Reports of past alcohol and drug use following participation in a motivation enhancing intervention: Implications for clinical assessment and program evaluation

Abstract

BackgroundThere is significant interest in the value of motivational approaches that enhance participant readiness to change, but less is known about clients’ self-reports of problematic behavior when participating in such interventions.MethodsWe examined whether participants in a motivationally-based intervention for DUI offenders changed their reports of substance use at postintervention (when reporting on the same 30 days that they reported on at preintervention). Specifically, Study 1 (N = 8,387) tested whether participants in PRIME For Life (PFL) changed their reports about baseline substance levels when asked at postintervention versus at preintervention. Study 2 (N = 192) compared changes in self-reported baseline drinking between PFL and intervention as usual (IAU) participants.ResultsMany participants in Study 1 did not change their reports about how much they used substances during the 30-day period before baseline. Among those who did, the most common change was an increase in reported amounts of baseline drug use, and typical and peak alcohol use. This sample also showed changes in reports of their baseline pattern of high-risk-use (consistent versus occasional). At postintervention, participants who were younger, single, or endorsing more indicators of alcohol dependence were more likely to later report greater frequency of baseline drug use, and greater peak and typical number of baseline drinks. Gender, education, and race were also associated with reporting inconsistency on some behaviors. In Study 2, PFL participants showed greater increases in reports of peak alcohol use compared to IAU, but both conditions showed similar increases for drugs and typical alcohol use.ConclusionsIn both research and clinical settings, a segment of participants may initially report less substance use than they do when asked later about the same baseline period. These preliminary findings suggest clinicians and researchers may find postintervention evaluations yield reports of greater baseline alcohol or drug use for some people. For some behaviors, this may occur more often in interventions that target client motivation. Future research should attempt to identify which reports – preintervention vs. postintervention – better reflect actual baseline substance use.

Emerging adults in substance misuse intervention: preintervention characteristics and responses to a motivation-enhancing program

“…We based this decision on previous research indicating that individuals experiencing legal issues based on their substance use and participating in court-ordered intervention report higher levels of previous use when asked following program participation than when queried about the same time period prior to the program [27, 28]. While we cannot be certain these postintervention-collected data were more accurate, we see reason to believe that it might be.…”

A Comparison of Underage, Young, Middle, and Late Adults in Indicated Prevention Following Impaired Driving

“…Except for substance use and related behaviors, all items were asked at pretest and again at posttest. For substance use and related behavior items, we used posttest reports of preprogram behavior, because previous research indicated that individuals with legal issues related to their substance use report higher levels of previous use when asked after program participation than when asked prior to the program (Rosengren et al, ; Stinchfield, ). At baseline, members of this population are usually disgruntled about attending a court‐ordered program and concerned about confidentiality related to their legal entanglements, which are factors hypothesized to decrease the accuracy of self‐report (Del Boca & Darkes, ).…”

Methods for Quantifying the Clinical Significance of Change During Intervention Program Participation

“…For the 90 days before PFL, we used posttest responses about drinking that occurred during that time period. We based this decision on previous research indicating that court-ordered individuals experiencing legal entanglements based on their substance use and participating in real-world, court-ordered intervention studies report higher levels of previous use when asked following program participation than they had at baseline (Rosengren, Beadnell, Nason, Stafford, & Daugherty, 2012; Stinchfield, 1997). While we cannot be certain this posttest-collected data were more accurate, we reasoned that factors that can decrease the accuracy of self-report—such as unhappiness about attending a court-ordered program, social desirability, and concerns about confidentiality given their legal entanglements (Del Boca & Darkes, 2003)—were likely to be less salient at the posttest time point.…”