Teenagers Who Report More Negative Consequences Benefit Most From Substance-Use Intervention

By Will Boggs MD

July 15, 2019

NEW YORK (Reuters Health) - Teenagers who report more negative consequences from alcohol or marijuana use benefit most from a brief primary-care substance-use intervention, researchers report.

"Our previous work has shown that teens who report any alcohol use benefit from a brief substance-use intervention, as they report reduced consequences from both alcohol and marijuana one year later; thus, providers should screen for use, and if teens report any use, provide a brief intervention," said Dr. Elizabeth J. D'Amico from RAND Corporation, in Santa Monica, California.

"This study highlights that when teens report experiencing problems from their alcohol or marijuana use, it is even more crucial to provide brief intervention," she told Reuters Health by email.

Increasing evidence supports the efficacy of screening and brief interventions for substance use, but these interventions infrequently occur in primary care.

In a secondary analysis of their earlier randomized controlled trial, Dr. D'Amico's team sought to determine which teens might benefit the most from brief primary-care interventions in the long-term by examining demographic and alcohol- and marijuana-related baseline moderators of 12-month alcohol and marijuana outcomes.

Based on a sample of 294 participants, among adolescents who reported more alcohol consequences at baseline, those who received CHAT (a 15- to 20-minute intervention using motivational interviewing) reported significantly less alcohol use, less heavy alcohol use and fewer negative consequences of alcohol at 12 months, compared with similar teens in usual care.

Similarly, teens who reported more marijuana consequences at baseline and received CHAT reported less marijuana use one year later, compared with similar teens in usual care, the researchers report in Pediatrics, online July 11.

In contrast, teens in CHAT who reported fewer marijuana consequences at baseline reported more marijuana use one year later, compared with similar teams in usual care.

At 12 months, male participants in CHAT reported fewer marijuana consequences than male participants in usual care, whereas female participants in usual care reported fewer marijuana consequences than female participants in CHAT.

African-American adolescents assigned to CHAT reported fewer marijuana consequences at 12 months than did African-American teens in usual care, but white adolescents assigned to usual care reported fewer marijuana consequences than white youth assigned to CHAT.

"The marijuana findings are the most interesting because it shows that we have to think about how we talk to teens about this drug depending upon whether they are experiencing problems from use," Dr. D'Amico said. "For those teens who are experiencing problems, discussing the pros and cons of use and how to change behavior if they are ready is an effective approach."

"For those teens who use marijuana and report few problems, and therefore may not be as willing to change their behavior, providers should focus more on helping them think about ways to recognize when their marijuana use may become problematic, and encourage coping strategies in situations where they may be more likely to use more marijuana," she said.

"It's very important to screen for alcohol and marijuana use in the primary-care setting and provide brief intervention as needed," Dr. D'Amico said. "Approximately one out of every five teens will report some substance use, and a brief intervention can help reduce problematic substance use during this important developmental period. Teens who report less alcohol and marijuana use tend to do better academically and report better mental and physical health during high school and emerging young adulthood."

"There is often little time for physicians to intervene on substance use with teens in primary care; however, there are ways to integrate screening and brief intervention into the primary-care appointment by utilizing resources within that setting," she said. "Given the brevity of CHAT, it can seamlessly fit into a primary-care appointment, and our work has shown that it can be learned by people with varying educational backgrounds, making uptake feasible for different types of providers (e.g., nurses, social workers, residents, physician assistants)."

SOURCE: https://bit.ly/30uNUmi

Pediatrics 2019.