This randomized controlled trial evaluated the use of two brief intervention conditions for adolescents (aged 12–18 years) who have been identified in a school setting as abusing alcohol and other drugs. Adolescents and their parent (N = 315) were randomly assigned to receive either a 2-session adolescent only (BI-A), 2-session adolescent and additional parent session (BI-AP), or assessment only control condition (CON). Interventions were manually guided and delivered in a school setting by trained counselors. Adolescents and parents were assessed at intake and at 6 months following the completion of the intervention. Analyses of relative (change from intake to 6-months) and absolute (status at 6-months) outcome variables indicated that for the most part, adolescents in the BI-A and BI-AP conditions showed significantly more reductions in drug use behaviors compared to the CON group. Also, youth receiving the BI-AP condition showed significantly better outcomes compared to the BI-A group on several variables. Problem-solving skills and utilization of additional counseling services mediated outcome. The value of a school-based brief intervention for students is discussed.
Two manually-guided brief interventions were evaluated with a randomized controlled trial. Adolescents (aged 13-17 years) suspected of abusing alcohol and other drugs and their parent were randomly assigned to receive either a 2-session adolescent only (BI-A), 2-session adolescent and additional parent session (BI-AP), or assessment only control condition (CON). Adolescents were identified in a school setting and the intervention was delivered by trained counselors. Outcome analyses (N=284; 90% of those enrolled) of relative change (from intake to 12-months) and absolute status (at 12-months) revealed a general pattern of reductions in drug use behaviors, particularly with the cannabis outcome measures, in both active conditions (BI-A and BI-AP). Students in the control condition showed worse outcome compared to the BI-A and BI-AP groups. Among the four mediating variables measured at 6-months, use of additional services, motivation to change and parenting practices had significant influences on 12-month outcome; problem solving skills approached significance as a mediator. The potential value of a brief intervention for drug abusing adolescents is discussed.
This study evaluated institutional sustainability of the Early Risers "Skills for Success" conduct problems prevention program. In a previous early-stage effectiveness trial Early Risers had been successfully implemented by a nonprofit community agency with guidance, supervision, technical assistance and fiscal support/oversight provided by program developers. The current advanced-stage effectiveness trial applied a randomized, control group design to determine whether this community agency could replicate earlier positive findings with a new cohort of participants, but with less direct involvement of program developers. An intent-to-intervene strategy was used to compare children randomly assigned to Early Risers or a no-intervention comparison group. Compared to results obtained in an early-stage effectiveness trial, program attendance rates were much lower and only one positive outcome was replicated. Failure to replicate program effects was not attributed to poor program implementation, because data collected pertaining to exposure, adherence and quality of delivery were acceptable, and a participation analysis showed that families who attended at higher levels did benefit. It was difficulties that the community agency experienced in engaging families in program components at recommended levels that primarily accounted for the results. Possible organizational barriers that impeded sustainability included unreliable transportation, poor collaboration between the agency and the local public school system, high staff turnover, agency downsizing, and fiduciary responsibility and accountability. It was concluded that both program developers and program providers need to be proactive in planning for sustainability.
The present study assessed the ability of the Early Risers' Skills for Success Program to maintain program effects 1 year post intervention. Participants were 327 kindergarten and first-grade children who screened positive for aggressive behavior and who were randomized to program and control conditions. Program children participated in 2 continuous years of active intervention followed by 1 year of no formal intervention activities. Following the active intervention phase, program children, compared to controls, showed significant gains in school adjustment and social competence but not in academic achievement (August, Lee, Bloomquist, Realmuto, & Hektner, 2003). At the 1-year follow up, program effects were not maintained using intent-to-intervene analyses. Level-of-dosage analyses, however, revealed significant relationships between children's level of participation and measures of their social competence, externalizing problems, and academic achievement. We discuss discrepancy in findings by type of analyses within the context of transporting well-controlled efficacy trials to effectiveness trials in real-world settings.
Approximately half of those receiving treatment for an alcohol use disorder (AUD) also suffer with an anxiety or depressive (“internalizing”) disorder. Because all internalizing disorders mark a poor alcohol treatment outcome, it seems reasonable to supplement AUD treatment with a psychiatric intervention when these disorders co-occur with AUD. However, this conclusion may be faulty given that the various possible inter-relationships between AUD and internalizing disorders do not uniformly imply a high therapeutic yield from this approach. Unfortunately, the studies conducted to date have been too few and too small to resolve this important clinical issue with confidence. Therefore, we used a meta-analytic method to synthesize the effects from published randomized controlled trials (RCTs) examining the impact of supplementing AUD treatment with a psychiatric treatment for co-occurring internalizing disorder (N=15). We found a pooled effect size (d) of .32 for internalizing outcomes and .22 for a composite of alcohol outcomes; however, the alcohol outcomes effect sizes were greater than this for some specific outcome domains. Subgroups that differed in terms of internalizing outcomes included treatment type (medication vs. CBT) and treatment focus (anxiety vs. depression). There was also a trend for the studies with better internalizing disorder outcomes to have better alcohol outcomes. These results indicate that clinical outcomes (both psychiatric and alcohol-related) could be somewhat improved by supplementing AUD treatment with psychiatric treatment for co-occurring internalizing disorder.
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