A Cochrane review explored the evidence for brief interventions undertaken in schools to reduce substance misuse and other problematic behavioural outcomes for adolescents who use substances
Citation: Perng SJ (2015) Interventions to tackle substance use in schools. Nursing Times ; 111: 10, 23.
Author: Shoa-Jen Perng is associate professor and dean at the Department of Nursing, Tzu Chi College of Technology, Hualien City, Taiwan.
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Substance use among adolescents can lead to increases in medical costs and mortality rates, as well as social insecurity issues among young people. Research on the development and evaluation of early interventions to prevent licit and illicit drug use among adolescents is substantial.
Brief interventions are time-limited substance use prevention services that are delivered to those considered to be part of the high-risk population. In recent years the use of BIs has been expanded to schools from healthcare and substance misuse treatment settings. Most brief interventions rely on the principles of motivational interviewing; nurses should be capable of building therapeutic relationships with adolescents and applying motivational interviewing techniques to assess their stage of readiness to change behaviours, and move them to action.
Cochrane review question
What are the effects of brief school-based interventions on reducing substance use and other behavioural outcomes among adolescents compared with alternative interventions or assessment only?
The review evaluated six randomised controlled trials of brief school-based interventions compared with information provision (three studies, n = 732 participants) and assessment only (three studies, n = 407 participants). Overall, the quality of the evidence was moderate in the information-provision comparison, and low or very low in the assessment-only comparison (Carney et al, 2014).
The primary outcomes in this review were reduction or cessation of substance use, including:
- General substance use (alcohol and drug use);
- Alcohol frequency and quantity;
- Cannabis use frequency;
- Quantity and tobacco use frequency.
The secondary outcomes were engagement in criminal activity and in delinquent or problem behaviours related to substance use. Because of statistically significant heterogeneity between the studies, pooling of results was difficult for some outcomes.
Summary of key evidence
The findings of this review and a meta-analysis revealed that, compared with the assessment-only control, brief interventions reduced cannabis frequency across three studies. The effects of brief interventions in studies of individual interventions were generally significant for all substance use outcomes, except for alcohol quantity and tobacco frequency. The results of two studies measuring behavioural outcomes related to delinquent or criminal behaviours were not pooled because of heterogeneity issues, and the effects of brief interventions on outcomes were controversial between studies.
When comparing brief interventions with the information-only control, meta-analyses showed that brief interventions had no effect on reducing any substance use, alcohol use frequency, alcohol quantity, cannabis dependence, cannabis use frequency or behavioural outcomes. Also, two studies of individual interventions showed there were no significant effects of brief interventions on tobacco frequency and cannabis quantity.
The quality of the studies included in this review was generally relatively low, making the development of recommendations for best practice difficult. This review suggests that studies of brief school-based interventions show mixed evidence for reducing adolescent substance use and other problem behaviours. Some evidence indicated that brief interventions were effective at reducing adolescent substance use, particularly cannabis, when compared with assessment only. There was limited quality evidence that brief school-based interventions were more effective at reducing substance use than assessment only but similar to information provision.
More high-quality studies conducted in a variety of countries are needed to examine the effectiveness of brief school-based interventions targeting substance use among adolescents.
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Carney T et al (2014) Brief school-based interventions and behavioural outcomes for substance-using adolescents. Cochrane Database of Systematic Reviews; Issue 2. Art No: CD008969. DOI: 10.1002/14651858.CD008969.pub2