Prevention of Substance Use in Youth in Ukraine
Condition: Substance Use Disorders
MeSH terms: Substance-Related Disorders
Study type: Interventional

Summary: 
      The objective of this study is to explore the efficacy of brief motivational interventions
      (BMIs) for treatment of youth with alcohol and other drug problems after at least 3 months.
      The results of previous studies indicate that brief interventions for unhealthy alcohol use
      have been shown to be effective in primary care settings, with most studies focusing on
      adults and few studies focusing on youth. To date, no BMI studies have been conducted in the
      Ukraine among youth with alcohol or other drug use. Of particular concern are emerging adults
      ages 18-25 who may be at particularly high risk for alcohol problems given historical events
      related to the fall of the Soviet Union and the subsequent economic down turn.

      This study will evaluate the efficacy of BMI by comparing BMI and no BMI conditions among two
      samples of youth screening positive on the prescreen survey for risky drinking. The subject
      pool will come from the Psychoneurological Department: the first location is located in the
      Railway Clinical Hospital, its clinical base, and the second in classes in the department at
      Kiev National Medical University.

      The total sample of 120 will be broken down to 1.) 60 patients from Railway Clinical
      Hospital; and 2.) 60 students from Kiev National Medical University. Participants will be
      stratified by recruitment site and randomized to condition: BMI and control, with follow-up
      assessment at 3 months. In addition to being the first of study to evaluate the efficacy of
      BMI on substance use problems among youth in Ukraine, this study will examine BMI
      intervention processes in relation to alcohol and other drug outcomes. Findings will inform
      research and clinical practice to enhance early identification and prevention of problematic
      alcohol use trajectories among emerging adults
    

Detailed description: 
      Research Hypothesis

        1. The rates and correlates of alcohol and other drug use, abuse and dependence, among
           young adults age 18-25 presenting to a Psychoneurological Department in the Railway
           Clinic Hospital in Kiev and Kyiv National Medical University will be high on the
           prescreen survey and may not be related to self-identification of problems.

        2. The quality of life of young people with alcohol and substance use problems can be low
           compare to people without these problems. The quality of life can be improved after
           Brief Motivational Interventions.

        3. The rates of intentional and unintentional injury (e.g., motor vehicle, violence related
           (fighting), sports injury, and other non-suicidal self-injury behavior) will be higher
           among emerging adults with greater alcohol and other drug use.

        4. The Brief Motivational Interventions will help young people with alcohol and substance
           use problems and will be more effective for those with drinking motives that are social
           enhancement/externalizing and for those with less depression, anxiety levels, sleep
           disorders, impulsivity, sensation seeking, and aggression.

        5. The Brief Motivational Interventions will help young people with alcohol and substance
           use problems and will found to be effective in reducing primary outcomes (alcohol and
           other drug use, as well as substance use related consequences) and secondary outcomes
           (depression and anxiety levels, sleep disorders, aggression, and quality of life).

      Background According to the World Health Organization (WHO), youth in the Ukraine have the
      greatest level of alcohol consumption in the world, with typical age of initiation being 10 -
      13 years old. When examining poisoning among youth in the Ukraine, 60% is caused by alcohol
      3. Although the legal drinking age in the Ukraine is 18 for wine and liquor, beer is not
      legally classified as an alcoholic beverage and thus has no minimum drinking age. In 2011WHO
      ranked the Ukraine as 5th in the world in capita alcohol consumption. Recently, attempts have
      been made to address these issues. For example, in 2010 legislation was passed restricting
      access to low alcohol content beverages (e.g., beer) to youth, prohibiting access in various
      settings (i.e., public transportation, education, playgrounds, etc.).

      Young adults are a particularly interesting cohort to examine in Ukraine, as these youth were
      raised following the downfall of the Soviet Union in 1991, during a socio-economic downturn.
      For example, data from the Ukrainian Longitudinal Monitoring Survey shows about 4 in 10 males
      and 1 in 10 females drank alcohol in the last month. Despite these alarming statistics, a
      paucity of data exists which examines correlates of alcohol use among young adults in
      Ukraine. Consistent with problem behavior theory, a variety of studies from the U.S. and
      Europe show that alcohol use and other problem behaviors tend to cluster during adolescence
      and young adulthood, likely due to shared risk and protective factors, with some researchers
      and clinicians viewing alcohol misuse as a self-harm behavior. Although commonly, self-harm
      has the connotation of an intentional, self-inflicted, physical injury or suicide attempt,
      substance use and eating disorders may be also considered non-suicidal self-harm behavior.
      Further, some researchers assign the choice of involvement with HRO (e.g., increased risk of
      injury including unintentional death) and the non-observance of safety rules during work as
      self-harm behaviors. The boundaries between suicide and non-suicidal self-harm behaviors are
      not always clearly defined, and in some cases behaviors that usually fall outside the
      boundaries of self-harm may indeed represent self-harm if performed with explicit intent to
      cause tissue damage. Self-harm is listed in the DSM-IV-TR as a symptom of borderline
      personality disorder or it can be a comorbid disorder. The motivations for self-harm vary, as
      it may be used to fulfill a number of different functions. For example, it may function as a
      coping mechanism, which provides temporary relief of intense feelings (e.g., anxiety,
      depression, stress, and emotional numbness), a sense of failure or self-loathing, or other
      mental traits including low self-esteem. Self-harm is most common during adolescence and
      young adulthood, usually first appearing between the ages of 12 and 24.

      Early intervention for emerging adults with risky drinking may be a more effective use of
      resources than exclusive focus on treatment of those with alcohol use disorders (Nathan,
      1988). A pilot study conducted in Ukraine survey emerging adults in an inpatient hospital and
      found that most did not think they had an alcohol problem. Further, our data found that
      common motives for alcohol use were related to coping with negative affect (e.g., stress,
      anxiety) and social influences (e.g., because my friends use alcohol). These findings are
      similar to that of American studies with college students, in which common motives for
      drinking included: coping-anxiety, coping-depression, social, enhancement, and conformity
      (Grant et al., 2007). In this regard, brief motivational interventions (BMIs) may be useful
      to enhance desire to change behavior and address motives for use in order to reduce risk of
      future alcohol problems. The need for early intervention may be particularly important for
      young adults with alcohol use and co-morbid anxiety and/or depression.

      In spite of the available literature data about the problem of alcohol consumption there is
      the lack of information about efficacy of BMIs to reduce alcohol and other substance use
      among emerging adults in Ukraine. Among emerging adults in the U.S., studies suggest BMI
      approaches are promising among emerging adults.

      In Europe, studies also showed the high efficacy of BMI in youth and adults. The goal of a
      German study was to gain knowledge about the target group of medically referred alcohol
      intoxicated adolescents and young adults, and to identify the utility of the administered
      BMI. Namely, researchers tried to find out more about the age and gender structure of
      participants, their alcohol and drug use history and their history of previous incidents of
      acute alcohol intoxication, their risky substance use and symptoms of psychopathology. Also,
      they assessed how many participants of the BMI took advantage of recommended further
      counseling regarding their alcohol use. Third, it was examined in what characteristics the
      group of "help accepters" differs from the group of "help avoiders" with regard to
      socio-demographic characteristics and substance use patterns. Yet, this research faced
      several limitations. First, the BMI was only semi-structured. It was uncontrolled stage-
      1-design (there was not a control group); thus, researchers were not able to demonstrate the
      efficacy of the BMI. It remains unclear, if the BMI initiated change motivation or had the
      effect of motivational enhancement. The efficacy of the subsequent youth-specific counseling
      services was not examined. Another European study illuminates the existing evidence
      concerning the efficacy of brief motivational intervention [20]. Thus, there remain
      unanswered questions around the effectiveness of brief alcohol intervention across different
      settings, different population groups including emerging adults, about the optimal
      intervention content, and the longevity of intervention effects.

      In this regard, a recent U.S. study in primary care used the Composite International
      Diagnostic Interview Alcohol Module to identify adults with alcohol problems in 3 randomized
      controlled trials comparing BMI with no BMI. These were conducted in the USA in order to
      identify key intervention components. This study examined 3 sets of audio-recorded BMIs (2
      from null studies - no difference in drinking between BMI and no BMI groups; and 1 from a
      positive study - less drinking in BMI group compared with no BMI group). The drinking
      decreased among participants in all 3 studies. Intervention characteristics that are
      considered as central to efficacious BMIs (such as changes in self- or other reports of
      drinking quantity and/or frequency, drinking intensity and drinking within recommended
      limits) were not strong predictors of drinking outcome. The quality of the BMI processes was
      not predictive in these studies and may require attention to factors beyond constructs
      typically examined. Therefore, more detailed analysis and prospective studies are necessary.
      For example, the varying efficacy of BMI may depend on different factors such as drinking
      motives, impulsivity, depression, anxiety, sleep disorders, and aggression.

      Study Design Over a one year period, this Psychoneurological Department based study will use
      a randomized controlled trial (RCT) design. Also, the Psychological Faculty of Kyiv National
      Medical University. Eligible young adults will complete a screening survey. Given the fact
      that we plan to include patients and students, we chose this subject pool for the study
      because it combines the psychiatric ward and base of students at the university. Those with
      risky drinking will be enrolled in the RCT and randomized to conditions and stratified by
      patient/student and given either the brief motivational intervention or the control brochure.
      A follow-up assessment will be conducted at 3 months.

      Statistical Design

      SPSS software version 18 will be used for data analysis. A regression model will be applied
      according to the distribution of the data.
    

Intervention name(s): Brief Motivational Interview
Intervention type(s): Behavioral
Intervention description(s): Motivational interviewing is a technique which aims to be both non-judgmental and non-confrontational. Its success depends largely on the presentation of objective feedback based on information provided by an individual. The technique involves acknowledgement that individuals who attend a counselling session, assessment or prevention program may be at different levels of readiness to change their alcohol consumption patterns, including:
No perception of any alcohol consumption problem
Realization of alcohol consumption problem with no corresponding action
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Prevention