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Computer and therapist based brief interventions among cannabis-using adolescents presenting to primary care: one year outcomes.

ABSTRACT: This paper describes outcomes from a randomized controlled trial examining the efficacy of brief interventions delivered by a computer (CBI) or therapist (TBI) among adolescents in urban primary care clinics.Patients (ages 12-18) self-administered a computer survey. Adolescents reporting past year cannabis use completed a baseline survey and were randomized to control, CBI or TBI, with primary (cannabis use, cannabis related consequences - CC) and secondary outcomes [alcohol use, other drug use (illicit and non-medical prescription drugs), and driving under the influence of cannabis (DUI)] assessed at 3, 6, and 12 months.1416 adolescents were surveyed; 328 reported past year cannabis use and were randomized. Comparisons of the CBI relative to control showed that at 3 months the group by time interaction (G × T) was significant for other drug use and CC, but not for cannabis use, alcohol use, or DUI; at 6 months, the G × T interaction was significant for other drug use but not for cannabis use, alcohol use, or CC. For analyses comparing the TBI to control, at 3 months the G×T interaction was significant for DUI, but not significant for cannabis use, alcohol use, or CC; at 6 months, the G×T interaction was not significant for any variable. No significant intervention effects were observed at 12 months.Among adolescent cannabis users presenting to primary care, a CBI decreased cannabis related problems and other drug use and a TBI decreased cannabis DUI in the short-term. Additional boosters may be necessary to enhance these reductions over time.

SUBMITTER: Walton MA

PROVIDER: S-EPMC3770780 | biostudies-literature | 2013 Oct

REPOSITORIES: biostudies-literature

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Computer and therapist based brief interventions among cannabis-using adolescents presenting to primary care: one year outcomes.

Walton Maureen A MA Bohnert Kipling K Resko Stella S Barry Kristen L KL Chermack Stephen T ST Zucker Robert A RA Zimmerman Marc A MA Booth Brenda M BM Blow Frederic C FC

Drug and alcohol dependence 20130525 3

<h4>Aims</h4>This paper describes outcomes from a randomized controlled trial examining the efficacy of brief interventions delivered by a computer (CBI) or therapist (TBI) among adolescents in urban primary care clinics.<h4>Methods</h4>Patients (ages 12-18) self-administered a computer survey. Adolescents reporting past year cannabis use completed a baseline survey and were randomized to control, CBI or TBI, with primary (cannabis use, cannabis related consequences - CC) and secondary outcomes ...[more]

PMID: 23711998

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Project description:Background and aimsDespite their high comorbidity, the effects of brief interventions (BI) to reduce cannabis use, alcohol use and anxiety symptoms have received little empirical attention. The aims of this study were to examine whether a therapist-delivered BI (TBI) or computer-guided BI (CBI) to address drug use, alcohol consumption (when relevant) and HIV risk behaviors, relative to enhanced usual care (EUC), was associated with reductions in parallel trajectories of alcohol use, cannabis use and anxiety symptoms, and whether demographic characteristics moderated reductions over time.DesignLatent growth curve modeling was used to examine joint trajectories of alcohol use, cannabis use and anxiety symptoms assessed at 3, 6 and 12 months after baseline enrollment.SettingHurley Medical Center Emergency Department (ED) in Flint, MI, USA.ParticipantsThe sample was 780 drug-using adults (aged 18-60 years; 44% male; 52% black) randomly assigned to receive either a TBI, CBI or EUC through the HealthiER You study.Interventions and comparatorED-delivered TBI and CBIs involved touchscreen-delivered and audio-assisted content. The TBI was administered by a Master's-level therapist, whereas the CBI was self-administered using a virtual health counselor. EUC included a review of health resources brochures in the ED.MeasurementsAssessments of alcohol use (10-item Alcohol Use Disorders Identification Test), cannabis use (past 30-day frequency) and anxiety symptoms (Brief Symptom Inventory-18) occurred at baseline and 3-, 6- and 12-month follow-up.FindingsTBI, relative to EUC, was associated with significant reductions in cannabis use [B = -0.49, standard error (SE) = 0.20, P < 0.05) and anxiety (B = -0.04, SE = 0.02, P < 0.05), but no main effect for alcohol use. Two of 18 moderation tests were significant: TBI significantly reduced alcohol use among males (B = -0.60, SE = 0.19, P < 0.01) and patients aged 18-25 years in the TBI condition showed significantly greater reductions in cannabis use relative to older patients (B = -0.78, SE = 0.31, P < 0.05). Results for CBI were non-significant.ConclusionsEmergency department-based therapist-delivered brief interventions to address drug use, alcohol consumption (when relevant) and HIV risk behaviors may also reduce alcohol use, cannabis use and anxiety over time, accounting for the overlap of these processes.

Project description:Rates of cannabis use are highest during emerging adulthood (age 18-25), with the prevalence of near daily and daily increasing among this age group. Emerging adults are clinically challenging in terms of harmful cannabis use due to perceptions of high rates of peer use, social acceptance, and low risk of harm. Brief interventions to increase awareness and promote motivation to change are therefore particularly important for this age group. There is existing evidence on the effectiveness of brief interventions for alcohol in emerging adults, but it is not clear if comparable evidence is present for cannabis. The objective of this systematic review is to summarize and critically appraise the existing literature of brief interventions for cannabis use both narratively, to describe the content and delivery of existing interventions, and meta-analytically, to determine the aggregated efficacy of these interventions on cannabis use and other outcomes (e.g., other substance use, mental health, help-seeking behaviors, and academic and occupational outcomes).A systematic search of randomized controlled trials, quasi-experimental trials, and pre-post designs will be conducted in the following electronic databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Allied and Complementary Medicine, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO. Ongoing trials will be identified using the World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov , and Current Controlled Trials. Unpublished trials will be identified using Proquest Dissertations, OpenGrey, Google Scholar, and brief interventions on the Substance Abuse and Mental Health Services Administration webpage. Two authors will independently screen and extract data from articles using a predetermined screening and extraction forms (which will include risk of bias assessments). Calibration exercises will be performed prior to full screening and extraction. Disagreements will be resolved through discussion or consultation with a third reviewer. All studies will be reported narratively, and if appropriate, we will perform random effects meta-analyses with subgroup analyses and meta-regression.Results of this review are expected to provide guidance on the content, delivery methods, and effectiveness of brief interventions for cannabis use to assist post-secondary institutions in identifying brief intervention strategies to implement prior to or in response to legalization.CRD42018085412.

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Computer and therapist based brief interventions among cannabis-using adolescents presenting to primary care: one year outcomes.

Publications

Computer and therapist based brief interventions among cannabis-using adolescents presenting to primary care: one year outcomes.

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