Mandated college students’ response to sequentially administered alcohol interventions in a randomized clinical trial using stepped care.

Abstract

Objective Students referred to school administration for alcohol policies violations currently receive a wide variety of interventions. This study examined predictors of response to two interventions delivered to mandated college students (N = 598) using a stepped care approach incorporating a peer-delivered 15-minute BA session (BA; Step 1) and a 60–90 minute brief motivational intervention delivered by trained interventionists (BMI; Step 2). Method Analyses were completed in two stages. First, three types of variables (screening variables, alcohol-related cognitions, mandated student profile) were examined in a logistic regression model as putative predictors of lower-risk drinking (defined as 3 or fewer heavy episodic drinking [HED] episodes and/or 4 or fewer alcohol-related consequences in the past month) six weeks following the BA session. Second, we used generalized estimating equations to examine putative moderators of BMI effects on HED and peak blood alcohol content (pBAC) compared to assessment-only control (AO) over the 3, 6, and 9 month follow-ups. Results Participants reporting lower scores on the Alcohol Use Disorders Identification Test (AUDIT), more benefits to changing alcohol use, and those who fit the ‘Bad Incident’ profile at baseline were more likely to report lower risk drinking 6 weeks after the BA session. Moderation analyses revealed that ‘Bad Incident’ students who received the BMI reported more HED at 9-month follow up than those who received AO. Conclusion Current alcohol use as well as personal reaction to the referral event may have clinical utility in identifying which mandated students benefit from treatments of varying content and intensity.

Scoping review of stepped care interventions for mental health and substance use service delivery to youth and young adults

“…ensuring that the stepped care approach is sufficiently individualized for the target YYA population, for example, identifying which youth would most benefit from a step up in treatment intensity (Borsari et al, 2016 ; Pettit et al, 2017 ), and considering comorbidities, accommodating for youth from minority populations and/or those from disadvantaged neighbourhoods/backgrounds (Kendall et al, 2016 ).…”

“…Proportion of studies by health setting (overall n = 36; adult n = 18; youth and young adult [YYA] n = 10; children n = 8). Other settings included a study with multiple settings and a specialized mental health care organization a. integrating parents, family, and the community in the stepped care treatment approach (Kendall et al, 2016;Salloum et al, 2014;Silverman et al, 2016;van der Leeden et al, 2011); b. ensuring that the stepped care approach is sufficiently individualized for the target YYA population, for example, identifying which youth would most benefit from a step up in treatment intensity (Borsari et al, 2016;Pettit et al, 2017), and considering comorbidities, accommodating for youth from minority populations and/or those from disadvantaged neighbourhoods/backgrounds (Kendall et al, 2016). c. Targeting stepped care and treatments for specific age groups was a major point in the discussions (Birleson & Vance, 2008).…”

Statistical design and analysis in trials of proportionate interventions: a systematic review

“…The majority of stepped-care studies (73%; 27 of 37) focussed on the therapeutic areas of depression, anxiety, stress or some form of mental health disorder. Other therapeutic areas targeted included: weight loss [11, 12], alcohol consumption [13, 14], eating disorders [15, 16], whiplash injuries [17], blood pressure control [18], resilience and well-being of families living with childhood chronic illness [19], and impairment in older dizzy people [20].…”

Predictors of cannabis use among first-time justice-involved youth: A cohort study

“…One possible approach for substance use SSIs is motivational interviewing (MI), a communication technique used to reduce alcohol and cannabis use among school-mandated college students ( Borsari et al, 2016 ) and in two studies of general substance using adolescent populations ( Martin and Copeland, 2008 ; Walker et al, 2011 ); however, the limited data available suggest MI for universal prevention may not be as effective ( McCambridge et al, 2011 ). Adult criminal justice systems are incorporating MI techniques through digital health interventions to reduce substance use and in staff trainings to promote overall harm reduction and associated consequences, but studies are with those already using substances.…”