Motivational Intervention with Parental Participation in Adolescent Alcohol Use

There have been various efforts to improve awareness and to reduce substance abuse among adolescents. Studies have shown that for 18- to 19-year-old adolescents, an individual motivational interview (IMI) effectively reduces alcohol-related problems. IMI is designed to empathize, offer personalized feedback, and show the negative effects of their drinking behavior on their goals. This type of individualized intervention decreased average drinking days and high-volume intake among 13- to 17-year-old alcohol users as well. IMI for adolescents does not incorporate the parents’ influence in alcohol use. A study of sixth graders, whose parents participated in the Family Check-Up (FCU), showed that parental monitoring affected a positive outcome such as on subsequent alcohol use in ninth grade. FCU is an assessment and feedback intervention similar to the IMI approach, but focusing on familial issues. Researchers hypothesized that the addition of the FCU to an IMI would significantly improve the outcomes in adolescent alcohol use. They reported their results in Archives of Pediatrics & Adolescent Medicine [2011;165(3):269-274]. The study population was recruited from an urban emergency department (ED) in the northeast United States between January 1, 2003, and January 31, 2008. Eligible participants were 13- to 17-year-old patients who tested with a positive blood alcohol level (n=239) in addition to those who self-reported drinking alcohol 6 hours before the ED visit (n=25). Of the 239 alcohol-positive eligible patients and families, 46.0% (n=110) agreed to participate, as did 60.0% (n=15) of those who self-reported alcohol use. Patients were randomly divided into 2 groups: IMI or IMI+FCU. The IMI was administered prior to randomization—after the adolescents’ blood alcohol level reached below 0.1%. The 45-minute counseling session focused on personal responsibility, motivation for drinking, personalized feedback, and self-efficacy. The IMI+FCU group returned for a family assessment task, a video-recorded session of parent(s)-child discussing family issues such as beliefs on substance use. Parents received feedback 1 week later, including self-assessment, support and clarification, and plan for change. Researchers collected baseline data from the previous 3-month history in Adolescent Drinking Questionnaire: frequency (drinking days per month), quantity (drinks per occasion), high-volume drinking (≥5 drinks per occasion), and frequency of intoxication (feeling drunk). Outcomes were measured at 3, 6, and 12 months to determine how the alcohol use changed after intervention. Three outcome measurements were used in the analysis: drinking frequency, quantity, and high-volume drinking; frequency of intoxication correlated closely to high-volume drinking (P<.001). In both groups, drinking initially decreased (to 39.3% at 3-month follow-up compared with 100% at baseline), but increased with time (55.2% at 6 months and 67.9% at 12 months). However, although drinking frequency rose during follow-up, compared with the initial number of drinking days it was still significantly lower at each follow-up: t96=6.82, IMI to 3 months; t91=6.09, IMI to 6 months; and t82=4.18, IMI to 12 months (P<.001 for all). Both groups reported significantly reduced quantity per drinking compared with the amount initially indicated at IMI. High-volume drinking followed a similar pattern of drinking frequency, which decreased significantly at 3 months (from 84.0% at baseline to 24.0%), then increased over time (35.3% at 6 months, and 53.3% at 12 months). In comparing the outcomes between the IMI and the IMI+FCU groups, adolescents in the latter group showed a statistically more significant improvement in the short-term high-volume drinking (32.1%; 95% confidence interval [CI], 19.9%-44.4% vs 14.6%; 95% CI, 3.8%-25.5%, respectively, at the 3-month follow-up; P=.048; and 43.6%; 95% CI, 30.5%-56.8% vs 27.0%; 95% CI, 12.7%-41.3%, respectively, at 6 months; P=.10). According to researchers, both groups reported “a statistically and clinically significant decrease in alcohol use, quantity of use per drinking occasion, and high-volume drinking…brief motivational interventions, whether of the individual or individual plus parent type, have the potential for a clinically meaningful short-term effect on high-volume drinking in adolescents.”