Substance misuse has been a bit of a theme on the Mental Elf this week and I’m continuing with that today, firstly with this piece from the Lifestyle Elf. Don’t forget, if you’re interested in healthy lifestyle issues (exercise, obesity, quitting smoking, alcohol, substance misuse), you should be following the excellent Lifestyle Elf blog.
Earlier this week the Lifestyle Elf highlighted a systematic review of interventions to prevent children of substance-affected parents from becoming users themselves. But how about teens who are in the early stages of using drugs, alcohol or other substances, but don’t yet meet diagnostic criteria for substance abuse or dependence and so may not need specialist drug treatment? It’s this group who were the focus for another new systematic review published in the same peer-reviewed journal, which looked at evidence from controlled trials (with or without randomisation) on the impact of early interventions for substance-using adolescents on both substance-use and behaviour.
Through an extensive and systematic search, the reviewers found nine studies suitable for inclusion, involving 1,895 participants, of whom 1,638 (86 %) received the full intervention and attended all follow-up appointments. Seven studies contained information which allowed for the calculation of an effect size (Hedges’ g; 0.20 is considered small, 0.50 medium, and 0.80 large) and were included in a meta-analysis. Eight studies used brief motivational interventions and worked with individuals; they were conducted in different settings including schools, community centres and correctional facilities. One took place in Australia and the rest in the US. Follow-up ranged from 1-12 months.
Here’s what they found:
- The effect of interventions was small but significant for all outcomes combined (g = 0.25, p < 0.001), for substance use (g = 0.24, p < 0.001) and for behavioural outcomes (g = 0.28, p < 0.001)
- Interventions delivered to individuals and over more than one session had a stronger effect on both behaviour and substance use than single session interventions or those delivered to groups
- Effect sizes for the programme ‘Teen Intervene’ were consistently larger than for other interventions; it was the only intervention which included a session with the adolescents’ parents
- Studies varied in how outcomes were defined, measured and reported and in their quality, but study quality was generally high
- Few studies have directly examined behavioural outcomes for substance use interventions delivered in group formats
The authors concluded:
The findings for this systematic review clearly demonstrate the value of early interventions for effectively targeting adolescent substance use and that these can reduce substance use and also impact on other behavioural outcomes. Interventions that are delivered in an individual format and across multiple-sessions seem particularly beneficial.
This looks promising, but the authors point out that it is unclear whether these findings can be generalised to low- and middle-income countries and highlight the need for high quality evaluations in such countries, where some promising intervention work is being done on substance use and other problem behaviours, but has not been tested in well-designed experimental studies.
Carney T, Myers B. Effectiveness of early interventions for substance-using adolescents: findings from a systematic review and meta-analysis (PDF). Substance Abuse Treatment, Prevention, and Policy 2012, 7:25