Group motivational interviewing for adolescents: change talk and alcohol and marijuana outcomes

Mechanisms of Behavior Change in Adolescent Substance Use Treatment: A Systematic Review of Treatment Mediators and Recommendations for Advancing Future Research

Substance use disorders commonly onset during adolescence, yet the best available treatments yield only modest and transient effects. Elucidating treatment mediators is essential for improving treatment options. This review summarizes over 20 years of research on mediators of adolescent substance use treatment; k = 17 studies assessing both treatment or treatment ingredient to mediator (a path) and mediator to treatment outcome (b path) paths were included. Mediators were categorized using the Science of Behavior Change target class framework. Overall, mediation tests supported four of eight self-regulation, two of 10 stress resilience and reactivity, six of 19 interpersonal and social process, and two of four treatment engagement and adherence mediators. To enhance the capacity of this work to inform clinical practice, we recommend future research examine theoretically informed mechanisms using temporally sequenced data among other methodological guidelines.

Understanding effects of the group process on drinking outcomes for emerging adults experiencing homelessness

BACKGROUND

There is little research on group process for motivational interviewing-based group interventions with young people. We examine how change talk, group climate and cohesion, and facilitator empathy among emerging adults experiencing homelessness affect their drinking outcomes.

METHODS

Data come from a clinical trial at three drop-in centers serving emerging adults experiencing homelessness in Los Angeles County and focus on those who received the intervention (n = 132). Participants completed baseline, 3-, 6-, and 12-month follow-up surveys. They were predominantly male and non-white. Group sessions were digitally recorded and coded for percentage change talk (PCT), group climate and cohesion, and facilitator empathy.

RESULTS

Because baseline alcohol use was significantly higher at site 1 than sites 2 and 3, we examined associations separately by site. At 6 months, higher PCT was associated with fewer drinks per drinking day for sites 2 and 3, whereas higher PCT was associated with more drinks per drinking day for site 1. There were no effects of PCT at 12 months. Higher group cohesion scores were associated with fewer drinking days at 6 months; higher facilitator empathy was associated with fewer maximum drinks in a day at both 6 and 12 months. Group climate was not associated with drinking outcomes.

CONCLUSIONS

These findings highlight the importance of measuring multiple factors in the group process to understand outcomes. What is "uttered" during group and what is observed provide different methods to evaluate the group process and allow us to better bridge the gap between research and practice.

Technical and relational process in MI sessions with a sample of Hispanic/Latinx adults who engage in heavy drinking: A latent growth mediation model

The current study tests the Motivational Interviewing (MI) technical and relational hypotheses in a sample of Hispanic/Latinx adults (N = 276) who engage in heavy alcohol consumption. MI causal theory hypothesizes that therapist use of MI consistent skills (i.e., technical hypothesis) and embodiment of the MI Spirit (i.e., relational hypothesis) will elicit client change talk, which is a putative mechanism of positive client outcome after the session. We tested these associations in a rigorous parallel process latent growth curve mediation modeling framework. The data are from a completed randomized clinical trial of a culturally-adapted (CAMI) versus un-adapted MI targeting hazardous alcohol use and consequences. Results. The unconditional growth models for the mediator (i.e., proportion of change talk relative to sustain talk) and two study outcomes (i.e., percent of heavy drinking days; alcohol-related consequences) showed a linear effect over a 12-month period with a slower rate of growth at later timepoints. Contrary to expectations, the latent growth mediation models did not show relationships between MI-consistent skills (i.e., technical predictor) or latent MI Spirit (i.e., relational indicator) and the slope factor for proportion change talk. The slope factor for proportion change talk was also not associated with the slope factors for percent heavy drinking and consequences over follow-up. Conclusions. In this novel population for MI process analysis, the technical and relational hypotheses were not supported. Studies that are exploratory may be needed to further investigate the causal model in populations that are not often represented in MI process research.

Prevention of hazardous use of alcohol among high school students: a study protocol for the randomized controlled trial 'Our choice'

BACKGROUND

Adolescent hazardous alcohol use is prevalent and has serious short- and long-term consequences. The trial 'Our Choice' examines efficacy, feasibility and acceptability of prevention interventions targeting school, parent, and student levels at Danish high schools. We hypothesize that students in a structural intervention (school and parent levels) reduce hazardous alcohol use and related health behaviors compared to students in an assessment only control group 12 months post baseline; and that adding group-based Motivational Interviewing (group MI) yields further improvements. The study examines the efficacy of interventions targeting multiple levels with the aim of providing novel insights into prevention of adolescent hazardous alcohol use and related health outcomes.

METHOD

The study employs a parallel group cluster randomized controlled trial design with three conditions: (1) structural condition targeting school and parent levels, (2) structural condition combined with group MI which also targets the student level, and (3) assessment-only control condition. A participatory approach is used to adapt and develop interventions. Sixteen high schools in Denmark and about N = 3100 first-year students (15-18 years) enrolled in high school in August 2023 will be recruited. Data will be collected via online questionnaires pre-interventions (baseline), 2, 6, 9 and 12 month post baseline and analyzed with generalized linear mixed models. The primary outcome is past month high intensity drinking; secondary outcomes are alcohol use, alcohol-related consequences, well-being, tobacco, and illegal substance use. Feasibility and acceptability will be assessed via surveys (students) and interviews (high school staff) to inform future implementation.

DISCUSSION

'Our Choice' is the first trial to compare the efficacy of a structural intervention targeting school- and parent levels to an intervention targeting these levels and the student level via group MI - on hazardous drinking and related health outcomes among students. Preventing and reducing hazardous alcohol use during adolescence is crucial due to the short- and long-term negative consequences. The tested interventions can be implemented at low cost. The study has significant implications for adolescent health and well-being and has potential to inform evidence-based decisions on alcohol prevention policy, education, and health professions.

TRIAL REGISTRATION NUMBER

The trial was retrospectively registered at ClinicalTrials.gov on August 24th, 2023.

TRIAL REGISTRATION NUMBER

ID NCT06018389.

Long-Term RCT outcomes for adolescent alcohol and cannabis use within a predominantly Hispanic sample

Because adolescents are unlikely to seek, receive, or complete treatment for alcohol and/or cannabis misuse, it is important to enhance the lasting impact of clinical contacts when they do occur. Adolescents (N = 506; 72.5% Hispanic) were randomized to motivational interviewing (MI) versus alcohol and cannabis education (ACE). Latent growth models estimated change over time. Significant reductions in alcohol use were observed, with slightly greater reductions by 12-month follow-up for MI. Both interventions significantly reduced cannabis use, with no treatment group differences. When outcomes were examined comparing Hispanic to non-Hispanic participants, there were no significant differences in intervention efficacy by group. MI's inherently client-centered and culturally adaptive approach may contribute to its equitable degree of behavior change for youth across race/ethnic backgrounds.

Using Machine Learning of Online Expression to Explain Recovery Trajectories: Content Analytic Approach to Studying a Substance Use Disorder Forum

BACKGROUND

Smartphone-based apps are increasingly used to prevent relapse among those with substance use disorders (SUDs). These systems collect a wealth of data from participants, including the content of messages exchanged in peer-to-peer support forums. How individuals self-disclose and exchange social support in these forums may provide insight into their recovery course, but a manual review of a large corpus of text by human coders is inefficient.

OBJECTIVE

The study sought to evaluate the feasibility of applying supervised machine learning (ML) to perform large-scale content analysis of an online peer-to-peer discussion forum. Machine-coded data were also used to understand how communication styles relate to writers' substance use and well-being outcomes.

METHODS

Data were collected from a smartphone app that connects patients with SUDs to online peer support via a discussion forum. Overall, 268 adult patients with SUD diagnoses were recruited from 3 federally qualified health centers in the United States beginning in 2014. Two waves of survey data were collected to measure demographic characteristics and study outcomes: at baseline (before accessing the app) and after 6 months of using the app. Messages were downloaded from the peer-to-peer forum and subjected to manual content analysis. These data were used to train supervised ML algorithms using features extracted from the Linguistic Inquiry and Word Count (LIWC) system to automatically identify the types of expression relevant to peer-to-peer support. Regression analyses examined how each expression type was associated with recovery outcomes.

RESULTS

Our manual content analysis identified 7 expression types relevant to the recovery process (emotional support, informational support, negative affect, change talk, insightful disclosure, gratitude, and universality disclosure). Over 6 months of app use, 86.2% (231/268) of participants posted on the app's support forum. Of these participants, 93.5% (216/231) posted at least 1 message in the content categories of interest, generating 10,503 messages. Supervised ML algorithms were trained on the hand-coded data, achieving F1-scores ranging from 0.57 to 0.85. Regression analyses revealed that a greater proportion of the messages giving emotional support to peers was related to reduced substance use. For self-disclosure, a greater proportion of the messages expressing universality was related to improved quality of life, whereas a greater proportion of the negative affect expressions was negatively related to quality of life and mood.

CONCLUSIONS

This study highlights a method of natural language processing with potential to provide real-time insights into peer-to-peer communication dynamics. First, we found that our ML approach allowed for large-scale content coding while retaining moderate-to-high levels of accuracy. Second, individuals' expression styles were associated with recovery outcomes. The expression types of emotional support, universality disclosure, and negative affect were significantly related to recovery outcomes, and attending to these dynamics may be important for appropriate intervention.

Examining the influence of adolescent:provider alliance on youth hazardous drinking: Findings from a randomized controlled trial

PURPOSE

Behavioral interventions to reduce hazardous drinking are only moderately successful in promoting sustained behavior change and post-intervention effect sizes among adolescents remain modest. This study aimed to explore a relevant therapeutic active ingredient, adolescent:provider alliance, as a moderator of short-term (3 month) adolescent intervention outcomes within the course of a larger parent randomized control trial (RCT).

METHODS

Participants were community-based youth engaged in hazardous drinking (N = 168) who were randomized to 2 sessions of either motivational interviewing (MI) or mindfulness (brief adolescent mindfulness; BAM). Youth reported pre-intervention hazardous drinking at baseline and rated therapeutic alliance (a metric of adolescent:provider "connectedness" that helps facilitate working relationships during interventions) immediately post-intervention; they reported hazardous drinking again at 3 months post-intervention. Negative binomial regressions predicted post-intervention hazardous drinking score from adolescent:provider alliance, intervention condition, and their interaction.

RESULTS

Mean hazardous drinking was reduced by 34-40 % across both intervention conditions, with no significant between-condition differences. Stronger adolescent:provider alliance was associated with lower hazardous drinking scores at 3 months, but this effect was attenuated after controlling for baseline hazardous drinking. Contrary to predictions, adolescent:provider alliance did not appear to moderate the effect of intervention condition in this sample of young people engaged in hazardous drinking.

CONCLUSIONS

Consistent with prior literature, baseline hazardous drinking was a robust predictor of treatment outcomes. At the same time, these results suggest that future work may benefit from continuing to examine and disaggregate the nature of adolescent:provider alliance across the spectrum of empirically supported brief interventions for adolescent hazardous drinking.

CLINICAL TRIALS REGISTRATION NUMBER

ClinicalTrials.gov identifier: NCT03367858. Data Sharing Statement: Requests for deidentified individual participant data can be made to the first author.

Developing Motivational Interviewing Skills Among Undergraduate Nursing Students

The current study evaluated changes in undergraduate nursing students' knowledge and self-efficacy in motivational interviewing. Fourth-year undergraduate nursing students completed a hybrid, online curriculum. Changes in knowledge and self-efficacy were assessed using a pretest/posttest design. Repeated measures analysis of variance was used to determine differences between knowledge and self-efficacy mean scores. Of the 144 students who participated in the study, 88.2% were female, 96.5% were non-Hispanic/Latino, 88.9% were White, and mean age was 21.3 years. There were significant increases in knowledge and self-efficacy mean scores between pre-survey and post-survey 1 and 2. There were no differences between post-surveys 1 and 2 scores. A hybrid, online curriculum using asynchronous modules and synchronous simulation training can facilitate nursing students' learning experiences and enhance knowledge and self-efficacy about motivational interviewing. [Journal of Psychosocial Nursing and Mental Health Services, 61(5), 17-24.].

Feasibility and acceptability of incorporating social network visualizations into a culturally centered motivational network intervention to prevent substance use among urban Native American emerging adults: a qualitative study

Background

Coupling social network visualizations with Motivational Interviewing in substance use interventions has been shown to be acceptable and feasible in several pilot tests, and has been associated with changes in participants’ substance use and social networks. The objective of this study was to assess acceptability and feasibility of an adaptation of this behavior change approach into a culturally centered behavior change intervention for American Indian/Alaska Native (AI/AN) emerging adults living in urban areas. AI/AN populations experience high rates of health disparities and substance use. Although 70% of AI/AN people live outside of tribal lands, there are few culturally tailored health interventions for these AI/AN populations. Social networks can both increase and discourage substance use. Leveraging healthy social networks and increasing protective factors among urban AI/AN emerging adults may help increase resilience.

Methods

We conducted thirteen focus groups with 91 male and female participants (32 urban AI/AN emerging adults ages 18–25, 26 parents, and 33 providers) and one pilot test of the three workshop sessions with 15 AI/AN emerging adults. Focus group participants provided feedback on a proposed workshop-based intervention curriculum that combined group Motivational Interviewing (MI) and social network visualizations. Pilot workshop participants viewed their own social networks during group MI sessions focused on substance use and traditional practices and discussed their reactions to viewing and discussing their networks during these sessions. We used a combination of open coding of focus group and workshop session transcripts to identify themes across the group sessions and content analysis of comments entered into an online social network interview platform to assess the extent that participants had an intuitive understanding of the information conveyed through network diagrams.

Results

Focus group and pilot test participants reacted positively to the intervention content and approach and provided constructive feedback on components that should be changed. Themes that emerged included feasibility, acceptability, relevance, understandability, and usefulness of viewing personal network visualizations and discussing social networks during group MI workshops. Workshop participants demonstrated an intuitive understanding of network concepts (network composition and structure) when viewing their diagrams for the first time.

Conclusions

Social network visualizations are a promising tool for increasing awareness of social challenges and sources of resilience for urban AI/AN emerging adults. Coupled with Motivational Interviewing in a group context, social network visualizations may enhance discussions of network influences on substance use and engagement in traditional practices.

Trial Registration: ClinicalTrials.gov Identifier: NCT04617938. Registered October 26, 2020

Coping drinking motives, neural functional coupling during emotion processing, and alcohol use in young adults with bipolar disorder

BACKGROUND

Rates of alcohol use disorders in individuals with bipolar disorder are 3 to 5 times greater than in the general population and exceed rates of alcohol use disorders reported in other affective and anxiety disorders. Despite this high rate of comorbidity, our understanding of the psychosocial and neural mechanisms that underlie the initiation of alcohol misuse in young adults with bipolar disorder remains limited. Prior work suggests that individuals with bipolar disorder may misuse alcohol as a coping mechanism, yet the neural correlates of coping drinking motives and associated alcohol use have not been previously investigated in this population.

METHODS

Forty-eight young adults (22 bipolar disorder type I, 26 typically developing; 71% women; average age ± standard deviation = 22 ± 2 years) completed the Drinking Motives and Daily Drinking Questionnaires, and a Continuous Performance Functional magnetic resonance imaging (fMRI) Task with Emotional and Neutral Distracters. We calculated the relative difference in anterior cingulate cortex (ACC) functional coupling with the anterior insula and amygdala in response to emotional distracters compared with neutral stimuli and investigated the relations with coping drinking motives and alcohol use.

RESULTS

Across all participants, coping drinking motives were associated with greater quantity of recent alcohol use. In individuals with bipolar disorder, greater ACC-anterior insula functional coupling was associated with greater coping drinking motives, and greater quantity and frequency of recent alcohol use. The relative difference in ACC-anterior insula functional coupling was not associated with coping drinking motives or alcohol use in the typically developing group. Greater ACC-anterior insula functional coupling in individuals with bipolar disorder was also associated with greater anxiety symptoms and recent perceived psychological stress. Exploratory analyses suggest that the relations between ACC-anterior insula functional coupling and coping drinking motives may be confounded by anticonvulsant use.

CONCLUSION

Results suggest that a difference in ACC-anterior insula functional coupling during emotion processing may underlie alcohol use as a maladaptive coping mechanism in young adults with bipolar disorder.

Training Providers in Motivational Interviewing to Promote Behavior Change

Motivational Interviewing (MI) is a highly specified behavior change communication approach to improve patient-provider relationships, provider communication, and patient health outcomes. Because MI is built on a foundation of patient autonomy support, a feature known to positively influence behavior change during adolescence and emerging adulthood, MI is an evidence-based framework that can inform interventions targeting improvements in health outcomes among youth. MI can be difficult to implement with adequate fidelity, because learning MI requires time and commitment from busy providers with competing priorities. This review addresses best practices for implementing MI within adolescent serving medical settings (eg, pediatrics, family practices, rural health clinics, community health organizations, and so forth), including an orientation to MI, examples of efficacious interventions that were developed leveraging MI, and consideration for the design of training programs that include ongoing support to maximize the likelihood of sustainment.

The Relationship Between Drinking Behavior and Conversational Processes During a Brief Alcohol Reduction Intervention for People with HIV

People with HIV (PWH) frequently engage in unhealthy alcohol use, which can adversely affect antiretroviral adherence and HIV disease progression. Brief interventions based on Motivational Interviewing (MI), including the Brief Negotiated Interview (BNI), can help to reduce drinking. This study examines MI processes observed during a single 15-20 min BNI session delivered by social workers to PWH with unhealthy alcohol use (N = 59) in the context of a stepped care intervention to reduce alcohol consumption. BNI sessions were coded for technical and relational processes encouraged in MI, such as autonomy support, instructive language, and self-exploration. Multiple regression analyses explored the relationship between: (1) Participants' pre-intervention drinking behaviors (weekly drinks and heavy drinking days) and these MI processes, and (2) MI processes and intervention outcomes. Results indicated that PWH who reported more weekly drinks at baseline engaged in less self-exploration, while social workers delivering the BNI used less instructive language for those who reported more heavy drinking days. PWH who engaged in more self-exploration and received more autonomy support had fewer heavy drinking days 6 months after the intervention. These findings suggest the value of providing more opportunities within BNIs to encourage self-exploration, as it may help to enhance intervention efficacy.

Randomized controlled trial of motivational interviewing for alcohol and cannabis use within a predominantly Hispanic adolescent sample

Hispanic youth represent one of the fastest-growing minority groups. Yet, we know little about Hispanic adolescents' response to empirically-supported interventions for adolescent addiction, including motivational interviewing (MI). This randomized controlled trial (RCT) compared MI to an active educational treatment for adolescent alcohol and cannabis use (alcohol and cannabis education; ACE). Adolescents who regularly use substances (N = 448; n = 347 Hispanic; n = 101 non-Hispanic white; ages 13-18) were randomized to two 1-hr individual sessions of MI or ACE. We examined 6-month outcomes and mechanisms of change across Hispanic and non-Hispanic white youth. Treatment response was comparable across ethnicities (Hispanic vs. non-Hispanic white youth). Additionally, adolescents in the MI condition showed greater reductions in alcohol use compared to those in ACE, with support for motivation and self-efficacy as mechanisms of treatment response. Direct effects of MI on cannabis use were not observed; however, a significant indirect effect of motivation was observed for reductions in cannabis use. Data support the efficacy of MI in reducing adolescent alcohol use, through the vehicle of enhanced motivation and self-efficacy. While consistent treatment response was observed for adolescent alcohol use across ethnicities (Hispanic vs. non-Hispanic white), further exploration into potential underexplored mechanisms of Hispanic adolescents' treatment response is requisite to strengthening prevention and intervention programming for Hispanic adolescents' cannabis use. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Marijuana use and intentions among American Indian adolescents: Perceived risks, benefits, and peer use

OBJECTIVE

The present study examines how perceptions of peer use, risks of use, and benefits to oneself and others from marijuana use are associated with past-month marijuana use and intentions to use marijuana socially among American Indian (AI) youth.

METHOD

The American Drug and Alcohol Survey (ADAS), a measure of substance use and related factors, was administered to AI youth living on or near reservations across six geographic regions (n = 3,498, 49.5% female, M age = 14.8).

RESULTS

Greater perceived peer use was significantly associated with more frequent past-month marijuana use (b = .05, p = .038) and intentions to use marijuana socially (b = .74, p < .001). Greater benefits to oneself were associated with greater marijuana use intentions (b = .35, p < .001). Greater perceived risks and benefits to others were significantly associated with less frequent past-month use (b = -.02, p = .002; b = -.01, p = .007, respectively) and intentions to use marijuana socially (b = -.05, p = .001; b = -.03, p = .002, respectively). Multilevel moderation analyses revealed that the effects of perceived peer use and benefits to oneself were related to intentions to use although stronger for those who had used; however, the effects of perceived risks and benefits to others were only significantly related to intentions to use marijuana for those who had used marijuana.

CONCLUSIONS

Results suggest that perceived benefits to others and risks are malleable factors that may be effective components of treatment programs for youth who report lifetime marijuana use, but that perceived peer use and benefits to oneself may be useful in both treatment and prevention efforts for youth who have or have not used marijuana. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Emergence of Employees' Change Readiness for Energy-Conservation Behavior During Guided Group Discussions

Studies of energy conservation efforts to reduce CO₂ emissions in the residential sector are abundant; however similar efforts in organizations have not received as much attention as they deserve. In this study, we focus on methods for increasing employees’ readiness to change their behaviors in favor of energy conservation, specifically examining the use of guided group discussions (GGDs). We use observational research methods to examine the micro-level of behavioral dynamics and understand the emergence of change readiness. We describe how facilitators (“change agents”) can conduct GGDs and foster employees’ change readiness using the established communication approach of Motivational Interviewing (MI). We also explore how employees can increase each other’s change readiness regarding energy conservation behavior. Based on our sample of eight videotaped GGDs (5430 behavioral events), interaction analysis reveals that solution-focused communication elicits change readiness in employees, whereas problem-focused communication prompts resistance to change. We further show that employees can motivate their co-workers to express “green” intentions: when employees verbalized statements in favor of energy saving, this increased other employees’ change readiness, while verbalized statements against energy saving had the opposite effect. This demonstrates that GGD participants are active individuals who can spark behavior change in their co-workers. Finally, based on our findings we propose several communication guidelines for working with groups and discuss the importance of solution-focused energy management practices to facilitate change readiness for energy saving in the workplace.

Patient motivation in group metacognitive therapy for generalized anxiety disorder

OBJECTIVE

The aim of this study was to investigate the predictive value of motivational language (change talk [CT] and sustain talk [ST]) on treatment outcome of group metacognitive therapy (g-MCT) for generalized anxiety disorder (GAD).

METHOD

Video recordings of the first, fourth, and seventh therapy sessions (55 patients) were encoded using the Motivational Interviewing Skill Code (MISC) manual. The strength of the patients' motivational utterances was encoded as CT or ST with seven subcategories.

RESULTS

The strength of CT-utterances and ST-utterances differed significantly between treatment responders and non-responders as therapy progressed. The strength of ST-utterances increased significantly more among non-responders than responders, whereas CT and positive taking steps utterances increased more among treatment responders than non-responders. CT and ST in session 1 were not associated with treatment outcome. CT and ST in sessions 4 and 7 significantly predicted lower and higher worry-scores at post-treatment, respectively. This effect was particularly evident for taking steps utterances in session 7.

CONCLUSION

These findings confirm the predictive value of MISC in sessions 4 and 7 of g-MCT for GAD and highlight the importance of therapists addressing patient motivation.

A Change Talk Model for Abstinence Based on Web-Based Anonymous Gambler Chat Meeting Data by Using an Automatic Change Talk Classifier: Development Study

BACKGROUND

Change and sustain talks (negative and positive comments) on gambling have been relevant for determining gamblers' outcomes but they have not been used to clarify the abstinence process in anonymous gambler meetings.

OBJECTIVE

The aim of this study was to develop a change talk model for abstinence based on data extracted from web-based anonymous gambler chat meetings by using an automatic change talk classifier.

METHODS

This study used registry data from the internet. The author accessed web-based anonymous gambler chat meetings in Japan and sampled 1.63 million utterances (two-sentence texts) from 267 abstinent gamblers who have remained abstinent for at least three years and 1625 nonabstinent gamblers. The change talk classifier in this study automatically classified gamblers' utterances into change and sustain talks.

RESULTS

Abstinent gamblers showed higher proportions of change talks and lower probability of sustain talks compared with nonabstinent gamblers. The change talk model for abstinence, involving change and sustain talks, classified abstinent and nonabstinent gamblers through the use of a support vector machine with a radial basis kernel function. The model also indicated individual evaluation scores for abstinence and the ideal proportion of change talks for all participants according to their previous utterances.

CONCLUSIONS

Abstinence likelihood among gamblers can be increased by providing personalized evaluation values and indicating the optimal proportion of change talks. Moreover, this may help to prevent severe mental, social, and financial problems caused by the gambling disorder.

Can a pure motivational interviewing intervention be manualized and still efficacious? A test of feasibility and initial efficacy

The importance of attending to the therapeutic process despite the challenges in manualizing it is demonstrated in the empirical evolution of motivational interviewing (MI). Whereas manuals exist for adaptations of MI, no manual has been developed and tested for MI in its pure form (pure MI). This study evaluated the feasibility and initial efficacy of a pure MI intervention manual - MI for risky social drinking (MI-RSD) - designed to target risky social drinking behaviors in college students with social anxiety. A pilot sample of 42 college students completed measures of alcohol use and mental health symptoms and the MI-RSD intervention. We developed a manual for the 2-session MI-RSD intervention, trained 4 clinical doctoral students, and used observer-, therapist- and participant-completed measures to evaluate fidelity. Therapists met beginner proficiency in MI fidelity and participant gave high ratings of therapist adherence to MI and working alliance, demonstrating intervention feasibility. Also, participants reported significant reductions in hazardous drinking and evaluation fears, but not in social interaction anxiety. We offer preliminary evidence that pure MI can be manualized and effective. Specifically, MI-RSD represents an alternative to MI adaptations in mitigating alcohol-related harm for young adults. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Early and Late Adolescent Factors that Predict Co-use of Cannabis with Alcohol and Tobacco in Young Adulthood

The changing legal landscape of cannabis in the USA has coincided with changes in how cannabis is used, including its co-use with other substances. This study analyzed 10 years of data from a diverse cohort of youth (N = 2429; 54% Hispanic, 16% Asian, 16% white, 3% black, 10% multiracial) to examine predictors in early and late adolescence of co-use of alcohol with cannabis (AC) and tobacco with cannabis (TC) at age 21. Two forms of co-use were examined: concurrent (use of both substances in past month) and sequential (use of one substance right after the other). Analyses focused on four predictor domains: individual (e.g., resistance self-efficacy), peer (e.g., time spent around peers who use), family (e.g., sibling use), and neighborhood (i.e., perceived alcohol and drug problems in neighborhood). For each co-use combination (AC or TC), we estimated parallel process piecewise latent growth models in a structural equation modeling framework using Mplus v8. The final AC and TC co-use models included all predictor variables from the four domains. Increases in positive expectancies and time spent around peers who use AC, as well as steeper decreases in resistance self-efficacy, were all related to a greater likelihood of AC co-use in young adulthood. Increases in sibling TC use and time spent around peers who use TC, as well as steeper decreases in resistance self-efficacy, were all related to a greater likelihood of TC co-use in young adulthood. Overall, findings highlight the importance of addressing peer influence in prevention programming during both early and late adolescence.

Recruitment and retention in randomized controlled trials with urban American Indian/Alaska Native adolescents: Challenges and lessons learned

BACKGROUND

Although the majority of American Indians/Alaska Natives reside in urban areas, there are very few randomized controlled trials analyzing culturally centered substance use prevention interventions for this population.

METHODS

We describe methods employed to recruit and retain urban American Indian/Alaska Native adolescents into a randomized controlled trial, which was focused on testing the potential benefits of a substance use prevention intervention for this population. We also report challenges encountered in recruitment and retention of participants and strategies employed addressing these challenges. Data collection occurred from August 2014 to October 2017.

RESULTS

We partnered with two community-based organizations in different cities in California. We utilized American Indian/Alaska Native recruiters from communities, placed flyers in community-based organizations, and asked organizations to post flyers on their web and social media sites. We also offered gift cards for participants. Our initial recruitment and retention model was moderately successful; however, we encountered five main challenges: (1) transportation, (2) increasing trust and interest, (3) adding research sites, (4) getting the word out about the project, and (5) getting youth to complete follow-up surveys. Strategies employed to overcome transportation challenges included shortening the number of sessions, offering sessions on both weekends and weekdays, and increasing bus tokens and transportation options. We hired more staff from American Indian/Alaska Native communities, added more research sites from our previously established relationships, and were more proactive in getting the word out on the project in American Indian/Alaska Native communities. We also utilized more field tracking and emailed and mailed survey invitations to reach more participants for their follow-up surveys. Because of our efforts, we were nearly able to reach our initial recruitment and retention goals.

CONCLUSION

Although our research team had previously established relationships with various urban American Indian/Alaska Native communities, we encountered various recruitment and retention challenges in our study. However, by identifying challenges and employing culturally appropriate strategies, we were able to collect valuable data on the potential effectiveness of a substance use prevention intervention for urban American Indian/Alaska Native adolescents. Findings from this study assist toward the development of potentially successful strategies to successfully recruit and retain urban American Indian/Alaska Native adolescents in randomized controlled trials.

Three As of American Indian adolescent marijuana use: Availability, acceptability, and approval

BACKGROUND

American Indian (AI) adolescents report high rates of marijuana use and related consequences and availability of marijuana has a robust relationship with marijuana use. The purpose of the present study was to examine the role of perceptions of approval (i.e., injunctive norms), and acceptability (i.e., descriptive norms and perceived harm) in the relationship between marijuana availability and marijuana use.

METHODS

Data collected from 2009 to 2013 included 3498 AI 7th-12th graders residing on or near a reservation (47.8 % female). Multilevel mediation analyses were conducted using the MLmed macro in IBM SPSS v26.0 to account for the nesting of data within schools.

RESULTS

The associations between marijuana availability and perceived risks (b=-.38, p < .001), descriptive norms (b = .80, p < .001), and injunctive norms related to marijuana use (b=-.24, p < .001), were significant. The associations between perceived risks (b=-.27, p < .001), descriptive norms (b = .14, p < .001), and injunctive norms (b=-.18, p < .001) and marijuana use were also significant. The indirect effects of marijuana availability on marijuana use through the pathways of perceived risks (b = .10, p < .001, 95 %CI[.08, .12]), descriptive norms (b = .11, p < .001, 95 %CI[.09, .14]), and injunctive norms related to marijuana use (b = .04, p < .001, 95 %CI[.03, .06]) were significant. The direct effect linking marijuana availability to marijuana use remained significant (b = .28, p < .001) but decreased by 37.8 %. when controlling for perceived risks, descriptive norms, and injunctive norms related to marijuana use.

CONCLUSIONS

Interventions aiming to reduce AI adolescent marijuana use should focus on availability and may also be well served by targeting descriptive and injunctive norms, as well as perceived risks of marijuana use.

Motivational Interviewing Adapted to Group Setting for the Treatment of Relapse in the Behavioral Therapy of Obesity. A Clinical Audit

Motivational interviewing (MI) is devised to change unhealthy behaviors by increasing motivation. We adapted MI to a group format for the treatment of relapse during the behavioral treatment of obesity and performed a clinical audit to evaluate its effectiveness in stopping weight regain. The program was structured in seven weekly sessions, plus a 6-month follow-up. Patients (n = 86) completed a questionnaire on motivation to change in both healthy diet and physical activity, and a self-reported measurement of calorie intake and physical activity at baseline, at program end and at 6-month follow-up. The attendance to the program was high, with only 13 patients (15%) not completing the program and 24% not attending the 6-month follow-up. By the end of follow up, the prevalence of patients in either precontemplation or contemplation was reduced from over 60% at enrollment to approximately 20%, whereas the sum of patients in action or maintenance stages was increased from 9.5% in healthy diet and 14% in physical activity to 39.7% and 41.3%, respectively. These changes translated into significant behavioral changes (mean calorie intake, −13%; total physical activity, +125%; sedentary time, −8%) and finally into reduced body weight ( −3%). We conclude that MI programs adapted for groups may be used to stop relapse in individuals following a behavioral intervention for obesity.

Examining the Effects of a Brief, Group-Based Motivational Implementation Strategy on Mechanisms of Teacher Behavior Change

Training and consultation are core implementation strategies used to support the adoption and delivery of evidence-based prevention programs (EBPPs), but are often insufficient alone to effect teacher behavior change. Motivational interviewing (MI) and related behavior change techniques (e.g., strategic education, social influence, implementation planning) delivered in a group format offer promising supplements to training and consultation to improve EBPP implementation. Beliefs and Attitudes for Successful Implementation in Schools for Teachers (BASIS-T) is a theoretically informed, motivational implementation strategy delivered in a group format prior to and immediately after EBPP training. The purpose of this study was to examine the proximal effects of BASIS-T on hypothesized mechanisms of behavior change (e.g., attitudes, subjective norms, intentions to implement) in the context of teachers receiving training and consultation to implement the Good Behavior Game. As part of a pilot trial, 83 elementary school teachers from 9 public elementary schools were randomly assigned (at the school-level to reduce contamination across participants) to a BASIS-T (n = 44) or active comparison control (n = 39) condition, with both conditions receiving Good Behavior Game (GBG) training and consultation. A series of mixed effects models revealed meaningful effects favoring BASIS-T on a number of hypothesized mechanisms of behavior change leading to increased motivation to implement GBG. The implications, limitations, and directions for future research on the use of MI with groups of individuals and other behavior change techniques to increase the yield of training and consultation are discussed.

Study protocol for a group-based motivational interviewing brief intervention to reduce substance use and sexual risk behavior among young adults experiencing homelessness

BACKGROUND

Young people experiencing homelessness have alarmingly high rates of alcohol and other drug (AOD) use, which is associated with sexual risk behaviors such as unprotected sex, trading sex, and sex with multiple casual partners. Few risk reduction programs for this population have been developed and rigorously evaluated, particularly those that address both of these interrelated behaviors, use a collaborative and non-judgmental approach, and are feasible to deliver in settings where homeless young people seek services. This paper describes the protocol of a study evaluating a four-session Motivational Interviewing (MI)-based group risk reduction intervention for this population. The protocol has been shown to be efficacious in pilot work over 3 months with 200 homeless young adults [1]. The current study seeks to refine the intervention protocol and evaluate the program on a larger scale.

METHODS/DESIGN

In a cluster-cross-over randomized controlled trial, 18-25 year olds will receive the AWARE risk reduction program (n = 200) or standard care (n = 200) at one of three drop-in centers serving homeless youth in the Los Angeles area. We will evaluate intervention effects on primary outcomes of AOD use and sexual risk behavior, as well as secondary outcomes of health-related quality of life and social stability, over a 12-month period.

DISCUSSION

This project has the potential to fill a significant gap in prevention services by demonstrating that a brief intervention, feasible to deliver within settings where young people experiencing homelessness typically seeks services, can significantly reduce the interrelated problems of AOD use and sexual risk behavior. Trial registration ClinicalTrials.gov Identifier: NCT03735784. Registered November 18, 2018, https://clinicaltrials.gov/ct2/show/record/NCT03735784 (retrospectively registered).

Motivational interviewing for social anxiety disorder: An examination of the technical hypothesis

ABSTRACT Background and objective: Motivational interviewing (MI) was originally developed to treat problematic drinking but is increasingly integrated into treatment for anxiety disorders. A causal model has been proposed which suggests technical and relational factors may account for the efficacy of MI. The technical hypothesis suggests that therapist MI-consistent behaviours are related to client change talk, and change talk is linked to treatment outcome. Research examining the technical hypothesis has typically been conducted in MI for substance use; therefore, the current study aimed to explore the technical hypothesis in MI for social anxiety disorder (SAD). Method: Participants diagnosed with SAD (n = 85) each received MI prior to receiving group cognitive-behavioural therapy (CBT). MI sessions were coded for behaviours relevant to the MI technical hypothesis. Results: The proportion of MI-consistent therapist behaviours and reflections of change language significantly predicted the proportion of change talk by the client during MI sessions; however, therapist and client behaviours did not predict treatment outcome. Conclusion: The findings support one path of the MI causal model in the context of social anxiety, though indicate that the occurrence of these behaviours during an MI pre-treatment may not extend to predict treatment outcome following CBT.

Motivational interviewing and culture for urban Native American youth (MICUNAY): A randomized controlled trial

To date, few programs that integrate traditional practices with evidence-based practices have been developed, implemented, and evaluated with urban American Indians/Alaska Natives (AI/ANs) using a strong research design. The current study recruited urban AI/AN teens across northern, central, and southern California during 2014-2017 to participate in a randomized controlled trial testing two cultural interventions that addressed alcohol and other drug (AOD) use. Adolescents were 14-18 years old (inclusive), and either verbally self-identified as AI/AN or were identified as AI/AN by a parent or community member. We tested the added benefit of MICUNAY (Motivational Interviewing and Culture for Urban Native American Youth) to a CWG (Community Wellness Gathering). MICUNAY was a group intervention with three workshops that integrated traditional practices with motivational interviewing. CWGs were cultural events held monthly in each city. AI/AN urban adolescents (N = 185) completed a baseline survey, were randomized to MICUNAY + CWG or CWG only, and then completed a three- and six-month follow-up. We compared outcomes on AOD use, spirituality, and cultural identification. Overall, AOD use remained stable over the course of the study, and we did not find significant differences between these two groups over time. It may be that connecting urban AI/AN adolescents to culturally centered activities and resources is protective, which has been shown in other work with this population. Given that little work has been conducted in this area, longer term studies of AOD interventions with urban AI/AN youth throughout the U.S. are suggested to test the potential benefits of culturally centered interventions.

Assessment of the completeness of intervention reporting of randomized clinical trials for alcohol use disorders: Effect of the TIDieR checklist and guide

BACKGROUND/PURPOSE

Properly designed randomized controlled trials (RCTs) are the gold standard in patient-centered clinical research. Incomplete intervention reporting affects the readers' ability to evaluate treatment efficacy. Previous studies show that detailed descriptions of trial interventions remains insufficient for reliable replication. Understanding reporting areas in need of improvement can improve the quality of intervention reporting.

METHODS

This cross-sectional review uses the Template for Intervention Description and Replication (TIDieR) checklist to evaluate the quality of intervention reporting in RCTs. The primary outcome was to investigate the completeness of intervention reporting of RCTs reporting outcomes for patients with alcohol use disorder (AUD) published in highly ranked addiction journals. The secondary outcomes were to: 1) evaluate whether publication of the TIDieR checklist resulted in better intervention reporting practices and 2) determine whether particular trial characteristics were associated with the completeness of intervention reporting.

RESULTS

The final analysis included 56 records. The mean number of reported TIDieR items was 5.1 (SD = 1.47) of a possible 12. TIDieR checklist publication did not increase the average completion of the TIDieR checklist items (p = 0.76). Improved TIDieR adherence was associated with trials with double blinding, non-drug interventions, and CONSORT endorsement.

DISCUSSION/CONCLUSIONS

We found the reporting of interventions to be inadequate in our sample of AUD-related RCTs. Fundamental details were often not reported, hampering both clinical and research reproducibility. Moving forward, it may be necessary to consider additional mechanisms to either improve TIDieR uptake or to find other solutions to improve intervention reporting.

Understanding Which Teenagers Benefit Most From a Brief Primary Care Substance Use Intervention

BACKGROUND AND OBJECTIVES

The primary care (PC) setting provides an opportunity to address adolescent alcohol and marijuana use. We examined moderators of effectiveness for a PC brief motivational intervention on adolescents' alcohol and marijuana use and consequences 1 year later.

METHODS

We conducted a randomized controlled trial in 4 PC clinics from April 2013 to November 2015 and followed adolescents using Web-based surveys. We examined whether demographic factors and severity of use moderated 12-month outcomes. Adolescents aged 12 through 18 were screened by using the National Institute on Alcohol Abuse and Alcoholism Screening Guide. Those identified as at risk were randomly assigned to the intervention (CHAT) or to usual care (UC).

RESULTS

The sample (n = 294) was 58% female, 66% Hispanic, 17% African American, 12% white, and 5% multiethnic or of other race with an average age of 16 years. After controlling for baseline values of outcomes, teens in CHAT who reported more negative consequences from drinking or had an alcohol use disorder at baseline reported less alcohol use, heavy drinking, and consequences 1 year later compared with teens in UC. Similarly, teens in CHAT with more negative consequences from marijuana use at baseline reported less marijuana use 1 year later compared with teens in UC; however, teens in CHAT who reported fewer marijuana consequences at baseline reported greater marijuana use 1 year later compared with teens in UC.

CONCLUSIONS

A brief intervention can be efficacious over the long-term for adolescents who report problems from alcohol and marijuana use. Findings emphasize the importance of both screening and intervention in at-risk adolescents in PC.

Specificity of expectancies prospectively predicting alcohol and marijuana use in adulthood in the Pittsburgh ADHD longitudinal study

Alcohol and marijuana use expectancies are presumed to be drug-specific, but prospective study of this assumption is lacking. In addition, these associations may operate differently for adults with attention-deficit/hyperactivity disorder (ADHD) histories, as expectancies have been found to be less associated with alcohol and marijuana use among this population. The first aim of the present study was to investigate whether associations between alcohol and marijuana expectancies and substance use were specific to the substances they assess. The second aim was to determine whether these associations differed as a function of ADHD history. Participants (N = 491; 281 ADHD, 210 non-ADHD) were young adults followed longitudinally between ages 21 to 23 and 29 as part of the Pittsburgh ADHD Longitudinal Study (PALS). Autoregressive models were estimated separately for positive and negative expectancies for frequency of alcohol and marijuana use and compared between ADHD groups. Although there were exceptions, results generally support the specificity of associations between outcome expectancies and respective substance use both concurrently and prospectively, but this specificity was primarily present for those without a history of ADHD. These findings suggest that young adults perceive and respond distinctly to the effects of alcohol and marijuana, but a history of ADHD may interfere with this process. These findings also extend our prior cross-sectional findings that expectancies are less associated with alcohol and marijuana use for individuals with ADHD histories. Additional research examining implicit cognitions is needed to further examine risk for substance use among those with ADHD histories. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Motivational interviewing technical process and moderated relational process with underage young adult heavy drinkers

This study tested technical and relational processes hypothesized to explain the therapeutic benefit of an efficacious brief motivational interview (BMI). A randomized controlled trial compared the efficacy of a BMI to an attention-matched control (i.e., relaxation training [REL]) for reducing heavy alcohol consumption and associated negative consequences. Participants were underage, past-month heavy drinkers recruited from community settings (N = 167; ages 17-20; 62% female; 59% White). Data were collected on session recordings, using established motivational interviewing process measures. Statistical analyses followed 3 steps. First, a latent class model determined the optimal class solution for characterizing proportion change talk means within BMI and REL. Next, the probability of proportion change talk class membership was examined as a mediator and then as a moderated mediator of BMI efficacy. The latent class model yielded a 3-class solution, including a low-increasing proportion change talk class (n = 61), a moderate-increasing proportion change talk class (n = 97), and a nonlinear proportion change talk class (n = 7). Across the outcomes examined, membership in the moderate-increasing class rather than the low-increasing class mediated BMI effects on alcohol-related consequences at 6 weeks. Mediation tests for consequences at 3 months and heavy drinking were nonsignificant. Moderated mediation results for therapist empathy and MI Spirit were nonsignificant. Findings suggest that moderate increases in prochange statements, relative to anti- or neutral-change statements, help explain BMI effects on reducing alcohol-related negative consequences soon after intervention. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Consumer Health Information Technology in the Prevention of Substance Abuse: Scoping Review

BACKGROUND

Addiction is one of the most rapidly growing epidemics that currently plagues nations around the world. In the United States, it has cost the government more than US $700 billion a year in terms of health care and other associated costs and is also associated with serious social, physical, and mental consequences. Increasing efforts have been made to tackle this issue at different levels, from primary prevention to rehabilitation across the globe. With the use of digital technology rapidly increasing, an effort to leverage the consumer health information technologies (CHITs) to combat the rising substance abuse epidemic has been underway. CHITs are identified as patient-focused technological platforms aimed to improve patient engagement in health care and aid them in navigating the complex health care system.

OBJECTIVE

This review aimed to provide a holistic and overarching view of the breadth of research on primary prevention of substance abuse using CHIT conducted over nearly past five decades. It also aimed to map out the changing landscape of CHIT over this period.

METHODS

We conducted a scoping review using the Arksey and O'Malley's modified methodological framework. We searched 4 electronic databases (PubMed, Cochrane, Scopus, and EMBASE). Papers were included if the studies addressed the use of CHIT for primary prevention of substance abuse and were published in English between 1809 and 2018. Studies that did not focus solely on primary prevention or assessed additional comorbid conditions were eliminated.

RESULTS

Forty-two papers that met our inclusion criteria were included in the review. These studies were published between 1970 and 2018 and were not restricted by geography, age, race, or sex. The review mapped studies using the most commonly used CHIT platforms for substance abuse prevention from mass media in the 1970s to mobile and social media in 2018. Moreover, 191 studies that were exclusively focused on alcohol prevention were excluded and will be addressed in a separate paper. The studies included had diverse research designs although the majority were randomized controlled trials (RCT) or review papers. Many of the RCTs used interventions based on different behavioral theories such as family interactions, social cognitive theories, and harm-minimization framework.

CONCLUSIONS

This review found CHIT platforms to be efficacious and cost-effective in the real-world settings. We also observed a gradual shift in the types and use of CHIT platforms over the past few decades and mapped out their progression. In addition, the review detected a shift in consumer preferences and behaviors from face-to-face interactions to technology-based platforms. However, the studies included in this review only focused on the aspect of primary prevention. Future reviews could assess the effectiveness of platforms for secondary prevention and for prevention of substance abuse among comorbid populations.

Greater risk for frequent marijuana use and problems among young adult marijuana users with a medical marijuana card

BACKGROUND

This study compared young adults with and without a medical marijuana (MM) recommendation from a provider ("MM card") on their developmental trajectories of frequent marijuana use and marijuana-related problems in young adulthood.

METHODS

The analytic sample consists of young adult past month marijuana users (N = 671) who were part of a larger, diverse, and predominantly California cohort. Analyses are based on data from seven surveys completed from ages 13-19.

RESULTS

At age 19, 28% of participants reported having an MM card to legally purchase marijuana from an MM dispensary. A multiple group latent growth model indicated that young adults who had an MM card showed steeper increases in frequent marijuana use (i.e., 20-30 days of use in the past month) from ages 13-19 compared to young adults who did not have an MM card. Logistic regression models that matched MM cardholders and non-MM cardholders on individual sociodemographic characteristics found that MM cardholders were more likely to report marijuana negative consequences, selling marijuana/hashish, and driving under the influence of marijuana in the past year. In addition, MM cardholders were more likely to have tried cutting down or quitting in the past 3-months.

CONCLUSIONS

Among young adult marijuana users, those with an MM card had a higher risk profile for marijuana use and related problems compared to those without an MM card. Given expanding state legalization of MM, this issue warrants further attention.

Mechanisms of behavior change in motivational interviewing: do we understand how MI works?

This work provides an overview of Motivational Interviewing (MI) theory, the nature of the evidence for its mechanisms of action, and considers future directions. There are three hypotheses purported to explain how MI works: The Technical Hypothesis, the Relational Hypothesis, and the Conflict Resolution Hypothesis. In contrast to the latter two hypotheses, the Technical Hypothesis has received the most empirical attention in the MI process literature. Research shows that clinician technical skills in MI are well-defined, they relate to the intended client mechanisms (i.e. change talk and sustain talk), but the evidence supporting client mechanisms as predictors of subsequent changes to behavior is less conclusive. Future research and clinical implications are briefly considered.

"C.H.A.M.P. Families": Description and Theoretical Foundations of a Paediatric Overweight and Obesity Intervention Targeting Parents-A Single-Centre Non-Randomised Feasibility Study

Childhood obesity represents a significant global health challenge, and treatment interventions are needed. The purpose of this paper is to describe the components and theoretical model that was used in the development and implementation of a unique parent-focussed paediatric overweight/obesity intervention. C.H.A.M.P. Families was a single-centre, prospective intervention offered to parents of children aged between 6–14 years with a body mass index (BMI) ≥85th percentile for age and sex. The intervention included: (1) eight group-based (parent-only) education sessions over 13-weeks; (2) eight home-based activities; and (3) two group-based (family) follow-up support sessions. The first section of the manuscript contains a detailed description of each intervention component, as well as an overview of ongoing feasibility analyses. The theoretical portion details the use of evidence-based group dynamics principles and motivational interviewing techniques within the context of a broader social cognitive theory foundation. This paper provides researchers with practical examples of how theoretical constructs and evidence-based strategies can be applied in the development and implementation of parent-focussed paediatric obesity interventions. Given the need for transparent reporting of intervention designs and theoretical foundations, this paper also adds to the areas of implementation science and knowledge translation research.

Motivation and adherence to psychosocial treatment for alcohol and drug use-related problems

Abstract This is a prospective cohort study of 150 individuals attending a specialized health service for substance-related disorders. The study investigated the association between motivation to remain in treatment and treatment adherence. All service users were interviewed soon after admission to the treatment program and were followed-up during the first two months of treatment. A Cox Regression Model was used to estimate the hazard ratios for dropout during the two months following the admission interview. The results indicated that individuals with a primary-school education, lack of income, and low motivation toward treatment at the admission interview presented a higher risk of treatment dropout. This study showed the importance of motivation in changing addictive behavior and in adherence to treatment as essential factors for recovery.

Testing implementation support for evidence-based programs in community settings: a replication cluster-randomized trial of Getting To Outcomes®

Background

Community organizations can have difficulty implementing evidence-based prevention programs. More research is needed on implementation support interventions designed to help these organizations implement programs with quality.

Methods

Preparing to Run Effective Programs (PREP) is a randomized controlled trial testing Getting To Outcomes (GTO), a 2-year implementation support intervention. It compares 15 Boys and Girls Club sites implementing CHOICE (control group), a five-session evidence-based alcohol and drug prevention program, with 14 similar sites implementing CHOICE supported by GTO (intervention group). PREP replicates a previous GTO study that had the same design, but featured a teen pregnancy prevention program instead. All sites received typical CHOICE training. Fourteen intervention sites received GTO manuals, training, and onsite technical assistance to help practitioners complete implementation best practices specified by GTO (i.e., GTO steps). During the first year, technical assistance providers helped the intervention group adopt, plan, and deliver CHOICE. Then, this group was trained on evaluation and quality improvement steps of GTO using feedback reports summarizing their own data, which yielded revised plans for subsequent implementation of CHOICE. This paper presents results regarding GTO’s impact on CHOICE fidelity (adherence, quality of delivery, dosage) and the proximal outcomes of the youth participants (aged 10–14)—attitudes and intentions regarding cigarettes, alcohol, and marijuana use. Fidelity was assessed at all sites by observer ratings and attendance logs. Proximal outcomes were assessed via survey at baseline, 3, and 6 months.

Results

After 1 year, fidelity and proximal outcomes were similar between Intervention and control groups. After 2 years (which included GTO quality improvement activities that took place between years 1 and 2), intervention sites had higher ratings of CHOICE adherence and quality of delivery (dosage remained similar). Proximal outcomes did not differ between groups in either year, although there was universally high endorsement of prosocial responses to those outcomes from the start.

Conclusions

Findings suggest that systematic implementation support provided by GTO can help community organizations achieve better fidelity. Findings replicate the implementation results from a previous GTO study using the same design, but with a different evidence-based program and different fidelity measures. Although proximal outcomes did not change, in large part due to ceiling effects, the implementation findings suggest GTO can support a variety of programs.

Trial registration

This project is registered at ClinicalTrials.gov with number NCT02135991. The trial was first registered on May 12, 2014.

A sequential analysis of motivational interviewing technical skills and client responses

BACKGROUND

The technical hypothesis of Motivational Interviewing (MI) proposes that: (a) client talk favoring behavior change, or Change Talk (CT) is associated with better behavior change outcomes, whereas client talk against change, or Sustain Talk (ST) is associated with less favorable outcomes, and (b) specific therapist verbal behaviors influence whether client CT or ST occurs. MI consistent (MICO) therapist behaviors are hypothesized to be positively associated with more client CT and MI inconsistent (MIIN) behaviors with more ST. Previous studies typically examine session-level frequency counts or immediate lag sequential associations between these variables. However, research has found that the strongest determinant of CT or ST is the client's previous CT or ST statement. Therefore, the objective of this paper was to examine the association between therapist MI skills and subsequent client talk, while accounting for prior client talk.

METHODS

We analyzed data from a manualized MI intervention targeting both alcohol misuse and sexual risk behavior in 132 adults seen in two hospital emergency departments. Transcripts of encounters were coded using the Motivational Interviewing Skills Code (MISC 2.5) and an additional measure, the Generalized Behavioral Intervention Analysis System (GBIAS). Using these measures, we analyzed the association between client talk following specific classifications of MICO skills, with the client's prior statement as a potential confounder or effect modifier.

RESULTS

With closed questions as the reference category, therapist simple reflections and paraphrasing reflections were associated with significantly greater odds of maintaining client talk as CT or ST. Open questions and complex reflections were associated with significantly greater odds of CT following ST, were not associated significantly with more ST following ST, and were associated with more ST following CT (i.e., through an association with less Follow Neutral).

CONCLUSIONS

Simple and paraphrasing reflections appear to maintain client CT but are not associated with transitioning client ST to CT. By contrast, complex reflections and open questions appeared to be more strongly associated with clients moving from ST to CT than other techniques. These results suggest that counselors may differentially employ certain MICO technical skills to elicit continued CT and move participants toward ST within the MI dialogue.

Effects of a group activity-based motivational enhancement therapy program on social media addictive behaviors among junior high school students in Thailand: a cluster randomized trial

Purpose

This study aimed to assess the effects of a group activity-based motivational enhancement therapy (GA-MET) program on social media addictive behaviors among junior high school students.

Materials and methods

This cluster randomized trial was performed in 245 junior high school students who used social media in the lower part of northeast Thailand. The GA-MET program group and the control group sessions lasted 8 weeks and were followed up 4 weeks later. The addictive social media behaviors, average duration of social media usage during weekdays and weekends (hours/day), child behaviors, self-esteem, and depression were investigated using a self-reported questionnaire. Multivariable linear regression was used to compare the mean and 95% CIs between two groups.

Results

The GA-MET program significantly decreased the average duration of social media usage during weekdays and weekends (hours/day) (−1.27, 95% CI: −2.18,−0.37 and −1.25, 95% CI: −2.22, −0.29, respectively), emotional behavior (−0.69, 95% CI: −1.18, −0.19), and depression (−4.03, 95% CI: −6.07, −1.99) in the treated group compared to the control group.

Conclusion

The GA-MET program could reduce the risk of social media addictive behaviors in junior high school students in Thailand by decreasing time spent on social media, emotional behaviors, and depression.

Evidence Base on Outpatient Behavioral Treatments for Adolescent Substance Use, 2014-2017: Outcomes, Treatment Delivery, and Promising Horizons

This article updates the evidence base on outpatient behavioral treatments for adolescent substance use (ASU) since publication of the previous review completed for this journal by Hogue, Henderson, Ozechowski, and Robbins (2014). It first summarizes the Hogue et al. findings along with those from recent literature reviews and meta-analytic studies of ASU treatments. It then presents study design and methods criteria used to select 11 comparative studies subjected to Journal of Clinical Child and Adolescent Psychology level of support evaluation. These 11 studies are detailed in terms of their sample characteristics, methodological quality, and substance use outcomes. Cumulative level of support designations are then made for each identified treatment approach. These cumulative designations are virtually identical to those of the previous review: ecological family-based treatment, individual cognitive-behavioral therapy, and group cognitive-behavioral therapy remain well-established; behavioral family-based treatment and motivational interviewing remain probably efficacious; drug counseling remains possibly efficacious; and an updated total of 5 multicomponent treatments combining more than 1 approach (3 of which include contingency management) are deemed well-established or probably efficacious. Treatment delivery issues associated with evidence-based approaches are then reviewed, focusing on client engagement, fidelity and mediator, and predictor and moderator effects. Finally, to help accelerate innovation in ASU treatment science and practice, the article outlines promising horizons in improving youth identification and access, specifying and implementing pragmatic treatment in community settings, and leveraging emerging lessons from implementation science.

Planting the seed for marijuana use: Changes in exposure to medical marijuana advertising and subsequent adolescent marijuana use, cognitions, and consequences over seven years

BACKGROUND

Marijuana use during adolescence is associated with neurocognitive deficits and poorer functioning across several domains. It is likely that more states will pass both medical and recreational marijuana legalization laws in the coming elections; therefore, we must begin to look more closely at the longitudinal effects of medical marijuana (MM) advertising on marijuana use among adolescents so that we can better understand effects that this advertising may have on their subsequent marijuana use and related outcomes.

METHODS

We followed two cohorts of 7th and 8th graders (mean age 13) recruited from school districts in Southern California from 2010 until 2017 (mean age 19) to examine effects of MM advertising on adolescents' marijuana use, cognitions, and consequences over seven years. Latent growth models examined trajectories of self-reported exposure to medical marijuana ads in the past three months and trajectories of use, cognitions, and consequences.

RESULTS

Higher average exposure to MM advertising was associated with higher average use, intentions to use, positive expectancies, and negative consequences. Similarly, higher rates of change in MM advertising exposure were associated with higher rates of change in use, intentions, expectancies, and consequences over seven years.

CONCLUSIONS

Results suggest that exposure to MM advertising may not only play a significant role in shaping attitudes about marijuana, but may also contribute to increased marijuana use and related negative consequences throughout adolescence. This highlights the importance of considering regulations for marijuana advertising, similar to regulations in place for the promotion of tobacco and alcohol in the U.S.

A meta-analysis of motivational interviewing process: Technical, relational, and conditional process models of change

OBJECTIVE

In the present meta-analysis, we test the technical and relational hypotheses of Motivational Interviewing (MI) efficacy. We also propose an a priori conditional process model where heterogeneity of technical path effect sizes should be explained by interpersonal/relational (i.e., empathy, MI Spirit) and intrapersonal (i.e., client treatment seeking status) moderators.

METHOD

A systematic review identified k = 58 reports, describing 36 primary studies and 40 effect sizes (N = 3,025 participants). Statistical methods calculated the inverse variance-weighted pooled correlation coefficient for the therapist to client and the client to outcome paths across multiple target behaviors (i.e., alcohol use, other drug use, other behavior change).

RESULTS

Therapist MI-consistent skills were correlated with more client change talk (r = .55, p < .001) as well as more sustain talk (r = .40, p < .001). MI-inconsistent skills were correlated with more sustain talk (r = .16, p < .001), but not change talk. When these indicators were combined into proportions, as recommended in the Motivational Interviewing Skill Code, the overall technical hypothesis was supported. Specifically, proportion MI consistency was related to higher proportion change talk (r = .11, p = .004) and higher proportion change talk was related to reductions in risk behavior at follow up (r = -.16, p < .001). When tested as two independent effects, client change talk was not significant, but sustain talk was positively associated with worse outcome (r = .19, p < .001). Finally, the relational hypothesis was not supported, but heterogeneity in technical hypothesis path effect sizes was partially explained by inter- and intrapersonal moderators.

CONCLUSIONS

This meta-analysis provides additional support for the technical hypothesis of MI efficacy; future research on the relational hypothesis should occur in the field rather than in the context of clinical trials. (PsycINFO Database Record

Effects of motivational interviewing fidelity on substance use treatment engagement in primary care

OBJECTIVE

Primary care (PC) may be an opportune setting to engage patients with opioid and alcohol use disorders (OAUDs) in treatment. We examined whether motivational interviewing (MI) fidelity was associated with engagement in primary care-based OAUD treatment in an integrated behavioral health setting.

METHODS

We coded 42 first session therapy recordings and examined whether therapist MI global ratings and behavior counts were associated with patient engagement, defined as the patient receiving one shot of extended-release injectable naltrexone or any combination of at least two additional behavioral therapy, sublingual buprenorphine/naloxone prescriptions, or OAUD-related medical visits within 30days of their initial behavioral therapy visit.

RESULTS

Autonomy/support global ratings were higher in the non-engaged group (OR=0.28, 95%CI: 0.09-0.93; p=0.037). No other MI fidelity ratings were significantly associated with engagement.

CONCLUSION

We did not find positive associations between MI fidelity and engagement in primary care-based OAUD treatment. More research with larger samples is needed to examine how providing autonomy/support to patients who are not ready to change may affect engagement.

PRACTICE IMPLICATIONS

Training providers to strategically use MI to reinforce change as opposed to the status quo is needed. This may be especially important in primary care where patients may not be specifically seeking help for their OAUDs.

Decisional balance and processes of change in community-recruited with moderate-high versus mild severity of cannabis dependence

Decisional Balance and Processes of Change are generally addressed in motivational interventions for the treatment of cannabis use disorders. However, specific aspects of these multifaceted constructs, with greater relevance for severe cannabis users, need to be ascertained to enable better interventions. This study aimed to compare the different facets of decisional balance and processes of change between mild and severe cannabis users in a community-based sample of young undergraduates. Thirty-one severe cannabis users and 31 mild cannabis users, indicated with the Severity of Dependence Scale, were assessed using the Decisional Balance Questionnaire (DBQ) and the Processes of Change Questionnaire (PCQ). We found that severe cannabis users had higher scores in the DBQ dimensions of Utilitarian Gains for the Self, Utilitarian Gains for Significant Others, and Self-approval, as well as in the total subscale of Gains but not Losses. The group of severe cannabis users also had higher scores in the PCQ dimensions of Self-revaluations and Counter-conditioning. Our results pinpoint specific dimensions of Decisional Balance and Processes of Change that are endorsed by severe cannabis users. This knowledge could be applied to inform motivational interventions targeting severe cannabis users.