The short-term results of a randomized trial testing a brief feedback and motivational intervention for substance use among homeless adolescents are presented. Homeless adolescents ages 14-19 (N = 285) recruited from drop-in centers at agencies and from street intercept were randomly assigned to either a brief motivational enhancement (ME) group or 1 of 2 control groups. The 1-session motivational intervention presented personal feedback about patterns of risks related to alcohol or substance use in a style consistent with motivational interviewing. Follow-up interviews were conducted at 1 and 3 months postintervention. Youths who received the motivational intervention reported reduced illicit drug use other than marijuana at 1-month follow-up compared with youths in the control groups. Treatment effects were not found with respect to alcohol or marijuana. Post hoc analyses within the ME group suggested that those who were rated as more engaged and more likely to benefit showed greater drug use reduction than did those rated as less engaged. Limitations of the study are discussed as are implications for development of future substance use interventions for this high-risk group.

A brief motivational intervention with 117 homeless adolescents was evaluated using a randomized design and 3-month follow-up. The intervention was designed to raise youths' concerns about their substance use, support harm reduction, and encourage greater service utilization at a collaborating agency. The study was designed to strengthen initial promising results of an earlier study (P. L. Peterson, J. S. Baer, E. A. Wells, J. A. Ginzler, & S. B. Garrett, 2006). Several modifications in the clinical protocol were included to enhance engagement with the intervention. Analyses revealed no significant benefits for intervention participants when homeless youths' substance use rates were compared with those of control participants. Service utilization during the intervention period increased for those receiving the intervention but returned to baseline levels at follow-up. Participants reported overall reductions in substance use over time. Differences between sampling methods for the current and previous study are discussed, as are the limitations of brief interventions with this population. Future research needs to elucidate mechanisms of change and service engagement for highly vulnerable youth.

The notion that client language about change is related to actual behavioral change is central to the practice of motivational interviewing (MI), but has not been examined in adolescent clients. In this study homeless adolescents who used alcohol or illicit substances but were not seeking treatment (n = 54) were recorded during brief motivational interventions. Adolescent language during sessions was coded based on MI concepts, and ratings were tested as predictors of rates of substance use over time. Types of adolescent speech included global ratings of engagement and affect, as well as counts of commitment to change, statements about reasons for change, and statements about desire or ability to change. Results of multivariate linear regression indicate that statements about desire or ability against change, although infrequent (M = 0.61 per 5 minutes), were strongly and negatively predictive of changes in substance use rates (days of abstinence over the prior month) at both 1-and 3-months post baseline assessment (p < .001). In contrast, statements about reasons for change were associated with greater reductions in days substance use at 1-month assessment (p < .05). Commitment language was not associated with outcomes. Results suggest that specific aspects of adolescent speech in brief interventions may be important in the prediction of change in substance use. Future studies are needed to test the observed relationships in larger samples and other clinical contexts, and assess if youth language about change mediates effects of clinical interventions.Motivational interviewing (MI;Miller & Rollnick, 2002) is a popular, empirically-based counseling method for a range of health-related problems. Defined as a "client-centered, directive method for facilitating intrinsic motivation to change by exploring and resolving ambivalence," (Rollnick & Miller, 1995), MI emphasizes formation of collaborative therapeutic relationships with clients through which client language about change may be strategically elicited and reinforced. "Change language" is defined as client expressions of problems with the current state, benefits of change, and hope and optimism about future change (Miller & Rollnick, 2002). In articulating a theory for MI, Miller and colleagues have stated that "1) The practice of MI should elicit increased levels of change and decreased levels of resistance from clients, 2) The extent to which clients verbalize arguments against change (resistance) during MI will be inversely related to the degree of subsequent behavior change, and 3) The extent to which clients verbalize change talk (arguments for change) during MI will be directly related to the degree of subsequent behavior change" Hettema, Steele, & Miller, 2005, p. 106).

Aims The study evaluated the effectiveness of an 8-week combined group plus individual 12-step facilitative intervention on stimulant drug use and 12-step meeting attendance and service. Design Multisite randomized controlled trial, with assessments at baseline, mid-treatment, end of treatment, and 3- and 6-month post-randomization follow-ups (FU). Setting Intensive outpatient substance treatment programs. Participants Individuals with stimulant use disorders (n = 471) randomly assigned to treatment as usual (TAU) or TAU into which the STAGE-12 intervention was integrated. Measurements Urinalysis and self-reports of substance use and 12-step attendance and activities. Intervention Group sessions focused on increasing acceptance of 12-step principles; individual sessions incorporated an intensive referral procedure connecting participants to 12-step volunteers. Findings Compared to TAU, STAGE-12 participants had significantly greater odds of self-reported stimulant abstinence during the active 8-week treatment phase; however, among those who had not achieved abstinence during this period, STAGE-12 participants had more days of use. STAGE-12 participants had lower ASI Drug Composite scores at and a significant reduction from baseline to the 3-month FU, attended 12-step meetings on a greater number of days during the early phase of active treatment, engaged in more other types of 12-step activities throughout the active treatment phase and the entire FU period, and had more days of self-reported service at meetings from mid-treatment through the 6-month FU. Conclusions The present findings are mixed with respect to the impact of integrating the STAGE-12 intervention into intensive outpatient drug treatment compared to TAU on stimulant drug use. However, the results more clearly indicate that individuals in STAGE-12 had higher rates of 12-step meeting attendance and were engaged in more related activities throughout both the active treatment phase and the entire 6-month follow-up period than did those in TAU.

The potential of MCs to benefit some patients is hindered by the lack of comfort of clinicians to recommend it. Training opportunities are badly needed to address these issues.