Brief school-based interventions and behavioural outcomes for substance-using adolescents
Tara Carney1, Bronwyn J Myers2,3,Johann Louw4, Charles I Okwundu5,6
1. South African Medical Research Council, Alcohol, Tobacco and Other Drug Research Unit, Cape Town, Western Cape, South Africa
2. South African Medical Research Council, Alcohol Tobacco and Other Drug Research Unit, Cape Town, Western Cape, South Africa
3. University of Cape Town, Department of Psychiatry and Mental Health, Cape Town, South Africa
4. University of Cape Town, Department of Psychology, Cape Town, Western Cape, South Africa
5. Stellenbosch University, Centre for Evidence-based Health Care, Faculty of Medicine and Health Sciences, Cape Town, South Africa
6. South African Medical Research Council, South African Cochrane Centre, Tygerberg, Western Cape, South Africa
Carney T, Myers BJ, Louw J, Okwundu CI. Brief school-based interventions and behavioural outcomes for substance-using adolescents. Cochrane Database of Systematic Reviews 2016, Issue 1. Art. No.: CD008969. DOI: 10.1002/14651858.CD008969.pub3
Access the full-text article here: 10.1002/14651858.CD008969.pub3
Can brief interventions delivered in schools reduce substance use among adolescents?
We reviewed evidence on the effects of brief school-based interventions for substance use and substance-related problem behaviours among adolescents. We found six studies.
Adolescents worldwide are known to use both legal and illegal substances, which can lead to other problems. These high rates of substance use are concerning, as early initiation of substance use is a risk factor for substance use disorders in later life, and alcohol and illegal drugs have been associated with years lost due to disability among youth aged 10 to 24 years.
We wanted to learn whether brief school-based interventions had an effect on substance misuse in adolescents. Brief interventions are short programmes that aim to help reduce or stop substance use. This review updates a previous review published in 2014.
The evidence is current to February 2015.
We included six studies in this review, with 1176 adolescents overall. The mean age of adolescents was 16.9 years. We were interested in studies with short-, medium-, and long-term follow-up periods to assess whether any effects were due to the brief intervention. The studies compared brief intervention programmes with two major kinds of comparison or control groups: 1) an information provision only (general health promotion materials and harm reduction information) group and 2) an assessment-only group, where adolescents received no intervention but were evaluated on substance use and other behaviour at follow-up appointments at different time periods following delivery of the intervention. Three studies with 732 adolescents compared brief interventions with information provision only, while the other three, with 444 adolescents, compared brief interventions with assessment only.
Trials were either conducted in the United States or the United Kingdom.
Delivery of the interventions was individual or group face-to-face feedback across high schools and further education colleges. All interventions were up to four sessions in length.
Our primary outcome was abstinence or reduction of substance use behaviour, and our secondary outcomes were engagement in criminal activity related to substance use and engagement in delinquent-type behaviours related to substance use.
For outcomes that concern substance use, the studies assessed use of alcohol and cannabis. When compared to information provision, brief interventions are probably not more efficacious in reducing substance use or delinquent behaviour. When compared to assessment-only controls, the interventions may have some significant effects on substance use and behaviours. At short-term follow-up, brief interventions significantly reduced cannabis frequency in one study. At medium-term follow-up, brief interventions significantly reduced frequency of alcohol use, alcohol abuse and dependence symptoms, and cannabis abuse symptoms in one study. At long-term follow-up, brief interventions significantly reduced alcohol abuse, cannabis frequency, and cannabis abuse and dependence symptoms in one study.
The pattern of results indicates that adolescents who received a brief intervention generally did better in reducing their alcohol and cannabis use than adolescents who received no intervention at all. However, adolescents who received a brief intervention did not seem to do better in reducing their alcohol and cannabis use than adolescents who received information-only interventions. It is therefore premature to make definitive statements about the effectiveness of brief school-based interventions for reducing adolescent substance use.
Quality of evidence
Overall, the evidence was of moderate or low quality, with two outcomes found to have very low quality of evidence. There were three major issues across the studies: 1) there was no blinding of adolescents, 2) there was uncertainty as to whether participant allocation to study groups was concealed, and 3) a small total number of adolescents and number of events. None of the included studies reported information about funding source or conflicts of interest.