Enrolling and Engaging High-Risk Youths and Families in Community-Based,Brief Intervention Services

Increasing interest has been shown in brief interventions for troubled persons, including those with substance abuse problems. Most of the published literature on this topic has focused on adults, and on the efficacy of these interventions. Few of these studies have examined the critical issues of enrollment and engagement in brief intervention services. The present article seeks to address the shortcomings in the current literature by reporting on our experiences implementing National Institute on Drug Abuse (NIDA)-funded brief intervention projects involving truant and diversion program youths.     

SBIRT for adolescent drug and alcohol use: Current status and future directions

Adolescence is a period of rapid biological, psychological, and social development in the human life cycle. Drug and alcohol misuse during this critical period poses substantial problems for individual and public health, yet is highly prevalent in the United States and elsewhere. The screening, brief interventions, and referral to treatment (SBIRT) model may be well-suited for identifying and intervening with adolescents who are at-risk of developing substance use disorders and those adolescents whose substance use puts them at risk for injury or illness. This article reviews the literature on SBIRT for adolescent populations, focusing on findings from randomized controlled trials. The limited evidence suggests that brief interventions may be effective with adolescents, but a number of gaps in the literature were identified. Considerations for implementing SBIRT with adolescent populations are discussed. Randomized trials are needed that have adequate statistical power, employ longer-term follow-ups, and test the effectiveness of SBIRT for adolescents in various service delivery settings.     

Brief intervention for smoking, problem drinking and drug abuse by high school students]

Adolescent smoking, drinking and illegal drug abuse (drug-related problems) in Japan were treated as a legal model in the second prevention area. This study showed the necessity and usefulness of early intervention concerning adolescent drug-related problems as adolescent mental health problems. First, school nurses were asked if they were consulted about drug-related problems by students. Many school nurses in junior and senior high schools were consulted about drug-related problems by students, and they emphasized the need for counseling systems for drug-related problems by professionals. The second part of the study involved brief interventions by the authors in high school students with a high risk of drug-related problems. The authors went to three high schools and conducted brief interventions on students who had drug-related problems and sought advice. We prepared several screening tests for assessment of drug-related problems, such as the Fagerstr?m Test for Nicotine Dependence (FTND). Adolescent Alcohol Involvement Scale (AAIS). Quantity-Frequency Scale (QF Scale). Core Alcohol Use Disorders Identification Test (Core AUDIT), CAGE and Drug Abuse Screening Test-20 (DAST-20). In the brief interventions, the authors assessed drug-related problems of students using these scales and advised them how to revolve such problems two or three times. Twenty-two students accepted brief interventions. All of them smoked, 62% of them showed problem drinking and 33% illegal drug use. At 6 months after the brief interventions, 16 out of 21 students reported their drug-related problems. Nineteen percent of them had reduced smoking, 67% of them decreased drinking and one half of them decreased their use of illegal drugs. Results of this study revealed the necessity and the usefulness of the brief intervention for high school students with drug-related problems.     

Brief interventions for problem drinking and women

Early identification and intervention among problem drinking women may avert the more severe, adverse consequences of alcohol abuse and dependence. Screening and brief interventions, while generally effective, have not been adequately examined among subgroups, such as women. The purpose of this review article is to examine the efficacy of brief interventions for the population of women in need of some alcohol treatment. Representative studies with random assignment to treatment conditions and either substantial numbers of women, or a special focus on women, were included. Findings suggest brief interventions are not consistently helpful to women drinkers.     

Brief alcohol intervention for college drinkers: How brief is?

Objective

Brief interventions for college student drinkers have been shown to be effective in reducing the amount of alcohol consumed as well as the number of alcohol-related problems. However, the duration of brief interventions varies substantially across studies.

Method

In the present study 114 undergraduate students who drank alcohol heavily were randomly assigned to a 10-minute brief intervention, a 50-minute brief intervention, or assessment-only control. The content of the active interventions was based on the same concept, and both interventions incorporated motivational interviewing components. Participants were assessed at baseline and 4-week post intervention on quantity of alcohol use, alcohol-related problems, and protective behavioral strategies.

Results

As hypothesized, there was a significant difference between participants in the 10-minute intervention and control condition regarding their alcohol consumption at 4-week follow up. However, there was no significant difference between the 50-minute intervention and the control condition on alcohol consumption. There were also no significant differences between active intervention conditions, and neither intervention showed advantages for reducing problems or increasing protective behaviors relative to the control condition.

Conclusions

Results suggest a very brief intervention can impact short-term alcohol use outcomes, with potentially no advantage of longer interventions for this population.     

Alcohol identification and brief advice in England: A major plank in alcohol harm reduction policy

Screening and brief interventions form a vital plank in England's plans to reduce alcohol-related harm. This article clarifies the use of terminology in England to describe various drinking categories and screening and brief interventions. It details efforts to implement these interventions, including recent incentive packages that have been put in place to encourage primary care to implement these interventions. It describes the Screening and Intervention Programme for Sensible Drinking research program that is underway to clarify tools and methods to introduce and support these interventions.[Lavoie D. Alcohol identification and brief advice in England: A major plank in alcohol harm reduction policy.     

NICE work if you can get it: Development of national guidance incorporating screening and brief intervention to prevent hazardous and harmful drinking in England

This paper describes the development of the first set of national guidance focused on the prevention of alcohol problems in England. These guidelines were produced by the National Institute for Health and Clinical Excellence (NICE) working with a multidisciplinary program development group of scientists, practitioners and lay members. In this work, screening and brief alcohol interventions represent a key element of a comprehensive public health strategy to prevent alcohol-related risk and harm across the population. The first controlled trials of brief alcohol intervention were published in the mid to late 1980's and there are now around 60 published trials in this field. After 25 years of accumulated evidence in this field, brief alcohol interventions have yet to make a significant impact on routine clinical practice. While it is imperative to have good science to make the case for brief intervention delivery, this work is in vain if practitioners are unwilling or unable to use these interventions with their patients. Evidence from the alcohol field and other clinical areas indicates that national prioritisation of brief alcohol intervention activity, by a body, such as NICE, is likely to be a key driver of implementation by practitioners. This paper summarises a suite of complementary system-level and practice recommendations, which were published by NICE in June 2010, and considers their likely impact on screening and brief alcohol in England.[Kaner E. NICE work if you can get it: Development of national guidance incorporating screening and brief intervention to prevent hazardous and harmful drinking in England.     

Brief interventions for risk consumption of alcohol at an emergency surgical ward

Patients admitted to an emergency surgical ward were screened for alcohol problems and randomized between an extensive alcohol counseling and a brief assessment followed by feedback of risky alcohol consumption. Some 165 patients were assessed for risk consumption and followed up 6 to 12 months, and it was found that patients in both interventions significantly reduced the amount they drank per occasion although they drank as often as before. The patients had also moved to a stage more ready to change. No differences in effect were found between the interventions. A brief assessment with feedback about risk consumption can be done on an emergency surgical ward by the surgical staff with a few hours of training and may reduce risky alcohol consumption significantly.     

The role of assisted self-help in services for alcohol-related disorders

Potentially harmful substance use is common, but many affected people do not receive treatment. Brief face-to-face treatments show impact, as do strategies to assist self-help remotely, by using bibliotherapies, computers or mobile phones. Remotely delivered treatments offer more sustained and multifaceted support than brief interventions, and they show a substantial cost advantage as users increase in number. They may also build skills, confidence and treatment fidelity in providers who use them in sessions. Engagement and retention remain challenges, but electronic treatments show promise in engaging younger populations. Recruitment may be assisted by integration with community campaigns or brief opportunistic interventions. However, routine use of assisted self-help by standard services faces significant challenges. Strategies to optimize adoption are discussed.     

Focus on Secondary Prevention: Implications of a Study on Intervention in Social Networks

Screening and brief intervention (SBI) as a method within secondary prevention of alcohol use–related problems has experienced enormous attention and interest over the past 20 years. Initial results were very promising and great effort was put into designing screening instruments and developing different kinds of interventions. However, at the same time, the approach has generated problems in its own right. Some of these problems relate to standardization of instruments and some to criteria of inclusion into samples; others relate to the focus on the individual drinking style independent from social influences. In light of these problems, it is necessary to elaborate on the theoretical foundation, as well as on the methods used in SBI. This article introduces a method for intervening in social networks with important implications for SBI. By putting emphasis on the motivational part of SBI and including social networks in the field of intervention, it may be assumed that the approach will produce better results than heretofore. The results from a Danish qualitative study on intervening into the social network of social drinkers are presented. This study was carried out between 1991 and 1999 and involved 13 adult Danes between 35 and 45 years of age. They all had a weekly alcohol consumption of 120 to 360 g of pure alcohol and they all considered themselves to be social drinkers. The results of this study show that enhanced awareness of the person's own drinking, as well as that of peers, may influence decisions about specific drinking situations. These findings and the perspectives for SBI are discussed. Recommendations for further research are also presented.     

Focus on secondary prevention: implications of a study on intervention in social networks

Screening and brief intervention (SBI) as a method within secondary prevention of alcohol use-related problems has experienced enormous attention and interest over the past 20 years. Initial results were very promising and great effort was put into designing screening instruments and developing different kinds of interventions. However, at the same time, the approach has generated problems in its own right. Some of these problems relate to standardization of instruments and some to criteria of inclusion into samples; others relate to the focus on the individual drinking style independent from social influences. In light of these problems, it is necessary to elaborate on the theoretical foundation, as well as on the methods used in SBI. This article introduces a method for intervening in social networks with important implications for SBI. By putting emphasis on the motivational part of SBI and including social networks in the field of intervention, it may be assumed that the approach will produce better results than heretofore. The results from a Danish qualitative study on intervening into the social network of social drinkers are presented. This study was carried out between 1991 and 1999 and involved 13 adult Danes between 35 and 45 years of age. They all had a weekly alcohol consumption of 120 to 360 g of pure alcohol and they all considered themselves to be social drinkers. The results of this study show that enhanced awareness of the person's own drinking, as well as that of peers, may influence decisions about specific drinking situations. These findings and the perspectives for SBI are discussed. Recommendations for further research are also presented.     

Reduction of alcohol-related harm on United States college campuses: The use of personal feedback interventions

This paper reviews research evaluating personalised feedback interventions (PFIs) for reducing the harms associated with alcohol abuse among US college students. PFIs provide students with feedback about their own alcohol use relative to college norms, as well as information about other aspects of their drinking behaviours, related problems and/or perceived risks. Studies conducted in the United States using randomised designs indicate that PFIs are efficacious for reducing various aspects of alcohol use and/or related negative consequences for both high-risk volunteer and mandated college students. To date, these studies have demonstrated that written-feedback-only PFIs are as efficacious as brief in-person PFIs, at least on a short-term duration. Therefore, college administrators should be encouraged to develop interventions to screen students and provide written personal feedback in order to reduce high-risk drinking patterns among college students. Web-based approaches might prove to be a very cost-effective strategy, although more research is needed to determine their efficacy, as well as what aspects of the feedback are the most effective.     

Using routine laboratory tests to detect heavy drinking in the general population

This article describes a new biomarker known as the Early Detection of Alcohol Consumption (EDAC) test, which has been steadily penetrating the U.S. market. The EDAC uses routine laboratory tests to make a prediction of heavy drinking in any given person. When tested in mainstream insurance populations, the EDAC has shown twice the specificity of the traditional liver enzyme tests and is significantly more sensitive than the CDT test, which is expected because the EDAC uses a combination of laboratory tests. Maximum diagnostic accuracy is achieved when the CDT test is used to confirm a positive EDAC test. Since brief interventions have proven successful, the early identification of alcohol problems becomes a vital role for physicians. Improved awareness of alcohol misuse can certainly be accomplished through an increased use of biomarkers, with and without concomitant self-report. The ultimate goal is to facilitate early intervention and the successful management of patients diagnosed with heavy drinking.     

Psychosocial Intervention Research on Co-Occurring Disorders

ABSTRACT

Treatments for people with severe mental illness and co-occurring substance use disorder continue to be developed and tested at a rapid pace. Progress over the past 20 years has been remarkable. In the late 1980s, there were essentially no relevant intervention studies, and 10 years ago, there were few controlled trials of any interventions. As of 2006, more than 40 controlled trials of psychosocial interventions have been reported, and pharmacological trials are also appearing rapidly. In this update on psychosocial interventions, we provide a brief overview of four areas: (1) the concept of integrated treatment, (2) the evidence on specific types of interventions, (3) the methodological problems that limit current research, and (4) suggestions for future research.     

Early intervention for alcohol and drug problems: Core issues for medical education

Abstract: There is increasing evidence that lifestyle problems, such as excessive drinking, cigarette smoking and drug abuse, can be successfully treated by brief intervention. The primary care physician is in a good position to identify these problems among patients, and to intervene with brief counselling at an early stage when prognosis is more favourable. This article provides a blueprint of core teaching issues for medical education on early intervention. Four specific questions are addressed: 1. who is the target population? 2. what are the key indicators? 3. how should physicians intervene? and 4. why is early intervention important? Practical strategies are discussed for early detection and brief counselling that can be readily implemented in busy clinical settings.     

Book Review: Adolescents, Alcohol and Substance Abuse: Reaching Teens Through Brief Interventions. Edited by Peter M. Monti, Suzanne M. Colby, and Tracy A. O'Leary, New York, The Guilford Press, 2001, 350 pp., ISBN 1-57230-658-0 (Hardback)

The book reviewed in this article discusses the use of brief interventions in the treatment of adolescent substance abuse. Topics covered include the developmental context within which adolescent substance use occurs, the use of the harm reduction approach to reduce substance use, current assessment instruments, and the role of cognitive and genetic factors in the etiology of substance abuse. Examples of specific brief interventions with adolescents are described and possible avenues for future transdisciplinary research are explored. This expansive sourcebook will be of value to clinicians and academicians alike.     

Expanding knowledge among Aboriginal service providers on treatment options for excessive alcohol use

Approaches to the prevention of alcohol problems among Aboriginal people in Australia have tended to emphasize primary and tertiary prevention, while neglecting secondary prevention or early intervention. In contrast, members of the wider Australian community can now access a variety of early interventions through general practice, in hospital settings and through drug and alcohol treatment agencies. As part of a survey of the use of brief interventions, 178 agencies throughout Australia were interviewed, and findings are presented from the 29 agencies in this sample which provided services primarily for Aboriginal people. Approximately half offered a variety of approaches including brief interventions, with goals of moderation; the other half were entirely abstinence-orientated. These findings are discussed in the context of expanding the options that might be offered by Aboriginal-run agencies.