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Liu XQ, Guo YX, Wang X. Delivering substance use prevention interventions for adolescents in educational settings: A scoping review. World J Psychiatry 2023; 13:409-422. [PMID: 37547731 PMCID: PMC10401500 DOI: 10.5498/wjp.v13.i7.409] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/26/2023] [Accepted: 06/13/2023] [Indexed: 07/18/2023] Open
Abstract
Currently, a proportion of adolescents use alcohol, tobacco, and illicit drugs, which inevitably harms their health and academic progress. Adolescence is a peak period for substance use initiation and a critical time for preventing substance use problems. Various entities, such as families, schools, and communities, have implemented a variety of interventions to alleviate adolescent substance use problems, and schools play a unique role. To explore the types, characteristics, and effectiveness of substance use interventions in educational settings for adole-scents, we conducted a scoping review and identified 32 studies after screening. We divided the 32 studies according to intervention type, including curriculum interventions focusing on cognitive-behavioral skill enhancement, exercise interventions, peer interventions and family-school cooperation, and electronic interventions. Except for the mixed results on electronic interventions, the results showed that the other interventions were beneficial to different extents in alleviating adolescent substance use problems. In addition, we analyzed and summarized the advantages and challenges of intervening in adolescent substance use in educational settings. Schools can use equipment and human resources to provide adolescents with various types of intervention measures, but they also face challenges such as stigmatization, ineffective coordination among multiple resources, and poor implementation effects. In the future, school-based intervention measures can fully utilize big data and artificial intelligence technology and collaborate with families and communities to intervene appro-priately while paying attention to the comorbidity risks of substance use disorders and psychological health issues.
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Affiliation(s)
- Xin-Qiao Liu
- School of Education, Tianjin University, Tianjin 300350, China
| | - Yu-Xin Guo
- School of Education, Tianjin University, Tianjin 300350, China
| | - Xin Wang
- School of Education, Tianjin University, Tianjin 300350, China
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Lefgren LJ, Stoddard OB, Stovall JE. Rationalizing self-defeating behaviors: Theory and evidence. JOURNAL OF HEALTH ECONOMICS 2021; 76:102407. [PMID: 33383261 DOI: 10.1016/j.jhealeco.2020.102407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 09/10/2020] [Accepted: 10/12/2020] [Indexed: 06/12/2023]
Abstract
Why do individuals engage in self-defeating behaviors like self-harm, addiction, and risky sexual behaviors? Why do they experience the apathy of depression or inaction when trapped by multiple competing problems? We propose a framework for explaining these and other related behaviors based on the insight that individuals can only experience a limited number of latent stimuli to which they are exposed. We conduct an experiment to test this model and find that more than two thirds of the subjects behave consistent with our theoretical framework.
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Affiliation(s)
- Lars J Lefgren
- Department of Economics, Brigham Young University and National Bureau of Economic Research, United States.
| | - Olga B Stoddard
- Department of Economics, Brigham Young University, United States.
| | - John E Stovall
- Department of Economics, Brigham Young University, United States.
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Stanger C, Budney AJ. Contingency Management: Using Incentives to Improve Outcomes for Adolescent Substance Use Disorders. Pediatr Clin North Am 2019; 66:1183-1192. [PMID: 31679606 PMCID: PMC6834344 DOI: 10.1016/j.pcl.2019.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Multiple interventions for treating adolescents with substance use disorders have demonstrated efficacy, but most teens do not show an enduring positive response to these treatments. Contingency management (CM)-based strategies provide a promising alternative, and clinical research focused on the development and testing of innovative CM models continues to grow. This article provides information on the principles that underlie CM interventions, key metrics that define their development and implementation, a brief review of studies that have tested these approaches, and some clinical CM tools. As with other interventions to help youth with substance use problems, there is much to learn about CM approaches.
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Affiliation(s)
- Catherine Stanger
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Dartmouth College, 46 Centerra Parkway, EverGreen Center Suite 300, HB 7255, Lebanon, NH 03766, USA.
| | - Alan J. Budney
- Professor, Center for Technology and Behavioral Health, Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH
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Craig SL, McInroy LB, Eaton AD, Iacono G, Leung VW, Austin A, Dobinson C. An Affirmative Coping Skills Intervention to Improve the Mental and Sexual Health of Sexual and Gender Minority Youth (Project Youth AFFIRM): Protocol for an Implementation Study. JMIR Res Protoc 2019; 8:e13462. [PMID: 31172957 PMCID: PMC6592518 DOI: 10.2196/13462] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/18/2019] [Accepted: 05/02/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Sexual and gender minority youth (SGMY, aged 14-29 years) face increased risks to their well-being, including rejection by family, exclusion from society, depression, substance use, elevated suicidality, and harassment, when compared with their cisgender, heterosexual peers. These perils and a lack of targeted programs for SGMY exacerbate their risk for HIV and other sexually transmitted infections. Cognitive behavioral therapy (CBT) interventions support clients by generating alternative ways of interpreting their problems and beliefs about themselves. CBT, tailored to the experiences of SGMY, may help SGMY improve their mood and coping skills by teaching them how to identify, challenge, and change maladaptive thoughts, beliefs, and behaviors. Based on the promising results of a pilot study, a CBT-informed group intervention, AFFIRM, is being tested in a pragmatic trial to assess its implementation potential. OBJECTIVE The aim of this study is to scale-up implementation and delivery of AFFIRM, an 8-session manualized group coping skills intervention focused on reducing sexual risk behaviors and psychosocial distress among SGMY. Our secondary aim is to decrease sexual risk taking, poor mental health, and internalized homophobia and to increase levels of sexual self-efficacy and proactive coping among SGMY. METHODS SGMY are recruited via flyers at community agencies and organizations, as well as through Web-based advertising. Potential participants are assessed for suitability for the group intervention via Web-based screening and are allocated in a 2:1 fashion to the AFFIRM intervention or a wait-listed control in a stepped wedge wait-list crossover design. The intervention groups are hosted by collaborating community agency sites (CCASs; eg, community health centers and family health teams) across Ontario, Canada. Participants are assessed at prewait (if applicable), preintervention, postintervention, 6-month follow-up, and 12-month follow-up for sexual health self-efficacy and capacity, mental health indicators, internalized homophobia, stress appraisal, proactive and active coping, and hope. Web-based data collection occurs either independently or at CCASs using tablets. Participants in crisis are assessed using an established distress protocol. RESULTS Data collection is ongoing; the target sample is 300 participants. It is anticipated that data analyses will use effect size estimates, paired sample t tests, and repeated measures linear mixed modeling in SPSS to test for differences pre- and postintervention. Descriptive analyses will summarize data and profile all variables, including internal consistency estimates. Distributional assumptions and univariate and multivariate normality of variables will be assessed. CONCLUSIONS AFFIRM is a potentially scalable intervention. Many existing community programs provide safe spaces for SGMY but do not provide skills-based training to deal with the increasingly complex lives of youth. This pragmatic trial could make a significant contribution to the field of intervention research by simultaneously moving AFFIRM into practice and evaluating its impact. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/13462.
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Affiliation(s)
- Shelley L Craig
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Lauren B McInroy
- College of Social Work, The Ohio State University, Columbus, OH, United States
| | - Andrew David Eaton
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Gio Iacono
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Vivian Wy Leung
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Ashley Austin
- Ellen Whiteside McDonnell School of Social Work, Barry University, Miami Shores, FL, United States
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Fix RL, Letourneau EJ, Mauro PM, McCart MR, Sheidow AJ. Factors promoting and impeding HIV testing among adolescents in juvenile drug court. AIDS Care 2018; 31:177-180. [PMID: 30442024 DOI: 10.1080/09540121.2018.1546818] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
A randomized pilot study compared Risk Reduction Therapy for Adolescents (RRTA) to treatment as usual (TAU); the present study examined whether intervention condition influenced HIV testing, barriers to HIV testing, and HIV communication among adolescents involved in juvenile drug courts overall and by sexual experience. Of 105 participants, 13.3% had HIV pre-treatment testing, whereas 27.2% (of 92 participants) indicated follow-up HIV testing. Sexually active youth in RRTA (but not in TAU) reported a significant increase in HIV testing over time. RRTA demonstrated the greatest increase in HIV testing (8% pre-treatment to 44% follow-up), but not significantly more than TAU. Prevalence of barriers to HIV testing were observed at consistent rates among adolescents who did not get tested for HIV within either treatment condition. Adolescents in both conditions reported increased communication about HIV at follow-up. HIV testing was positively associated with perceived need for testing and testing resource accessibility. Stigma remained a barrier to testing at follow-up for RRTA (22%) and TAU (21%) participants. The RRTA intervention increased HIV testing and both interventions increased adolescents' communication about HIV; however, barriers persisted, warranting treatment modification.
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Affiliation(s)
- Rebecca L Fix
- a Department of Mental Health , Johns Hopkins University , Baltimore , USA
| | | | - Pia M Mauro
- b Department of Epidemiology , Columbia University
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Mauro PM, McCart MR, Sheidow AJ, Naeger SE, Letourneau EJ. Parent and Youth Engagement in Court-Mandated Substance Use Disorder Treatment. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2017; 26:324-331. [PMID: 28943745 DOI: 10.1080/1067828x.2017.1305935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
While juvenile drug courts (JDCs) require treatment participation, youth and parent engagement in treatment cannot be mandated. We compared youths' and parents' self-reports of engagement in Risk Reduction Therapy for Adolescents (RRTA) and Treatment as Usual (TAU) in JDCs. Parents and youth receiving RRTA were more likely than those receiving TAU to report high engagement in treatment. High parent engagement in RRTA early in treatment predicted fewer missed appointments and lower youth substance use at 3 months. Emphasizing therapeutic techniques that increase parent engagement, as utilized in RRTA, could lead to improved participation and clinical outcomes in court-mandated treatment settings.
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Affiliation(s)
- Pia M Mauro
- Johns Hopkins Bloomberg School of Public Health.,Columbia University Mailman School of Public Health
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Stanger C, Lansing AH, Budney AJ. Contingency Management Approaches for Adolescent Substance Use Disorders. Child Adolesc Psychiatr Clin N Am 2016; 25:645-59. [PMID: 27613343 PMCID: PMC5019116 DOI: 10.1016/j.chc.2016.05.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Multiple interventions for treating adolescents with substance use disorders have demonstrated efficacy, but a majority of teens do not show an enduring positive response to these treatments. Contingency management (CM)-based strategies provide a promising alternative, and clinical research focused on the development and testing of innovative CM models continues to grow. This article provides an updated review on the progress made in this area. It is important to continue to search for more effective models, focus on post-treatment maintenance (reduce relapse), and strive for high levels of integrity and fidelity during dissemination efforts to optimize outcomes.
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Affiliation(s)
- Catherine Stanger
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Amy Hughes Lansing
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Alan J. Budney
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH
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Letourneau EJ, McCart MR, Sheidow AJ, Mauro PM. First Evaluation of a Contingency Management Intervention Addressing Adolescent Substance Use and Sexual Risk Behaviors: Risk Reduction Therapy for Adolescents. J Subst Abuse Treat 2016; 72:56-65. [PMID: 27629581 DOI: 10.1016/j.jsat.2016.08.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 07/27/2016] [Accepted: 08/17/2016] [Indexed: 11/19/2022]
Abstract
There is a need for interventions that comprehensively address youth substance use disorders (SUD) and sexual risk behaviors. Risk Reduction Therapy for Adolescents (RRTA) adapts a validated family-focused intervention for youth SUD to include sexual risk reduction components in a single intervention. In this first evaluation of RRTA, drug court involved youth were randomly assigned to RRTA (N=45) or usual services (US; N=60) and followed through 12-months post-baseline. RRTA included weekly cognitive behavior therapy and behavior management training and contingency-contracting with a point earning system managed by caregivers targeting drug use and sexual risk antecedents. Longitudinal models estimated within-group change and between-group differences through 6- and 12-month follow-up on outcomes for substance use, sexual risk behaviors, and protective HIV behaviors. Robust effects of the intervention were not detected under conditions of the study that included potent background interventions by the juvenile drug court. Considerations about future development and testing of sexual risk reduction therapy for youth are discussed, including the potential role of contingency management in future interventions.
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Affiliation(s)
- Elizabeth J Letourneau
- Family Services Research Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 176 Croghan Spur Road, Suite 104, Charleston, SC, 29407, United States.
| | - Michael R McCart
- Family Services Research Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 176 Croghan Spur Road, Suite 104, Charleston, SC, 29407, United States.
| | - Ashli J Sheidow
- Family Services Research Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 176 Croghan Spur Road, Suite 104, Charleston, SC, 29407, United States.
| | - Pia M Mauro
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 415 N Washington St., Suite 531, Baltimore, MD, United States.
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Martins SS, Lee GP, Kim JH, Letourneau EJ, Storr CL. Gambling and sexual behaviors in African-American adolescents. Addict Behav 2014; 39:854-60. [PMID: 24583275 DOI: 10.1016/j.addbeh.2014.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 01/31/2014] [Accepted: 02/05/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Late adolescence represents a developmental risk period when many youth become involved in multiple forms of high-risk behaviors with adverse consequences. This study assessed the degree to which two such behaviors, adolescent sexual behaviors and gambling, were associated in a community-based sample with a large African-American presence. STUDY DESIGN Data are derived from a cohort study. This study focuses on 427 African-American participants with complete information on gambling and sexual behaviors by age 18 (72% of original cohort). Gambling involvement and related problems were based on responses to the South Oaks Gambling Screen - Revised for Adolescents. Several questions assessed sexual behaviors, including age of initiation. Multivariable logistic regression models adjusted for demographics, intervention status, impulsivity, depressive and anxiety symptoms, and alcohol and illegal drug use. RESULTS Almost half of the sample (49%, n=211) had gambled at least once before age 18. More gamblers than non-gamblers had initiated sexual intercourse by age 18 (aOR: 2.29 [1.16, 4.52]). Among those who had initiated sexual activity, more gamblers than non-gamblers with high impulsivity levels at age 13 (vs. low impulsivity levels) had become pregnant or had impregnated someone. Among those who had initiated sexual activity by age 18, more male gamblers had impregnated someone by age 18 as compared to female gamblers becoming pregnant. CONCLUSIONS Gambling and sexual behaviors often co-occur among adolescents. Such findings prompt the need for the inclusion of gambling, an often overlooked risky behavior, in behavioral prevention/intervention programs targeting adolescents.
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Affiliation(s)
| | - Grace P Lee
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, United States
| | - June H Kim
- Department of Epidemiology, Columbia University, United States
| | - Elizabeth J Letourneau
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, United States
| | - Carla L Storr
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, United States; Department of Family and Community Health, University of Maryland School of Nursing, United States
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Letourneau EJ, McCart MR, Asuzu K, Mauro PM, Sheidow AJ. Caregiver Involvement in Sexual Risk Reduction with Substance Using Juvenile Delinquents: Overview and Preliminary Outcomes of a Randomized Trial. ADOLESCENT PSYCHIATRY 2014; 3:342-351. [PMID: 26413463 DOI: 10.2174/22106766113036660002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Substance using juvenile offenders have some of the highest rates for engaging in risky sexual behaviors compared to other adolescent subgroups. METHODS An overview of the literature on sexual risk behaviors among these youth is provided, including the empirical support for including caregivers/parents as critical partners in sexual risk reduction efforts with this population. In particular, there is (a) evidence that family factors contribute to adolescent sexual risk, (b) emerging support for caregiver focused interventions that target adolescent sexual risk, and (c) established support for caregiver focused interventions that target other complex adolescent behavior problems. In addition, this paper presents preliminary results from a randomized controlled trial evaluating a family-based intervention for substance using juvenile delinquents that combines contingency management (CM) for adolescent substance use with a novel sexual risk reduction (SRR) protocol. Results through six months post-baseline (corresponding with the end of treatment) are presented for intervention fidelity and outcomes including number of intercourse acts (Sex Acts), use of condoms or abstinence (Safe Sex), and obtaining HIV testing (Testing). CONCLUSIONS In comparison to youth focused group substance abuse treatment, the CM-SRR intervention was associated with significantly greater therapist use of SRR techniques and greater caregiver involvement in treatment sessions (supporting treatment fidelity) and significantly lower increases in Sex Acts (supporting treatment efficacy). There were also higher odds for Safe Sex and for Testing, although these results failed to reach statistical significance. Findings add to the growing literature supporting the feasibility and efficacy of caregiver focused interventions targeting sexual risk behaviors among high-risk adolescent populations.
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Affiliation(s)
- Elizabeth J Letourneau
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University
| | - Michael R McCart
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
| | - Kammarauche Asuzu
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University
| | - Pia M Mauro
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University
| | - Ashli J Sheidow
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC
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