Objective Adolescent substance use and abuse is a pressing public health problem, and is strongly related to interpersonal aggression. Such problems disproportionately impact minority youth, who have limited access to evidence-based interventions such as ecological family therapies, brief motivational interventions (BMI), and cognitive behavioral therapies (CBT). With a predominantly minority sample, our objective was to rigorously evaluate the efficacy of a school-based BMI/CBT, Guided Self-Change (GSC), for addressing substance use and aggressive behavior. Method We conducted a school-based RCT with 514 high school students (mean age 16.24 years, 41% female, 80% minority) reporting using substances and perpetrating aggression. We used structural equation modeling to compare participants randomly assigned to receive GSC or standard care (SC; education/assessment/referral-only), at post-treatment, and 3- and 6-months post-treatment, on alcohol use, drug use, and interpersonal aggression outcomes as assessed by the Timeline Follow-Back. Results Compared with SC participants, GSC participants showed significant reductions (p < .05) in total number of alcohol use days (Cohen’s d =0.45 at post-treatment, and 0.20 at 3-months post-treatment), drug use days (Cohen’s d =0.22 at post-treatment, and 0.20 at 3-months post-treatment), and aggressive behavior incidents (Cohen’s d =0.23 at post-treatment). Moreover, treatment effects did not vary by gender or ethnicity. Conclusions With minority youth experiencing mild to moderate problems with substance use and aggressive behavior, GSC holds promise as an early intervention approach that can be implemented with success in schools.

Psychosocial factors may directly impact HIV health measures such as viral load (VL), whether or not patients are taking antiretroviral treatment (ART) consistently. Structural equation modeling plus Baron and Kenny’s (1986) four-step approach were used to test a mediated model predicting VL among 246 HIV-infected adults who were on ART. Exogenous variables were social support, barriers to adherence, and stress. Moderators were alcohol use, marijuana use, and neurocognitive impairment. A small positive association between marijuana use and ART adherence approached significance. Only barriers to adherence predicted a decrease in adherence rates and an increase in VL. No other factors were significantly associated with either VL or adherence and no interaction effects between exogenous variables and moderators were identified. The association between barriers to adherence and VL was partially mediated by ART adherence. Findings provide modest support for a direct link between psychosocial variables and a virologic response to ART.

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