A group-based motivational interviewing brief intervention to reduce substance use and sexual risk behavior among homeless young adults

Abstract

Homeless young adults ages 18–25 exhibit high rates of alcohol and other drug (AOD) use, and sexual risk behaviors such as unprotected sex. Yet few programs exist for this population that are both effective and can be easily incorporated into settings serving this population. This pilot cluster cross-over randomized controlled trial evaluates AWARE, a voluntary four session group-based motivational interviewing (MI) intervention to reduce AOD use and sexual risk behavior. We evaluated AWARE with 200 homeless young adults using drop-in center services in Los Angeles County (mean age=21.8 years; 73% male; 79% heterosexual; 31% non-Hispanic White, 25% African American, 24% Hispanic, 21% multiracial/other). Surveys were completed at baseline and three months after program completion. Retention in the AWARE program was excellent (79% attended multiple sessions) and participants reported high levels of satisfaction with the program. AWARE participants self-reported positive change in their past 3 month and past 30 day alcohol use (ps ≤ .05), motivation to change drug use (ps < .05), and condom use self-efficacy (p = .05) compared to the control group. Among those with multiple sex partners, AWARE participants showed a decrease in unprotected sexual events (p < .05), whereas the control group did not. Results from this pilot evaluation are promising, suggesting that a brief group-MI risk reduction intervention can be effective in helping homeless young adults make positive changes in their alcohol and condom use. Further work is needed to more fully evaluate the efficacy of AWARE on AOD behavior and sexual risk behavior outcomes.

Group motivational interviewing for homeless young adults: Associations of change talk with substance use and sexual risk behavior.

“…Thus, more work is needed to examine the association of CT and ST for sexual risk and protective behaviors with a larger sample of sexually active youth. Of note, even though we were not able to show the association of CT and ST with these risky sexual behaviors with this small sample of young adults that reported sexual behavior, we did find positive intervention effects on condom use and condom use self-efficacy among the most sexually active young adults (Tucker et al, 2017). …”

“…This is likely due to the fact that the intervention was focused on alcohol, and marijuana was not specifically addressed as part of the program unless it was brought up during the group by group members (Tucker et al, 2017). .…”

“…For example, at the beginning of each session, the facilitator asked the group members to discuss ways to make the group comfortable and safe for one another (e.g., all agreed to confidentiality and to respect others in the group). MI strategies were used in every session to deliver content (Tucker et al, 2017). Specifically, the facilitator asked for permission to share information with the group and after presenting information, asked group members what they thought of the information, and reflected group member statements.…”

“…AWARE is a brief, group motivational interviewing (MI) (Miller & Rollnick, 2012) intervention developed to address both AOD use and sexual risk behavior among homeless 18–25 year olds in four 45 minute sessions (Tucker, D'Amico, Ewing, Miles, & Pedersen, 2017). Recent studies have shown that group MI is a promising intervention for at-risk youth (D’Amico, Hunter, Miles, Ewing, & Osilla, 2013; Engle, Macgowan, Wagner, & Amrhein, 2010; Feldstein Ewing, Walters, & Baer, 2012), and group MI-based interventions have been used to address AOD use and sexual risk behavior in young people involved in the criminal justice system (Magnan et al, 2013; Schmiege, Broaddus, Levin, & Bryan, 2009; Schmiege, Broaddus, Levin, Taylor, et al, 2009).…”

The role of therapist MI skill and client change talk class membership predicting dual alcohol and sex risk outcomes

“…Efficacy data show MI is effective for this broader range of conditions (Cushing, Jensen, Miller, & Leffingwell, ; Lundahl, Kunz, Brownell, Tollefson, & Burke, ; Martins & McNeil, ), but preventative medicine initiatives have also emphasized the importance of behavioral health comorbidity and the development of multiple health behavior change interventions (Prochaska et al, ). For MI, researchers have considered multiple targets such as diet and exercise (Rutten et al, ), treatment compliance and entry (Westra, Arkowitz, & Dozois, ), and substance use and sexual risk behavior (Tucker, D'Amico, Ewing, Miles, & Pedersen, ; Valasquez et al, ). Yet, this kind of dual focus could change the MI technical process.…”