Single vs. multiple drug prevention: is more always better?: a pilot study. School-based alcohol education: results of a cluster-randomized controlled trial. A computerized harm minimization prevention program for alcohol misuse and related harms: randomized controlled trial. Reducing the risks of alcohol use among urban youth: three-year effects of a computer-based intervention with and without parent involvement. Combining in-school and community-based media efforts: reducing marijuana and alcohol uptake among younger adolescents. Brief intervention for heavy-drinking college students: 4-year follow-up and natural history. Project Northland: outcomes of a communitywide alcohol use prevention program during early adolescence. Preventing heavy alcohol use in adolescents (PAS): cluster randomized trial of a parent and student intervention offered separately and simultaneously. Brief group alcohol interventions with college students: examining motivational components. Preventing adolescent drug abuse through a multimodal cognitive-behavioral approach: results of a 3-year study. Longitudinal substance initiation outcomes for a universal preventive intervention combining family and school programs. [Multicenter study on the efficacy of advice for the prevention of alcoholism in primary health care]. [Effectiveness of brief medical counseling to reduce drinkers' alcohol consumption]. A pediatric, practice-based, randomized trial of drinking and smoking prevention and bicycle helmet, gun, and seatbelt safety promotion. Effectiveness of brief intervention on non-dependent alcohol drinkers (EBIAL): a Spanish multi-centre study. A multihealth behavior intervention integrating physical activity and substance use prevention for adolescents. A cross-national trial of brief interventions with heavy drinkers. WHO Brief Intervention Study Group. Two brief alcohol interventions for mandated college students.
The purpose of this study was to compare the effects of a single drug, i.e., alcohol, against a multiple drug preventive intervention.
                A controlled trial was conducted with 448 8th grade students (mean age = 13 years old) from an inner-city middle school (n = 216) and a rural junior high school (n = 232) in 2000-2001. Students were randomized within school, and 3-month post-intervention follow-up data were collected.
                Two risk/protective factors were found to differ significantly in favor of youth receiving the single drug alcohol intervention (p's = 0.03), while the frequency of alcohol use and two additional risk/protective factors approached significance (p's < 0.10).
                These findings support the potential efficacy of a brief, single drug preventive intervention over a brief, multi-drug intervention in producing short-term alcohol outcomes for adolescents, and indicate differential effects of interventions for subgroups of substance using youth. This study aimed to examine the effects of a school-based alcohol education intervention.
                Two-arm three-wave cluster-randomized controlled trial, with schools as the unit for randomization. Surveys were conducted prior to intervention implementation, then 4 and 12 months after baseline.
                A total of 30 public schools in Schleswig-Holstein, Germany. Participants Baseline data were obtained from 1686 7th graders. The retention rate was 85% over 12 months. Intervention The intervention consisted of four interactive lessons conducted by teachers, booklets for students and booklets for parents.
                Knowledge, attitudes, life-time alcohol consumption (ever use alcohol without parental knowledge, ever been drunk and ever binge drinking) and past-month alcohol use.
                Intention-to-treat analyses revealed that intervention status was associated with more general knowledge about alcohol and lower levels of life-time binge drinking. No effects were found with respect to students' self-reported attitudes, intentions to drink, life-time alcohol use and past-month alcohol use.
                The results indicate that this brief school-based intervention had a small short-term preventive effect on alcohol misuse. Hazardous alcohol use is a leading cause of death among adolescents and young adults world-wide, yet few effective prevention interventions exist. This study was the first to examine a computerized harm minimization intervention to reduce alcohol misuse and related harms in adolescents.
                Cluster randomized controlled trial of a six-session curriculum-integrated harm minimization prevention program. The intervention was delivered by computer in the form of a teenage drama, which provided education through alcohol-related scenarios to which young people could relate.
                Schools in Australia.
                A total of 1466 year 8 students (13 years) from 16 high schools in Australia were allocated randomly to a computerized prevention program (n = 611, eight schools) or usual classes (n = 855, eight schools).
                Change in knowledge, alcohol use, alcohol-related harms and alcohol expectancies.
                A computerized prevention program was more effective than usual classes in increasing alcohol-related knowledge of facts that would inform safer drinking choices and decreasing the positive social expectations which students believed alcohol may afford. For females it was effective in decreasing average alcohol consumption, alcohol-related harms and the frequency of drinking to excess (more than four standard drinks; 10 g ethanol). For males the behavioural effects were not significant.
                A harm minimization approach is effective in educating young people about alcohol-related risks and is effective in reducing risky drinking and harms among girls. Reduction of problems among boys remains a challenge. This study tested a CD-ROM intervention with and without a parent involvement component to reduce risk of alcohol use among an urban sample of early adolescents.
                Youths (N = 514, mean age 11.5 years at recruitment) were assigned randomly by community site to receive the CD-ROM intervention, the CD-ROM plus parent intervention, or no intervention. All youths completed pretest, posttest and three annual follow-up measurements. After pretesting, youths and parents received their respective interventions.
                Main effects of the intervention and for measurement occasion as well as interaction effects of the intervention by measurement occasion were seen for substance use and related outcomes. Over time, youths in all 3 groups reported increased use of alcohol, tobacco and marijuana; youths who received the interventions reported smaller increases than control youths. At 3-year follow-up, alcohol use was lower for CD-ROM plus parent intervention youths than for CD-ROM only youths, who, in turn, reported less use than controls. Cigarette use was lower for youths in either intervention group than in the control group at posttest and at 1-, 2- and 3-year follow-ups. Marijuana use was lower for youths in either intervention than for controls at 1-, 2- and 3-year follow-ups. Youths in both intervention groups outperformed control youths at posttest and at 1- and 3-year follow-ups on levels of negative and peer influence toward substance use. Finally, at the 3-year follow-up, youths in the CD-ROM plus parent intervention group reported more family involvement in their alcohol use prevention efforts than did youths in the CD-ROM group, who, in turn, reported more positive levels of family involvement than youths in the control group.
                Study findings modestly support the CD-ROM intervention with and without the parent intervention to reduce alcohol use risks among urban early adolescents. This study tests the impact of an in-school mediated communication campaign based on social marketing principles, in combination with a participatory, community-based media effort, on marijuana, alcohol and tobacco uptake among middle-school students. Eight media treatment and eight control communities throughout the US were randomly assigned to condition. Within both media treatment and media control communities, one school received a research-based prevention curriculum and one school did not, resulting in a crossed, split-plot design. Four waves of longitudinal data were collected over 2 years in each school and were analyzed using generalized linear mixed models to account for clustering effects. Youth in intervention communities (N = 4,216) showed fewer users at final post-test for marijuana [odds ratio (OR) = 0.50, P = 0.019], alcohol (OR = 0.40, P = 0.009) and cigarettes (OR = 0.49, P = 0.039), one-tailed. Growth trajectory results were significant for marijuana (P = 0.040), marginal for alcohol (P = 0.051) and non-significant for cigarettes (P = 0.114). Results suggest that an appropriately designed in-school and community-based media effort can reduce youth substance uptake. Effectiveness does not depend on the presence of an in-school prevention curriculum. This study examined long-term response to an individual preventive intervention for high-risk college drinkers relative to the natural history of college drinking.
                A single-session, individualized preventive intervention was evaluated within a randomized controlled trial with college freshmen who reported drinking heavily while in high school. An additional group randomly selected from the entire screening pool provided a normative comparison. Participant self-report was assessed annually for 4 years.
                High-risk controls showed secular trends for reduced drinking quantity and negative consequences without changes in drinking frequency. Those receiving the brief preventive intervention reported significant additional reductions, particularly with respect to negative consequences. Categorical individual change analyses show that remission is normative, and they suggest that participants receiving the brief intervention are more likely to improve and less likely to worsen regarding negative drinking consequences.
                Brief individual preventive interventions for high-risk college drinkers can achieve long-term benefits even in the context of maturational trends. Project Northland is an efficacy trial with the goal of preventing or reducing alcohol use among young adolescents by using a multilevel, communitywide approach.
                Conducted in 24 school districts and adjacent communities in northeastern Minnesota since 1991, the intervention targets the class of 1998 (sixth-grade students in 1991) and has been implemented for 3 school years (1991 to 1994). The intervention consists of social-behavioral curricula in schools, peer leadership, parental involvement/education, and communitywide task force activities. Annual surveys of the class of 1998 measure alcohol use, tobacco use, and psychosocial factors.
                At the end of 3 years, students in the intervention school districts report less onset and prevalence of alcohol use than students in the reference districts. The differences were particularly notable among those who were nonusers at baseline.
                The results of Project Northland suggest that multilevel, targeted prevention programs for young adolescents are effective in reducing alcohol use. To evaluate the effectiveness of two preventive interventions to reduce heavy drinking in first- and second-year high school students. Design and
                Cluster randomized controlled trial using four conditions for comparing two active interventions with a control group from 152 classes of 19 high schools in the Netherlands.
                A total of 3490 first-year high school students (mean 12.68 years, SD=0.51) and their parents. Intervention conditions (i) Parent intervention (modelled on the Swedish Örebro Prevention Program) aimed at encouraging parental rule-setting concerning their children's alcohol consumption; (ii) student intervention consisting of four digital lessons based on the principles of the theory of planned behaviour and social cognitive theory; (iii) interventions 1 and 2 combined; and (iv) the regular curriculum as control condition. Main outcome measures Incidence of (heavy) weekly alcohol use and frequency of monthly drinking at 10 and 22 months after baseline measurement.
                  A total of 2937 students were eligible for analyses in this study. At first follow-up, only the combined student-parent intervention showed substantial and statistically significant effects on heavy weekly drinking, weekly drinking and frequency of drinking. At second follow-up these results were replicated, except for the effects of the combined intervention on heavy weekly drinking. These findings were consistent across intention-to-treat and completers-only analyses.
                Results suggest that adolescents as well as their parents should be targeted in order to delay the onset of drinking, preferably prior to onset of weekly drinking.
                © 2009 The Authors. Journal compilation © 2009 Society for the Study of Addiction. The utility of brief interventions with at-risk college drinkers would be enhanced if they could also be delivered in group settings without the need for risk prescreening. The current study therefore explored whether components of brief interventions could be effectively administered to mixed groups of drinking and non-drinking students. Specifically, the outcomes of two methods aimed toward increasing motivation for change were compared to controls. One intervention focused on enhancing actual-ideal drinking behavior discrepancy through a structured group discussion, while the other focused on enhancing self-norm drinking behavior discrepancy through the provision and discussion of didactic information. Among at-risk drinkers, significant reductions in heavy drinking episode frequency at four-week follow-up were found for the self-norm (S-N) group only, while reductions in alcohol problems were obtained in both the S-N and control groups. Results suggest that self-norm discrepancy enhancement strategies may be more effective than actual-ideal discrepancy strategies when used with a mixed drinking group. Students (N = 4,466) attending 56 schools in New York State were involved in a 3-year study testing the effectiveness of a cognitive-behavioral approach to substance abuse prevention. In a randomized block design, schools were assigned to receive (a) the prevention program with formal provider training and implementation feedback, (b) the prevention program with videotaped provider training and no feedback, or (c) no treatment. After pretest equivalence and comparability of conditions with respect to attrition were established, students who received at least 60% of the prevention program (N = 3,684) were included in analyses of program effectiveness. Significant prevention effects were found for cigarette smoking, marijuana use, and immoderate alcohol use. Prevention effects were also found for normative expectations and knowledge concerning substance use, interpersonal skills, and communication skills. This study evaluated the substance initiation effects of an intervention combining family and school-based competency-training intervention components. Thirty-six rural schools were randomly assigned to 1 of 3 conditions: (a) the classroom-based Life Skills Training (LST) and the Strengthening Families Program: For Parents and Children 10-14, (b) LST only, or (c) a control condition. Outcomes were examined 1 year after the intervention posttest, using a substance initiation index (SII) measuring lifetime use of alcohol, cigarettes, and marijuana and by rates of each individual substance. Planned intervention-control contrasts showed significant effects for both the combined and LST-only interventions on the SII and on marijuana initiation. Relative reduction rates for alcohol initiation were 30.0% for the combined intervention and 4.1% for LST only. The aim of this study was to analyse and to verify the efficacy of systematic advice for alcoholism prevention, assessing the reduction of the number in risk drinkers.
                A multicenter randomized controlled clinical trial was designed, to perform in general practitioner setting, on a sample of risk drinkers (alcohol intake > 280 g weekly, without dependence) sent by random in intervention group (systematic brief advice with support material and a five visit program during a year) and control group (once brief advice and a control in 1 year). The procedure to incorporate in both groups included physical exam, a blood test and the MALT questionnaire. A descriptive and analytic study on included variables was realised, assessing the percentage of drinkers who reduced alcohol intake below risk limit at the end of a year follow up, as well as the reduction intake in each group.
                Of the 139 included males, 75 were in the intervention group and 64 in the control group. The percentage of patients not excluded by MALT > 10, and/or liver disease, that finished the 1 year follow up, was 46%, being the sample average age of 43 +/- 11.8. Patients included in both groups were initially comparable. At the end of a year follow up there were statistically significant differences in: percentage of risk drinkers who decreased alcohol intake below 280 g weekly (82% intervention group; 47% control group); percentage of reduction in GPT, GGT, triglycerides, systolic blood pressure and the MALT questionnaire.
                The efficacy of isolated advice of general practitioner was proved to achieve the alcohol intake reduction below the risk limit accepted in male risk drinkers without alcohol dependence. The systematic follow up during a year significantly improves the results achieved with the isolated advice. To evaluate the effectiveness of medical counselling in reducing alcohol consumption in male heavy drinkers.
                A controlled, randomised, simple-blind intervention study.
                Four Primary Care teams in Area 10, Madrid.
                152 men who attended for on-demand treatment from the four teams and whose alcohol consumption was over 21 International Units (IU) a week.
                Brief medical counselling backed up by didactic material. Two questionnaires on alcohol consumption in IU, consumption habits and problems related to alcohol were administered, separated by an interval of between 6 and 18 months. Non-parametric tests for paired samples (McNemar) were applied.
                60% answered the second questionnaire. Neither sociodemographic nor health habit differences were found between those who responded and those who did not, except for social class. There were no appreciable differences between the intervention and control groups. The percentage of drinkers above 35 IU decreased significantly in the intervention group.
                The intervention was clearly effective in reducing the percentage of drinkers whose weekly consumption was over 35 IU. To prevent early adolescent health risk behaviors and to maintain or improve safety behaviors, we compared the effects of 2 interventions, delivered through pediatric primary care practices. The interventions, based on an office systems' approach, sought to prevent early drinking and smoking or to influence bicycle helmet use, gun storage, and seatbelt safety for children who were followed from fifth/sixth grades through eighth/ninth grades.
                Settings and Participants. Twelve pediatric practices in New England were paired according to practice size and assigned randomly within pairs to deliver the multicomponent interventions, which built on pediatric primary care clinicians performing as counselors and role models during health supervision visits and other office encounters.
                One intervention arm focused on alcohol and tobacco use. The other intervention arm focused on gun safety, bicycle helmet, and seatbelt use. Office systems provided infrastructure that supported the clinician's role. Clinician messages encouraged family communication and rule setting about the issues of the middle school years. The intervention was initiated during a health supervision visit and continued for 36 months. Both child and parent received quarterly newsletters to reinforce the clinician messages.
                The primary outcomes were ever drinking alcohol, ever smoking, ever using smokeless tobacco, using a bicycle helmet in the previous year, using a seatbelt in the previous 30 days, and guns in the child's home in locked storage.
                The pediatric practices recruited 85% (N = 3525) of the practices' fifth/sixth grade children and their responding parents. We obtained 36 months' follow-up data on 2183 child-parent pairs. Chart audit verified that the intervention was implemented. Additional data from interviews and surveys showed that parents, children, and pediatric clinicians found the intervention useful. Despite this, comparisons between the 2 study arms show no significant intervention effects in the prevention of alcohol and tobacco use or gun storage or seatbelt safety. There was a negative effect in the alcohol arm. Only bicycle helmet use showed a positive outcome.
                With rigorous evaluation, 2 office interventions failed to produce desired outcomes. Coordinated multiple settings for prevention interventions are probably necessary. The project was designed to compare the effectiveness of brief intervention (BI) versus simple advice (SA) in the secondary prevention of hazardous alcohol consumption.
                A randomized controlled trial with a 12-month follow-up was conducted. A total of 74 community-based primary care practices (328 physicians) located in 13 Spanish autonomous regions were recruited initially. Out of 546 men screened, only 229 were randomized into BI (n = 104) and SA (n = 125); 44.6% of practices finalized the study. The interventions on the BI group consisted of a 15-minute counselling visit carried out by physicians which included: (i) alcohol quantification, (ii) information on safe limits, (iii) advice, (iv) drinking limits agreement, (v) self-informative booklet with drinking diary record and (vi) unscheduled reinforcement visits. The SA group spent 5 minutes which included (i), (ii) and (iii).
                There were no significant differences between both groups at baseline on alcohol use, age, socioeconomic status and CAGE score. After the 12-month follow-up there was a significant decrease in frequency of excessive drinkers (67% of BI group reached targeted consumption, versus 44% of SA; P < 0.001) as well as weekly alcohol intake reduction (BI reached 52 versus 32% in SA; P < 0.001). A trend to improve outcome with the number of reinforcement visits was found with BI. The only predictor of success was the initial alcohol consumption level.
                Brief intervention is more effective than simple advice to reduce alcohol intake on adult men who attend primary care services in Spain. The primary purpose of this study was to test the efficacy of a brief, multi-health behavior intervention integrating physical activity and alcohol use prevention messages for high school-aged adolescents. A total of 604 participants, 335 9th and 269 11th grade students from a suburban high school in northeast Florida participated in this study. A randomized control trial was conducted with participants randomly assigned within grade levels to receive either a brief consultation and prescription with a mailed reinforcing follow-up flyer (Project SPORT) or a minimal intervention control consisting of a wellness brochure provided in school and a pamphlet about teen health and fitness mailed to the home. Differences between intervention groups were evaluated with a series of MANCOVA tests. Project SPORT participants demonstrated significant positive effects at 3-months postintervention for alcohol consumption, alcohol initiation behaviors, alcohol use risk and protective factors, drug use behaviors, and exercise habits, and at 12-months for alcohol use risk and protective factors, cigarette use, and cigarette initiation (p's < 0.05). A post hoc analysis examining interactions between past 30-day use of marijuana and/or cigarettes by treatment group indicates significant positive effects for drug using adolescents who received Project SPORT on alcohol consumption, drug use behaviors, and drug use initiation at 3-months, and for drug use behaviors and exercise habits at 12-months (p's < 0.05). A brief, 12-min one-on-one consultation integrating alcohol avoidance messages within those promoting fitness and other positive health behaviors holds promise for influencing adolescent alcohol and cigarette use and other health behaviors at posttreatment and 1 year later. Long-term sustained effects for cigarette and marijuana use, and both vigorous and moderate physical activity, were found among adolescents using marijuana and/or cigarettes prior to intervention. The relative effects of simple advice and brief counseling were evaluated with heavy drinkers identified in primary care and other health settings in eight countries.
                Subjects (1260 men, 299 women) with no prior history of alcohol dependence were selected if they consumed alcohol with sufficient frequency or intensity to be considered at risk of alcohol-related problems. Subjects were randomly assigned to a control group, a simple advice group, or a group receiving brief counseling. Seventy-five percent of subjects were evaluated 9 months later.
                Male patients exposed to the interventions reported approximately 17% lower average daily alcohol consumption than those in the control group. Reductions in the intensity of drinking were approximately 10%. For women, significant reductions were observed in both the control and the intervention groups. Five minutes of simple advice were as effective as 20 minutes of brief counseling.
                Brief interventions are consistently robust across health care settings and sociocultural groups and can make a significant contribution to the secondary prevention of alcohol-related problems if they are widely used in primary care. Encouraging but limited research indicates that brief motivational interventions may be an effective way to reduce heavy episodic drinking in college students. At 2 campuses, students (83% male) mandated to a substance use prevention program were randomly assigned to 1 of 2 individually administered conditions: (a) a brief motivational interview (BMI; n = 34) or (b) an alcohol education session (AE; n = 30). Students in the BMI condition reported fewer alcohol-related problems than the AE students at 3-and 6-month assessments. Trends toward reductions in number of binge drinking episodes and typical blood alcohol levels were seen in both groups. Process measures confirmed the integrity of both interventions. The findings demonstrate that mandated BMIs can reduce alcohol problems in students referred for alcohol violations.
                ((c) 2005 APA, all rights reserved).
There is some evidence that multi-component interventions for alcohol misuse prevention in young people can be effective. However, there is little evidence that interventions with multiple components are more effective than interventions with single components.