Reaching adolescents who drink harmfully: Fitting intervention to developmental reality

School of Applied Psychology, Griffith University, Gold Coast, PMB 50, Gold Coast Mail Centre, 4217, Australia.
Journal of Substance Abuse Treatment (Impact Factor: 3.14). 07/2003; 24(4):347-55. DOI: 10.1016/S0740-5472(03)00047-3
Source: PubMed


Alcohol use usually starts in early adolescence. While the greater proportion of young people develop adaptive patterns of drinking, many drink at harmful levels and may be at risk for future alcohol-related problems. Findings from the empirical literature suggest that universal prevention programs may delay onset of drinking among low-risk baseline abstainers; however, there is little evidence supporting their utility for at-risk adolescents. Further research is needed on how risk and protective factors interact to determine substance use trajectory, and intervention outcomes that take substance use trajectories into account may capture change more effectively than the use of absolute measures of substance use. Indicated prevention programs may benefit from modulations that account for adolescent individuation and identity formation. It is argued that motivational interviewing within a harm reduction framework is well suited to adolescents.

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    • "Short-term negative consequences include school-related problems (e.g. truancy, exclusion and poor attainment), unsafe sexual behaviour and unplanned pregnancies , trouble with parents, trouble with the police, accidents or physical injuries, and aggressive behaviour and disagreement with friends (e.g., Ellickson, Tucker, & Klein, 2003; Masterman & Kelly, 2003). Long-term negative consequences include a greater risk of binge drinking (Viner & Taylor, 2007) and alcohol dependence in adulthood (Bonomo, Bowes, Coffey, Carlin, & Patton, 2004), as well as alcohol abuse and social problems in adulthood (e.g., DeWit, Adlaf, Offord, & Ogborne, 2000; Hingson, Heeren, & Winter, 2006). "
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    ABSTRACT: Consideration of future consequences (CFC) is described as the attention that individuals pay to the potential outcomes of their behaviour, and how their behaviour is affected as a result of attention to these outcomes. Greater CFC has been associated with less alcohol use, thus indicating its potential utility in health-promotion initiatives. A focus group methodology was employed with 13–14 year olds (N = 129) in 16 high schools in Northern Ireland and Scotland to attain their thoughts on how adolescents in general consider the future consequences of alcohol consumption; and to provide some clarity on the nature of CFC and whether it is singular or dichotomous in nature (i.e. do individuals distinguish between immediate and long-term consequences and are they influenced by these in different ways). The participants indicated that the majority of adolescents do not consider the consequences of alcohol consumption at all; while to a lesser extent, some adolescents consider the consequences but ignore them. If adolescents do refrain from alcohol, immediate consequences are more influential in their decision-making than long-term consequences. These findings should help to inform and guide the development and delivery of health-promotion initiatives, and provide some clarity about the nature of CFC and the manner in which the construct should be examined or utilised during future research.
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    • "In this framework counseling is a partnership and the focus is to elicit intrinsic motivation to change through exploring and resolving ambivalence about behavior change (Miller & Rollnick, 2002). Motivational interviewing strategies are well suited for treating adolescents and young adults (Baer & Peterson, 2002; Masterman & Kelly, 2003) as the technique does not increase resistance and utilizes ambivalence to develop motivation to change, and furthermore the brief duration and emphasis on the participant's self-direction and independence may be particularly attractive to adolescents (Baer & Peterson, 2002; Tober, 1991). Adolescents often lack the resources to seek treatment on their own, and may be deterred if parental involvement is required (Walker, Roffman, Stephens, Berghuis, & Wakana, 2006). "

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    • "Individual baseline data could be utilized to create an idiosyncratic risk profile for each participant, allowing for a personalization of risk which may motivate them to consider participating in the program and/or changing their risk behaviors. Again, the incorporation of motivational interviewing techniques would be appropriate because they are geared towards individuals who are less interested in changing their behavior, do not require a lifetime commitment to change, and are not confrontational nor judgmental (Masterman & Kelly, 2003;Miller & Rollnick, 2002). Several unmeasured structural factors may further explain the high rates of initial nonparticipation among the adolescents in this study. "
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