One-year outcomes of a drug abuse prevention program for older teens and emerging adults: Evaluating a motivational interviewing booster component.

Substance misuse is among the most prevalent causes of adolescent morbidity and mortality in the United States, and approximately 5–8% of adolescents qualify for a diagnosis of substance abuse disorder (Brannigan, Schackman, Falco, & Millman, 2004; Sussman, Skara, & Ames, 2008a). Project Towards No Drug Abuse (TND) is a 12-session school-based substance abuse prevention program developed for older, at-risk teens, based on a motivation, skills, and decision-making model (Sussman et al., 2004). Project TND has been evaluated in six clustered-randomized controlled trials, which have demonstrated the impact of the program on 30-day substance use at a one-year follow-up or longer (Dent, Sussman, McCuller, & Stacy, 2001; Rohrbach, Sun, & Sussman, 2010b; Sun, Sussman, Dent, & Rohrbach, 2008; Sun, Skara, Sun, Dent, & Sussman, 2006; Sussman, Dent, Simon, Stacy, & Craig, 1998; Sussman, Dent, & Stacy, 2002; Sussman, Sun, McCuller, & Dent, 2003; Valente et al., 2007). Effects on ‘hard’ drug use (a summary index of use of cocaine, hallucinogens, stimulants, inhalants, ecstasy, pain killers, tranquilizers, and other drugs [i.e., PCP, steroids, GHB, and K]) have been found in all six trials at one year-follow-up. In addition, hard drug use effects were demonstrated in the two trials that assessed effects at two-year follow-up and the one trial that assessed effects at five-year follow-up. However, the impact on other substances has been less consistent across trials, with effects on alcohol use shown in three trials (Sussman et al., 1998; Sussman et al, 2002; Sussman et al., 2003; Valente et al., 2007), effects on marijuana shown in two trials (Rohrbach et al., 2010b; Sussman et al., 2002; Sussman et al., 2003), and effects on cigarettes shown in one trial (Sussman et al., 2002; Sussman et al., 2003), at one- or two-year follow-up. Previous research suggests that school-based drug abuse prevention programs have a greater chance of long-term success if youth are exposed to additional contacts with program providers of some type after delivery of the core program (Skara & Sussman, 2003). However, most of the support for booster programming has been obtained from meta-analyses that show programs containing booster sessions are relatively more likely to obtain effects (Rooney & Murray, 1996; White & Pitts, 1998). According to Cuijpers (2002), very few studies have provided a direct test of the relative effects of adding booster programs within an experimental or quasi-experimental trial. Therefore, systematic research on the importance of booster programming is greatly needed in the drug abuse prevention field. To date, no study has tested the efficacy of booster sessions with Project TND. Telephone boosters are feasible and promising for high-risk youth populations, and may be one of the only ways to reach participants after high school (McCuller, Sussman, Holiday, Craig, & Dent, 2002; Mermelstein, Hedeker, & Wong, 2003; Miguez, Vazquez, & Becona, 2002). Furthermore, telephone counseling has become a popular modality to deliver information to teens and adults, and has achieved significant effects in tobacco prevention and cessation (e.g., (Boyle, Pronk, & Enstad, 2004; Elder, Woodruff, & Eckhardt, 1994; Leed-Kelly, Russell, Bobo, & McIlvain, 1996; Mermelstein et al., 2003; Miguez et al., 2002; Skara & Sussman, 2003; Whelan, McBride, & Colby, 1993; Zhu, et al., 2000), prevention of at-risk drinking (Curry, Ludman, Grothaus, Donovan, & Kim, 2003), and prenatal substance abuse treatment (Laken & Ager, 1996). Motivational Interviewing (MI) was chosen as the booster component because the development of motivation to change is the core objective of MI (Miller & Rollnick, 2002). Motivation to change is created by developing discrepancy between current behavior and future goals, and occurs when people perceive a discrepancy between where they are and where they want to be (Smedslund et al., 2011). MI may be of importance as a vehicle of delivering drug abuse prevention booster programming though a telephone based modality (Kypri, Sitharthan, Cunningham, Kavanagh, & Dean, 2005). The type of one-on-one support provided via MI can encourage participants to identify self-perceived problems, respects their need for autonomy and decision-making, and provides adequate flexibility to the counselor to follow whatever behavior or issue the participant identifies. Thus, because the main goal of MI is to develop discrepancy and because it has been shown to be effective in some studies of drug using youth (Grenard, Ames, Pentz, & Sussman, 2006), MI was selected as an appropriate modality for a booster to TND. Little is known about whether the effects of drug abuse prevention programs are generalizable to risky sexual behaviors. Risky sexual behaviors among teens include failing to use condoms while having sex, having sex with multiple partners, and having sex while using drugs, and risky sexual behavior is associated with drug use (Sussman, 2007). One school-based drug abuse prevention study among general population young teens found a generalization effect on unsafe sexual behavior an average of 12 years after implementation of the program (Life Skills Training; Griffin, Botvin, & Nicols, 2006). However, additional replication studies are needed, as well as studies with other populations of youth, to establish greater credence to the findings of that one study. An economic function of programming would be served if, in general, drug abuse prevention programs that are successful in reducing substance use could also have an impact on risky sexual behaviors (MacDonald, Zanna, & Fong, 1998). Successful prevention of drug abuse and risky sexual behavior is especially important for young people at relatively higher risk for engaging in health-compromising behaviors. The participant population for the present study was comprised of continuation high school youth. In California, when reaching high school age, those youth who are unable to remain in the regular school system for functional reasons, including lack of credits and consistent use of substances, are transferred to continuation high school (CHS). Similar types of schools exist nationally (sometimes called “alternative” high schools in other states). In California, every school district that has an enrollment of over 100 students in 12th grade must have a CHS program; there are approximately 600 CHSs in the state. These youth, compared to general high school youth, are at relatively high risk for drug abuse and risky sexual behavior (Black, Sun, Rohrbach, & Sussman, 2011). CHS youth are more likely to begin assuming adult roles during the high school years, such as working full-time, getting married, and having children, making them resemble emerging adults rather than adolescents (Rohrbach, Sussman, Dent, & Sun, 2005).