, binge drinking significantly mediated the relationship between forced sexual intercourse and suicide for Hispanic (n = 1915) and Caucasian (n = 2928) adolescent females, but not for African American adolescent females (n = 1521). Results suggest the need for closer monitoring of adolescent victims of sexual assault who also abuse alcohol to intervene in early suicide behaviors. Treatment and intervention programs should also be culturally sensitive to account for differences in reaction to sexual trauma among race/ethnicity. Implications for suicide prevention and alcohol intervention strategies as well as suggestions to clinical providers are discussed.     

A randomized clinical trial comparing the efficacy of two active conditions of a brief intervention for heavy college drinkers

Brief interventions for college heavy drinkers have shown promise in reducing drinking and alcohol-related negative consequences. However, intervention duration, content, method of delivery, and follow-up length vary across studies. It therefore remains unclear whether intervention length significantly influences the interventions' efficacy. The present study is a randomized clinical trial systematically evaluating the efficacy of two brief interventions aimed at reducing alcohol use and alcohol-related negative consequences among college student drinkers. Treatment mediators were also evaluated. Participants (N = 278) were, on average, 20.1 years old (SD = 2.4), mostly Caucasian (87%) and female (71%). They were randomly assigned to a 10-minute brief intervention, a 50-minute brief intervention, or an attention-control group. Both active interventions were provided by clinical graduate students trained in Brief Alcohol Screening and Intervention for College Students (BASICS). As hypothesized, participants in both active conditions significantly reduced their alcohol consumption, as compared to the control group participants F(2,264) = 9.84, p = .00, η² = .07. There were no significant differences in alcohol-related negative consequences F(2,264) = 3.08, p = .06, η² = .02. The hypothesized mediators, alcohol drinking norms and coping behavioral strategies, explained significant variance in intervention efficacy, but neither self-efficacy nor alcohol expectancies were significant mediators. Given the preliminary nature of our investigation, more research is warranted to determine parameters of the critical mechanisms of change within brief alcohol interventions with college student drinkers.     

Family history of alcohol abuse associated with problematic drinking among college students

Studies examining family history of alcohol abuse among college students are not only conflicting, but have suffered various limitations. The current report investigates family history of alcohol abuse (FH+) and its relationship with alcohol expectancies, consumption, and consequences. In the current study, 3753 student participants (35% FH+), completed online assessments. Compared to FH− same-sex peers, FH+ males and FH+ females endorsed greater overall positive expectancies, consumed more drinks per week, and experienced more alcohol-related negative consequences. Further, FH+ females evaluated the negative effects of alcohol to be substantially worse than FH− females. An ANCOVA, controlling for age, GPA, race, and alcohol expectancies, resulted in family history main effects on both drinking and consequences. An interaction also emerged between gender and family history, such that FH+ males were especially vulnerable to high levels of alcohol consumption. Results reveal the scope of FH+ individuals in the college environment and the increased risk for these students, particularly male FH+ students, suggesting a need for researchers and college health personnel to focus attention and resources on this issue.     

Psychophysiological reactivity to emotional picture cues two years after college students were mandated for alcohol interventions

This study examined alcohol use behaviors as well as physiological, personality, and motivational measures of arousal in students approximately 2 years after they were mandated to a brief intervention program for violating university policies about on-campus substance use. Students were categorized into serious (medical referrals, n = 13) or minor (residence advisor referrals, n = 30) infraction groups based on the nature of the incident that led to their being mandated. Self-report measures of arousal, sensation seeking, reasons for drinking, and past 30-day alcohol use were completed. Physiological arousal during exposure to emotional picture cues was assessed by indices of heart rate variability. The minor infraction group reported significantly escalating alcohol use patterns over time and a pattern of less regulated psychophysiological reactivity to external stimuli compared to the serious infraction group. The serious infraction group was higher in sensation seeking and there was some evidence of greater disparity between their physiological and self-reported experiences of emotional arousal in response to picture cues than in the minor group. Thus, the two infraction groups represent different subsets of mandated students, both of whom may be at some risk for using alcohol maladaptively. The findings suggest that intervention strategies that address self-regulation may be beneficial for mandated college students.     

Forcible,drug-facilitated,and incapacitated rape in relation to substance use problems: Results from a national sample of college women

This is the first study to examine the relation between rape and substance use problems in college women as a function of three legally recognized forms of rape: forcible, incapacitated, and substance-facilitated rape. Data were collected via structured telephone interview with a large national sample of college women aged 18–34 years (n = 1980). Lifetime prevalence of any type of rape was 11.3% in the sample. Prevalence estimates for binge drinking and substance abuse were 15.8% and 19.8%, respectively. Lifetime experience of incapacitated rape and drug–alcohol facilitated rape, but not forcible rape, were associated with increased odds of past-year binge drinking and substance abuse. Findings have implications for secondary prevention and call for continued differentiation in assessment of rape type.     

Enhancing brief cognitive-behavioral therapy with motivational enhancement techniques in cocaine users

Background

We investigated the impact of enhancing brief cognitive-behavioral therapy with motivational interviewing techniques for cocaine abuse or dependence, using a focused intervention paradigm.

Methods

Participants (n = 74) who met current criteria for cocaine abuse or dependence were randomized to three-session cognitive-behavioral therapy (CBT) or three-session enhanced CBT (MET + CBT), which included an initial session of motivational enhancement therapy (MET). Outcome measures included treatment retention, process measures (e.g., commitment to abstinence, satisfaction with treatment), and cocaine use.

Results

Participants who received the MET + CBT intervention attended more drug treatment sessions following the study interventions, reported significantly greater desire for abstinence and expectation of success, and they expected greater difficulty in maintaining abstinence compared to the CBT condition. There were no differences across treatment conditions on cocaine use.

Conclusions

These findings offer mixed support for the addition of MET as an adjunctive approach to CBT for cocaine users. In addition, the study provides evidence for the feasibility of using short-term studies to test the effects of specific treatment components or refinements on measures of therapy process and outcome.     

Response of heavy-drinking voluntary and mandated college students to a peer-led brief motivational intervention addressing alcohol use

Little is known about the way in which mandated and heavy-drinking voluntary students comparatively respond to peer-led brief motivational interventions (BMIs) and the mediators and moderators of intervention effects. Research suggests that mandated students may be more defensive due to their involvement in treatment against their will and this defensiveness, in turn, may relate to treatment outcome. Furthermore, it is not clear how mandated and heavy-drinking voluntary students perceived satisfaction with peer-led BMIs relates to treatment outcomes. Using data from two separate randomized controlled trials, heavy drinking college students (heavy-drinking voluntary, n = 156; mandated, n = 82) completed a peer-led brief motivational intervention (BMI). Both mandated and heavy-drinking volunteer students significantly reduced drinking behaviors at 3-month follow-up, reported high levels of post-intervention session satisfaction, yet no effects for mediation or moderation were found. Findings offer continued support for using peer counselors to deliver BMIs; however, results regarding the mechanisms of change were in contrast to previous findings. Implications for treatment and future areas of research are discussed.     

Rewarding early abstinence in Veterans Health Administration addiction clinics

This study investigates the addition of a contingency management (CM) intervention to Veterans Health Administration substance use disorders treatment on during- and post-treatment outcomes for Veterans diagnosed with alcohol dependence only (n = 191) or stimulant dependence (n = 139). Participants were randomly assigned to 8 weeks of usual care or usual care plus CM. Follow-up assessments occurred at 2, 6 and 12 months. In the alcohol dependent subgroup, CM participants submitted significantly more negative samples (13 versus 11 samples, Cohen's d = 0.54), were retained significantly longer (7 versus 6 weeks, d = 0.47), achieved significantly longer median durations of abstinence (16 versus 9 consecutive visits; median difference = 7, 95% CI = 4–8), and submitted significantly more negative samples at follow-ups (unstandardized effect size = 0.669, se = 0.2483) compared to usual care participants. Intervention effects were non-significant for the stimulant dependent subgroup. The study provides support for the effectiveness of CM interventions for alcohol dependent patients.     

A randomized trial comparing telephone versus in-person brief intervention to reduce the risk of an alcohol-exposed pregnancy

Brief, effective interventions are needed to reduce the risk of an alcohol-exposed pregnancy in women who drink and do not use effective contraception. The Healthy Choices study compared telephone and in-person administration of a brief intervention. In addition to indicators of alcohol use and effective contraception, compliance with the intervention was examined. Women between the ages of 18 and 44 who were drinking above recommended levels and not using effective contraception were randomly assigned to either a telephone (n = 68) or in-person (n = 63) brief (two sessions) intervention. Overall, participants showed small but significant reductions in alcohol use and larger increases in effective use of contraception. Risk of alcohol-exposed pregnancy was thus significantly reduced, largely due to improved contraception with minor reductions in alcohol use. There was no significant difference in success of the intervention between the two conditions (telephone versus in-person). These findings suggest telephone-based brief intervention may be equally successful and cost-effective in reducing the risk of an alcohol-exposed pregnancy and thus fetal alcohol syndrome.     

Diagnosing alcohol abuse in alcohol dependent individuals: Diagnostic and clinical implications

In DMS-IV, the diagnosis of alcohol abuse is precluded by the diagnosis of alcohol dependence. The goal of this study was to examine the diagnostic and clinical implications of diagnosing alcohol abuse among alcohol dependent individuals. Treatment-seeking psychiatric outpatients with a lifetime history of alcohol dependence (n = 544), some of whom (n = 45) did not meet lifetime criteria for alcohol abuse completed in-depth, face-to-face, semi-structured clinical assessments of DSM-IV axis I and axis II psychopathology. Alcohol dependent patients who did not meet criteria for alcohol abuse were significantly more likely to be female, have a later age of onset for alcohol dependence, have fewer dependence symptoms, and have a lower rate of positive family history for alcoholism, and were less likely to report a lifetime history of DSM-IV drug use disorders and PTSD. These findings suggest that diagnosing alcohol abuse among alcohol dependent patients may be clinically useful as an index of severity and higher likelihood of comorbid drug abuse and dependence. Future studies are needed to establish whether these differences are clinically significant in terms of the course of the disorder and response to treatment.     

Changes in personal networks of women in residential and outpatient substance abuse treatment

Changes in personal network composition, support and structure over 12 months were examined in 377 women from residential (n = 119) and intensive outpatient substance abuse treatment (n = 258) through face-to-face interviews utilizing computer based data collection. Personal networks of women who entered residential treatment had more substance users, more people with whom they had used alcohol and/or drugs, and fewer people from treatment programs or self- help groups than personal networks of women who entered intensive outpatient treatment. By 12 months post treatment intake, network composition improved for women in residential treatment; however, concrete support was still lower and substance users are still more prevalent in their networks. Network composition of women in outpatient treatment remained largely the same over time. Both groups increased cohesiveness within the network over 12 months. Targeting interventions that support positive changes in personal networks may heighten positive long term outcomes for women entering treatment.     

A randomized controlled trial of a group motivational interviewing intervention for adolescents with a first time alcohol or drug offense

Group motivational interviewing (MI) interventions that target youth at-risk for alcohol and other drug (AOD) use may prevent future negative consequences. Youth in a teen court setting [n = 193; 67% male, 45% Hispanic; mean age 16.6 (SD = 1.05)] were randomized to receive either a group MI intervention, Free Talk, or usual care (UC). We examined client acceptance, and intervention feasibility and conducted a preliminary outcome evaluation. Free Talk teens reported higher quality and satisfaction ratings, and MI integrity scores were higher for Free Talk groups. AOD use and delinquency decreased for both groups at 3 months, and 12-month recidivism rates were lower but not significantly different for the Free Talk group compared to UC. Results contribute to emerging literature on MI in a group setting. A longer term follow-up is warranted.     

Different associations of alcohol cue reactivity with negative alcohol expectancies in mandated and inpatient samples of young adults

Alcohol cue reactivity, operationalized as a classically conditioned response to an alcohol related stimulus, can be assessed by changes in physiological functions such as heart rate variability (HRV), which reflect real time regulation of emotional and cognitive processes. Although ample evidence links drinking histories to cue reactivity, it is unclear whether in-the-moment cue reactivity becomes coupled to a set of consolidated beliefs about the effects of alcohol (i.e., expectancies) and whether treatment helps dissociate the relation of positive versus negative expectancies to cue reactivity. This study examined the relationship between reactivity to alcohol picture cues and alcohol expectancies in two groups of emerging adults: an inpatient sample with alcohol use disorders (n = 28) and a college student sample who previously were mandated to a brief intervention for violating university policies about alcohol use in residence halls (n = 43). Sequential regression analysis was conducted using several HRV indices and self-report arousal ratings as cue reactivity measures. Results indicated that the relationship between cue reactivity and negative alcohol outcome expectancies differed for the two groups. Greater cue reactivity, assessed using HRV indices, was associated with more negative expectancies in the inpatient sample but with less negative expectancies in the mandated student sample, while an opposite trend was found for subjective arousal. The present findings highlight the importance of characterizing cue reactivity through multi-dimensional assessment modalities that include physiological markers such as HRV.