June 2008

Grant Results

SUMMARY

From June 2001 through June 2004, researchers at the University of Minnesota Medical School developed and tested two brief interventions for mild-to-moderate substance abusing adolescents.

In both interventions, adolescents attended two group counseling sessions. In the second intervention, researchers added a parent-only group session, in which parents reviewed each child's substance abuse history, and set goals, with a focus on preventing relapse.

Key Findings

  • At the six-month follow-up, adolescents in both treatment groups displayed significant improvements in all substance use outcome variables including:
    • Fewer number of recent drug use days
    • Fewer number of recent binge drinking days
    • Increased recognition that they had a problem
    • Increased use of treatment options

Funding
The Robert Wood Johnson Foundation (RWJF) provided a grant of $177,322 for the project.

 See Grant Detail & Contact Information
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THE PROBLEM

An estimated 30 percent of adolescents in the United States display mild or moderate substance abuse behaviors, based on national data. Yet, according to the project director, available treatment for this group has decreased, in part because cost-conscious third-party payers have tightened eligibility criteria.

Brief and relatively inexpensive interventions have proven effective for adult substance abusers, and early pilot studies suggest that young adults may be receptive to the self-guided behavior change strategies that are a cornerstone of brief interventions.

Providing evidence that lower-cost interventions work for less severe adolescent substance abusers may rekindle managed care companies' interest in treating this population.

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RWJF STRATEGY

One of RWJF's primary goals is to reduce the harm caused by substance abuse. Program staff saw the emergence of managed care in the 1990s as an opportunity to work from within health care systems to promote best practices such as screening and brief intervention. In this regard, RWJF funded a number of studies, including:

  • A cost-benefit study of a brief intervention for problem drinkers in a primary care setting, which found that brief intervention generated $56,263 in cost savings in emergency room and hospital use, crime and motor vehicle accidents for every $10,000 invested, a benefit-to-cost ratio off 5.6 to 1. See Grant Results on ID# 027204.
  • A program called Cutting Back: Managed Care Screening and Brief Intervention for Risky Drinking. See Grant Results.
  • An evaluation of existing diagnostic screens for alcohol problems and to develop a quick, low-cost way to identify adolescents who might benefit from alcohol-use intervention. See Grant Results on ID# 032502.
  • A study that examined access to and utilization of substance abuse services by adolescents in a large, nonprofit health maintenance organization. See Grant Results on ID# 042739.

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THE PROJECT

The researchers sought to develop a manual covering two brief therapeutic interventions for adolescent substance abusers, and to test the therapies in a pilot study. Researchers also sought funding for a more comprehensive efficacy trial of the interventions.

To develop the manual, researchers conducted a literature review and got input from a team of national experts and a staff therapist. The manual guides therapists in delivering the two treatment regimens. In the first regimen — the "adolescent only" treatment — adolescents attended two individual counseling sessions that used these therapeutic strategies:

  • Personalized feedback to enhance the patient's motivation to change.
  • Cognitive-behavioral therapy, which seeks to change patients' perceptions, thoughts and feelings about their behavior.
  • A "stages of change" framework in which therapists encourage specific action steps.

For the second treatment regimen — the "youth plus parent" treatment — researchers added a parent-only individual session, while the adolescents received the same two sessions as those in the first regimen. In the parent-only session, counselors focused on:

  1. Reviewing the child's substance abuse history.
  2. Exploring family attitudes and behaviors to drugs and alcohol.
  3. Reinforcing good parenting practices.
  4. Setting goals, with a focus on preventing relapse.

For the pilot study, researchers recruited 79 mild-to-moderate substance abusing adolescents from a public school district in St. Paul, Minn. Researchers randomly assigned 26 of these students to the two-session "adolescent only" intervention, 26 to the three-session "youth plus parent" intervention and 27 to a control group. The research team assessed the students' substance abusing behavior at intake and at one and six months after treatment. (One control student dropped out before completing participation; 78 completed both follow-up assessments.)

The National Institute on Drug Abuse recently made a grant to the researchers to support a more comprehensive efficacy trial. See After the Grant for details.

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FINDINGS

The project director reported the following findings to RWJF in 2004.

  • At the six-month follow-up, researchers observed significant reductions in all substance use outcome variables (number of recent drug use days, number of recent binge drinking days, problem recognition and treatment utilization) in both treatment regimens. Both the "adolescent only" and the "youth plus parent" treatments showed significantly better outcomes than the control group; the "youth plus parent" group showed superior outcome to the "adolescent only" group on several measures.
    • Recent drug use days.
      • In the adolescent-only group, the mean number dropped from 12 at intake to six at six months.
      • In the youth-plus-parent group, the mean number dropped from 11 at intake to four at six months.
    • Binge drinking days.
      • In the adolescent-only group, the mean number dropped from four at intake to one at six months.
      • In the youth-plus-parent group, the mean number dropped from five at intake to one at the six-month follow-up.
    • Problem recognition.
      • In the adolescent-only group, the number of youths who recognized that they had a substance abuse problem rose from 10 at intake to 14 at one month and 19 at six months.
      • In the youth-plus-parent group, problem recognition rose from nine at intake to 16 at one month and 20 at six months.
    • Treatment utilization. By six months, 16 youths from the adolescent-only group and 27 from the youth-plus-parent group had sought treatment from an external source — e.g., a substance abuse treatment center or a substance abuse counselor. This finding supported the research team's hypothesis that engaging parents in the treatment process would result in more adolescents seeking additional treatment.

Communications

Researchers made 10 presentations at grand rounds, workshops and conferences, including the annual conference of the Florida Association of Drug and Alcohol Abuse in 2003 and the Third National Adolescent Conference in 2004. The research team has written a book chapter and submitted a manuscript for submission to a peer-reviewed journal. See the Bibliography.

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LESSONS LEARNED

  1. A comprehensive therapy manual should provide guidelines for how far from the given therapy a counselor can stray. Counselors often move outside of therapies covered in a manual to respond to the needs of specific patients. Such departures can weaken the credibility of a study. Identifying and preparing for these departures can result in higher fidelity to the treatment. (Project Director)
  2. Schools may provide an alternative to the traditional managed care setting for treating mild-to-moderate substance abusing adolescents. The research team received favorable feedback from school officials regarding the model's practical value in schools. School districts are beginning to recognize the treatment needs of young people. But they do not have the resources or training to offer intensive services in schools. A brief intervention may be more accommodating to resources and training levels of school counselors. (Project Director)

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AFTER THE GRANT

With funding from the National Institutes of Health (NIH), the researchers assessed the feasibility of brief interventions for adolescent drug abusers in a middle or high school setting.

In an April 2007 article in the Journal of School Health, investigators noted that a school setting ensures that the brief intervention program is accessible to the estimated 24.7 percent of United States high school students with nondependent drug habits.

In the article, the researchers cautioned that:

  • Administrative resistance to brief intervention programs could stem from fear of the implication that a school has a serious drug problem.
  • Brief interventions cannot be expected to provide a sufficient intensity of therapy for those with a substance dependence disorder.

Despite these concerns, however, investigators suggested that schools are a viable setting in which to conduct brief interventions.

As of June 2008, the project director, with funding from the National Institute on Drug Abuse and National Institute on Alcohol Abuse and Alcoholism, was conducting a randomized clinical trial testing the two treatment regimens examined in the pilot. The project director expected to complete the trial in 2009.

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GRANT DETAILS & CONTACT INFORMATION

Project

Studying the Effectiveness of a Brief Intervention for Drug-Abusing Adolescents

Grantee

University of Minnesota Medical School (Minneapolis,  MN)

  • Amount: $ 177,322
    Dates: June 2001 to June 2004
    ID#:  038324

Contact

Ken C. Winters, Ph.D.
(612) 273-9815
winte001@umn.edu

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Books

Winters K and Leitten W. Brief Intervention Manual for Use with Drug Abusing Adolescents. Minneapolis: University of Minnesota, October 2004.

Articles

Winters KC and Leitten W. "Brief Intervention for Drug-Abusing Adolescents in a School Setting." Psychology of Addictive Behaviors, 21(2): 249–254, 2007. Abstract available online.

Winters KC, Leitten W, Wagner E and O'Leary Tevyaw T. "Use of Brief Interventions for Drug Abusing Teenagers Within a Middle and High School Setting." Journal of School Health, 77(4): 196–206. Abstract available online.

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Report prepared by: Robert Crum
Reviewed by: Kelsey Menehan
Reviewed by: Molly McKaughan
Program Officer: Katherine M. Kraft

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