More behavioral recommendations produce more change: A meta-analysis of efficacy of multibehavior recommendations to reduce nonmedical substance use.

Abstract

Death and morbidity associated with substance use have risen continuously over the last few decades, increasing the need for rigorous examination of promising programs. Interventions attempting to change multiple behaviors have been designed to address interconnected problems such as use of both alcohol and drugs. This meta-analysis aimed to examine the efficacy of multibehavior interventions to curb nonmedical substance use in relation to the theoretical relation among different substance use behaviors. Specifically, our synthesis aimed to estimate the optimal number of recommendations for intervention efficacy and evaluate the impact of different combinations of recommendations on intervention efficacy. A synthesis of multibehavior interventions addressing nonmedical substance use was conducted to measure behavioral changes between the pretest and the follow-up. These changes were then compared across different numbers of recommendations. Sixty-nine reports and 233 effect sizes (k of conditions ϭ 155, n ϭ 28,295) were included. A positive linear relation was found between the number of targeted behaviors and intervention efficacy, which was stronger for drug use than alcohol use. Furthermore, recommendations on drug use worked better when paired with recommendations targeting other behaviors, whereas recommendations on alcohol use worked more independently. Lastly, multibehavior interventions were especially efficacious when delivered by experts. Overall, our synthesis indicated that targeting multiple substances is beneficial for changing drug use outcomes, but less so for alcohol use outcomes. Therefore, in the current substance use epidemic, innovative multibehavior programs appear to hold promise, especially to combat nonmedical drug use.

Health-promotion interventions targeting multiple behaviors: A meta-analytic review of general and behavior-specific processes of change.

“…As shown, although the number of observations is smaller as the number of recommendations exceeds four, no clear pattern of a curvilinear relation appeared in our data. This finding of a linear effect of the number of recommendations on behavioral and clinical outcomes is consistent with those of prior meta-analyses of HIV (Sunderrajan et al, 2021) and substance-use (Dai et al, 2020) interventions, although one meta-analysis from the lifestyle domain suggested an inverted-U relationship (see Wilson et al, 2015). Regarding the causes of such mixed findings, despite the inclusion of different domains and study reports, the differences may be due to different analytic methods.…”

“…Most of these covariates were suggested by previous meta-analyses synthesizing domain-specific evidence (cf. Dai et al, 2020; Sunderrajan et al, 2021; Wilson et al, 2015) and, if they predicted effect sizes, were included in the CHE+ models that tested how the number of behavioral recommendations affected behavioral and clinical change.…”

“…Initial tests of whether recommending change in multiple behaviors leads to greater behavioral change for each recommended behavior have been promising. Across three meta-analyses, multiple-behavior interventions outperformed single-behavior ones in how much behavioral change they produced on average (Dai et al, 2020; Sunderrajan et al, 2021; Wilson et al, 2015). Still, the shape of the impact of the number of behavioral recommendations on average clinical and behavioral change remains a question.…”

The impact of multiple-behavior HIV interventions as a function of regional disadvantages: An analysis of syndemics.

“…We used the same methods as other recent publications that have used other components of this project (Dai et al, 2020; Sunderrajan et al, 2021), which spanned various domains. We searched MEDLINE, APA PsycInfo, and EBSCO through July 27, 2022.…”

“…We also specified the single-behavior intervention as the reference group. The effect sizes represent changes in outcomes from the pretest to the posttest, which is the optimal approach when clinical trials use a variety of control groups (Dai et al, 2020; Sunderrajan et al, 2021). A review of the literature showed only one meta-analysis about multiple-behavior interventions (Sunderrajan et al, 2021).…”