Brief or early counselling interventionsThis is a featured page

This page examines the effectiveness of brief or early counselling interventions to prevent substance abuse and other addictions.

Brief interventions: Summary of the Evidence
(An excerpt "School-based and school-linked prevention of substance use problems: A knowledge summary", Canadian Association for School Health, 2008).

For populations using substances hazardously but who aren’t necessarily dependent, brief interventions employing cognitive-behavioural and/or motivational principles are increasingly used. These approaches, having shown substantial promise for addressing hazardous use of alcohol, tobacco, and other drugs with a range of populations and settings,[xxxii] [xxxiii] [xxxiv] are increasingly being evaluated for the secondary school setting. Cognitive-behavioural approaches focus on methodically building skills to deal with current issues of the client/student.

These approaches often include an assessment of the current situation followed by identification of personalised, usually time-limited goals and strategies which are monitored and evaluated. The approach is inherently empowering in nature, the outcome being to focus on acquiring and utilising new skills, with an emphasis on putting what has been learned into practice between sessions through homework. Motivational interviewing, developed by Miller and Rollnick is a person-centered interviewing style with the goal of resolving conflicts regarding the pros and cons of change, enhancing motivation, and encouraging positive changes in behaviour. The interviewer’s style is characterised by empathy and acceptance, with an avoidance of direct confrontation. Any statements about positive behaviour change brought up by the person in the discussion are encouraged to support self-efficacy and a commitment to take action.[xxxv]

There is no consensus on what constitutes a “brief” intervention. Interventions may range from four sessions to 5 min to receipt of one or more feedback sheets in the mail. They are often conducted by a health professional in which case a screening instrument is used to identify those using substances at hazardous levels (for example, the Rutgers Alcohol Problem Index (RAPI), which includes questions designed to assess consequences of problems, such as hangovers, cognitive impairment, and interpersonal conflict).[xxxvi] However because hazardous drinkers are often reluctant to discuss their drinking with a doctor or other practitioner, online self-assessment followed by brief intervention in the form of personalized feedback about one’s drinking has been found to be a popular intervention strategy among younger people.

There is some indication that targeted programming using these formats may be more effective for higher-risk adolescents than universal programs, but the evidence base is small because few programs have been rigorously evaluated. The meta-analysis by Gottfredson and Wilson (2003) found that cognitive-behaviourally oriented programs were more effective for higher-risk youth than others, but they called for more study in this area before drawing firm conclusions. In their review of brief interventions for adolescents, Tait and Hulse (2003) found that brief interventions directed to adolescents were effective across a diverse range of settings (dental clinics, schools, universities, substance treatment centres) and, therefore, probably diverse clients. Most of the interventions reviewed drew on motivational principles; those focusing on alcohol had a small effect, and those addressing tobacco had no effect, while the effect for the few concerned with multiple substances appeared substantial, but the sample was too small to generalize broadly.

Although the size of the effect for these interventions tends to be modest, it needs to be weighed against the amount of contact time involved.[xxxvii] In a review and discussion of school-based brief interventions, Winters and colleagues (2007) did not identify any actually set in schools; they found 3 studies of brief interventions for adolescents based in other settings, all of which showed modest results.[xxxviii]
At the post-secondary level, brief interventions (including online versions) have been found effective in reducing alcohol-related harms, and may have application in senior high school settings. One example is the Brief Alcohol Screening in College Students (BASICS) program which has been found effective in reducing binge and excessive drinking in college students in several long-term follow-up studies. BASICS consists of two one-on-one interviews designed to promote reduced alcohol consumption or abstinence among high-risk drinkers. The format consists of personalised feedback, including descriptive graphs presenting the person’s own drinking patterns in relation to normative trends, negative consequences of drinking, and related attitudes and beliefs. An attempt is made to resolve ambivalence about changing one’s drinking behaviour and to move toward a safer drinking plan.[xxxix]

A promising example of a brief intervention for alcohol problems in the secondary school setting has been rigorously tested in this country. Conrod, Stewart, Comeau and MacLean conducted a randomized controlled trial of the effect of a brief intervention targeting one of three personality profiles: anxiety sensitivity (AS), hopelessness (H), and sensation seeking (SS) in high schools in urban British Columbia and rural Nova Scotia.[xl] [xli] Students were randomly assigned to the appropriate personality intervention or to a no-treatment control group at each site and then reassessed 4 months later. All participating students had consumed alcohol in the previous 4 months; they were viewed as not yet having demonstrated significant drinking problems but at risk for doing so based on their personalities. Interventions were delivered by therapists and research assistants and consisted of two 90-minute sessions spread across 2 weeks; the number of students per group ranged from 2 to 7.

Each intervention incorporated principles from the motivational and cognitive–behavioural literatures. The three main components of the interventions were (a) psycho-education, (b) behavioural coping skills training, and (c) cognitive coping skills training. The interventions began with the psycho-educational component – girls and boys were educated about the personality variable in question and the problematic coping behaviours associated with that personality style. Students were encouraged to discuss the short-term reinforcing properties of a variety of problematic coping strategies (including alcohol use) to help them understand their specific motivations for engaging in problematic and risky behaviours. This was followed by a motivational intervention (weighing the short- and long-term positive and negative consequences of a particular behaviour) around the use of problematic behavioural strategies for coping with that particular personality dimension. Next, cognitive coping skills training helped students learn how to identify and challenge cognitive distortions specific to each personality, using stories and exercises from students’ lives.
These brief interventions led to significantly better outcomes compared to the control group students as measured by rates of abstinence, reduced drinking quantity, binge drinking rates, and alcohol problems. Interestingly, the intervention appeared to have effects on aspect of drinking behaviour particularly linked to each of the personality types. For example, the sensation-seeking group was more likely to engage in binge drinking than the other two personality groups, and the intervention appeared to have more impact on this drinking variable for the sensation-seeking group than the other two groups. The outcomes for this three-hour intervention were quite promising at four months and demonstrate the potential of a well targeted intervention, but it will be important to determine whether the effects are maintained over a longer period, and to replicate findings.

It will also be interesting to learn whether a sustainable delivery format can be found, given that this trial was conducted by specifically trained therapists. A bi-cultural competence approach has also been shown to be effective within a brief intervention program for Aboriginal youth which similarly targets personality and motivational factors.[xlii] Recent community collaboration led to the development and testing of a culturally relevant brief intervention program for First Nation youth in Nova Scotia designed to address the issue of alcohol abuse and prevention of alcohol problems among Mi’maq adolescents. The pilot results were positive in that compared to pre-intervention, students who participated in the intervention drank less, engaged in less binge-drinking episodes, had fewer alcohol-related problems, were more likely to abstain from alcohol use, and reduced their marijuana use at four-months post-intervention. No such significant changes were observed in a non-random group of eligible students who did not participate in the intervention. Future research should determine if the methodology for development of a similar intervention is effective for at-risk youth in other Aboriginal communities across Canada, and whether the promising, but preliminary results with marijuana mean that the benefits of the intervention might extend to adolescents’ use of substances other than alcohol. This 2 x 90 minute program was delivered in a sustainable format through the training of local First Nation school guidance counsellors and police officers as co-facilitators.[xliii]

Best advice 11:
with at-risk students (including Aboriginal students), consider school-based brief interventions (fewer than 4 sessions); these interventions, when guided by principles of recognition, respect, sharing, and responsibility, have been found to promote abstinence and reduced hazardous drinking and alcohol problems.

[i] McGrath, Y., Sumnall, H., McVeigh, J., & Bellis, M. (2006). Drug use prevention among young people: A review of reviews [Evidence briefing update]. Retrieved September 30, 2007, from http://www.nice.org.uk/niceMedia/docs/drug_use_prev_update_v9.pdf
[ii] Gottfredson, D.C., & Wilson, D.B. (2003). Characteristics of effective school-based substance abuse prevention. Prevention Science, 4(1), 27-38.
[iii] Spooner, C., & Heatherington, K. (2004). Social determinants of drug use [Tech. Rep. No. 228]. Retrieved September 30, 2007, from http://ndarc.med.unsw.edu.au/ndarcweb.nsf/website/Publications.reports.TR228
[iv] Toumbourou, J.W., Rowland, B., Jefferies, A., Butler, H., & Bond, L. (2004). Preventing drug-related harm through school re-organisation and behavior management [Prevention research evaluation report No. 12]. Melbourne, Australia: Australia Drug Foundation. Retrieved September 30, 2007, from http://www.druginfo.adf.org.au/downloads/Prevention_Research_Quarterly/PRQ_04Nov_Early_intervention_in_schools.pdf
[v] ibid
[vi] Gottfredson, D.C., & Wilson, D.B. (2003). Characteristics of effective school-based substance abuse prevention. Prevention Science, 4(1), 27-38.
[vii] Toumbourou, J.W., Stockwell, T., Neighbors, C., Marlatt, G.A., Sturge, J., & Rehm, J. (2007). Interventions to reduce harm associated with adolescent substance use: An international review. Lancet, 369, 1391-1401.
[viii] Webster-Stratton, C., & Taylor, T. (2001). Nipping early risk factors in the bud: Preventing substance abuse, delinquency, and violence in adolescence through interventions targeted at young children (0–8 Years). Prevention Science, 2(3).
[ix] Toumbourou, J.W., Stockwell, T., Neighbors, C., Marlatt, G.A., Sturge, J., & Rehm, J. (2007). Interventions to reduce harm associated with adolescent substance use: An international review. Lancet, 369, 1391-1401.
[x] Webster-Stratton, C., & Taylor, T. (2001). Nipping early risk factors in the bud: Preventing substance abuse, delinquency, and violence in adolescence through interventions targeted at young children (0–8 Years). Prevention Science, 2(3).
[xi] Foley, D., Goldfeld, S., McLoughlin, J., Nagorcka, J., Oberklaid, F., & Wake, M. (2000). A review of the early childhood literature. Retrieved September 30, 2007, from http://www.facs.gov.au/internet/facsinternet.nsf/vIA/families/$file/early_childhood.pdf
[xii] Schweinhart, L.J. (2004). The High/Scope Perry Preschool study through age 40. Summary, conclusions, and frequently asked questions. Retrieved September 30, 2007, from http://www.highscope.org/file/Research/PerryProject/3_specialsummary%20col%2006%2007.pdf
[xiii] Webster-Stratton, C., & Taylor, T. (2001). Nipping early risk factors in the bud: Preventing substance abuse, delinquency, and violence in adolescence through interventions targeted at young children (0–8 Years). Prevention Science, 2(3).
[xiv] Conduct Problems Prevention Research Group. (2004). The Effects of the Fast Track Program on Serious Problem Outcomes at the End of Elementary School. Journal of Clinical Child and Adolescent Psychology, 33(4), 650-661.
[xv] Foster, E.M., & Jones, D. (2006). Can a costly intervention be cost-effective?: An analysis of violence prevention [Abstract]. Archives of General Psychiatry, 63(11), 1284-1291.
[xvi] Kumpfer, K.L., Alvarado, R., & Whiteside, H.O. (2003). Family-based interventions for substance use and misuse prevention. Substance Use and Misuse, 38(11-13), 1759-1787.
[xvii] Roe, S., & Becker, J. (2005). Drug prevention with vulnerable young people: A review. Drugs: education, prevention and policy, 12(2), 85-99.
[xviii] Kumpfer, K.L., Alvarado, R., & Whiteside, H.O. (2003). Family-based interventions for substance use and misuse prevention. Substance Use and Misuse, 38(11-13), 1759-1787.
[xix] ibid
[xx] Dewit, D. (n/d). Strengthening Families for the Future. Executive Summary of Outcome Evaluation.
[xxi] Webster-Stratton, C., & Taylor, T. (2001). Nipping early risk factors in the bud: Preventing substance abuse, delinquency, and violence in adolescence through interventions targeted at young children (0–8 Years). Prevention Science, 2(3).
[xxii] ibid
[xxiii] Roe, S., & Becker, J. (2005). Drug prevention with vulnerable young people: A review. Drugs: education, prevention and policy, 12(2), 85-99.
[xxiv] DeWit, D.J., Steep, B., Silverman, G., Stevens-Lavigne, A., Ellis, K., & Smythe, C. (2000). Evaluating an in-school drug prevention program for at-risk youth. The Alberta Journal of Education Research, 2, 117-133.
[xxv] Eggert, L.L., Thompson, E.A., Herting, J.R., Nicholas, L.J., & Dicker, B.G. (1994). Preventing adolescent drug abuse and high school dropout through an intensive school-based social network development program. American Journal of Health Promotion, 8(3), 202-215.
[xxvi] Cho, H., Hallfors, D.D., & Sanchez, V. (2005). Evaluation of a high school peer group intervention for at-risk youth. Journal of Abnormal Child Psychology, 33(3), 363–374.
[xxvii] Stewart, S.H., Conrod, P.J., Allan, G., Marlatt, M., Comeau, N., Thush, C., & Krank, M. (2005). New developments in prevention and early intervention for alcohol abuse in youths. Alcoholism: Clinical and Experimental Research, 29(2).
[xxviii] Mushquash, C.J., Comeau, M.N., & Stewart, S.H. (2007). An alcohol abuse early intervention for First Nations adolescents. The First Peoples Child and Family Review, 3, 17-26.
[xxix] Hawkins, E., Cummins, L.H., & Marlatt, G. (2004). Preventing substance abuse in American Indian and Alaska native youth: Promising strategies for healthier communities. Psychological Bulletin, 130, 304–323.
[xxx] McGrath, Y., Sumnall, H., McVeigh, J., & Bellis, M. (2006). Drug use prevention among young people: A review of reviews [Evidence briefing update]. Retrieved September 30, 2007, from http://www.nice.org.uk/niceMedia/docs/drug_use_prev_update_v9.pdf
[xxxi] Foxcroft, D., Ireland, D.J., Lister-Sharp, D., Lowe, G., & Breen, R. (2003). Longer-term primary prevention for alcohol misuse in young people: A systematic review. Addiction, 98, 397-411.
[xxxii] Toumbourou, J.W., Stockwell, T., Neighbors, C., Marlatt, G.A., Sturge, J., Rehm, J. (2007). Interventions to reduce harm associated with adolescent substance use: An international review. Lancet, 369, 1391-1401.
[xxxiii] Wilson, D.B., Gottfredson, D.C., & Najaka, S.S. (2001). School-based prevention of problem behaviors: A meta-analysis. Journal of Quantitative Criminology, 17(3).
[xxxiv] Vasilaki, E.I., Hosier, S.G., & Cox, W.M. (2006). The efficacy of motivational interviewing as a brief intervention for excessive drinking: A meta-analytic review. Alcohol and Alcoholism, 41(3), 328-35.
[xxxv] Miller, W.R., & Rollnick, S. (2002). Motivational interviewing: Preparing people for change [2nd ed.]. New York: Guilford Press.
[xxxvi] Toumbourou, J.W., Stockwell, T., Neighbors, C., Marlatt, G.A., Sturge, J., & Rehm, J. (2007). Interventions to reduce harm associated with adolescent substance use: An international review. Lancet, 369, 1391-1401.
[xxxvii] Tait, R.J., & Hulse, G.K. (2003). A systematic review of the effectiveness of brief interventions with substance using adolescents by type of drug. Drug and Alcohol Review, 22, 337-346 (Abstract).
[xxxviii] Winters, K.C., Leitten, W., Wagner, E., O'Leary Tevyaw, T. (2007). Use of brief interventions for drug abusing teenagers within a middle and high school setting. The Journal of School Health, 77(4).
[xxxix] Baer, J.S., Kivlahan, D.R., Blume, A.W., McKnight, P., & Marlatt, G.A. (2001). Brief intervention for heavy-drinking college students: 4-year follow-up and natural history. American Journal of Public Health, 91(8), 1310–1316.
[xl] Comeau, N., Stewart, S.H., & Loba, P. (2001). The relations of trait anxiety, anxiety sensitivity, and sensation seeking to adolescents' motivations for alcohol, cigarette, and marijuana use. Addictive Behaviors, 26, 803-825.
[xli] Conrod, P., Stewart, S., Comeau, N., & Maclean, A.M. (2006). Efficacy of cognitive–behavioral interventions targeting personality risk factors for youth alcohol misuse. Journal of Clinical Child and Adolescent Psychology, 35(4), 550-563.
[xlii] Mushquash, C.J., Comeau, M.N., & Stewart, S.H. (2007). An alcohol abuse early intervention for First Nations adolescents. The First Peoples Child and Family Review, 3, 17-26.
[xliii] ibid


Examples of Brief or Early Intervention Programs

Drugs and Alcohol Podcast
(Identified by Health Promoting Schools, National Health Service, Scotland)
The Drugs and Alcohol Podcast has been produced to help provide young people with advice and information as they move into adulthood. It is one of a series on the Independent Living Podcast website with others on the themes of careers and housing. The Drugs and Alcohol Podcast takes the form of an interview with workers from the Clued Up drugs awareness project based in Kirkcaldy, Fife, and contains useful information about the dangers, causes and effects of drugs and alcohol. It also outlines other issues including sexual health, mental health, homelessness, self-esteem and confidence, and peer pressure, and their relationship with alcohol and drugs. The podcast is suitable for upper primary and secondary pupils.

Screening, Brief Intervention, Referral, and Treatment (SBIRT)
(Published by SAMHSA, United States)
SBIRT is a comprehensive, integrated, public health approach to the delivery of early intervention and treatment services for persons with or at risk for substance use disorders.

The workplace as a setting for addressing adolescent risky drinking
. DrugInfo, February (3)3, p. 5
The results of this Australian evaluation of brief interventions in youth-oriented workplaces is that even a two-hour intervention can have a significant impact.


CARE (Care, Assess, Respond, Empower) (Identified by SAMHSA, United States)
CARE (Care, Assess, Respond, Empower)--formerly called Counselors CARE (C-CARE) and Measure of Adolescent Potential for Suicide (MAPS)--is a high school-based suicide prevention program targeting high-risk youth. CARE includes a 2-hour, one-on-one computer-assisted suicide assessment interview followed by a 2-hour motivational counseling and social support intervention.

StopAlcoholAbuse.Gov
(Published by federal government, United States)
StopAlcoholAbuse.Gov is a comprehensive portal of Federal resources for information on underage drinking and ideas for combating this issue. People interested in underage drinking prevention—including parents, educators, community-based organizations, and youth—will find a wealth of valuable information here.

Teen Intervene
(Reviewed by SAMHSA, United States, August 2007)
Teen Intervene is an early intervention program targeting 12- to 19-year-olds who display the early stages of alcohol or drug use problems (e.g., using or possessing drugs during school) but do not use these substances daily or demonstrate substance dependence. Integrating stages of change theory, motivational enhancement, and cognitive-behavioral therapy, this intervention aims to help teens reduce and ultimately eliminate their alcohol and other drug use. The program is administered in a school setting by a trained professional in two or three 1-hour sessions conducted 10 days apart. During session 1, an individual session with the adolescent, the therapist elicits information about the adolescent's substance use and related consequences, examines the benefits and costs of behavior change, and helps the adolescent set goals. In session 2, the therapist assesses the adolescent's progress, discusses strategies for overcoming barriers, and negotiates the adolescent's continued work toward meeting goals. Session 3, an optional individual counseling session with the teenager's parent (or guardian), addresses the adolescent's substance use and the need for the parent to demonstrate healthy attitudes and behaviors related to substance use and to monitor and supervise the adolescent. This session also includes a brief wrap-up conversation with both the parent and the adolescent.


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