L. A. R. Stein

Enhancing Substance Abuse Treatment Engagement in Incarcerated Adolescents.

The purpose of this study was to determine whether motivational interviewing (MI), compared with an attention control condition (relaxation training [RT]) enhances substance abuse treatment engagement in incarcerated adolescents. At the start of incarceration, adolescents were randomly assigned to individually administered MI or RT. Subsequently, therapists and adolescents (N = 130) rated degree of adolescent participation in the facilitys standard care group-based treatments targeting crime and substance use. All adolescents received the facility standard care treatment after their individual MI or RT session. MI statistically significantly mitigated negative substance abuse treatment engagement. Other indicators of treatment engagement were in the expected direction; however, effect sizes were small and nonsignificant. These findings are significant, given concerns regarding the deleterious effects of treating delinquent adolescents in groups and the potential for adolescents to reinforce each others negative behavior, which in turn may lead to escalated substance use and other delinquent behaviors after release.

Measuring Mindfulness and Examining its Relationship with Alcohol Use and Negative Consequences

Mindfulness has been proposed as a useful adjunct to alcohol abuse treatment. However, very little research has examined the basic relationship between alcohol use and mindfulness. Inconsistency in definition and measurement of mindfulness across studies makes such research difficult to interpret and conduct. Therefore, the current research sought to validate an emerging mindfulness measure, the Five Facet Mindfulness Questionnaire (FFMQ), and examine its relationship with alcohol use and alcohol-related negative consequences among a sample of 316 college-aged adults. The purported factor structure of the FFMQ was examined using confirmatory factor analysis. Structural equation modeling was used to examine relations among mindfulness, alcohol use, and alcohol-related negative consequences. Consistent with past research, results supported the five-factor structure of the FFMQ. Structural equation modeling analyses revealed that two awareness-based factors of mindfulness were negatively related to alcohol use. After controlling for alcohol use, one acceptance-based factor (nonjudging of thoughts and feelings) was negatively related to alcohol-related consequences, and one awareness-based factor was positively related to consequences (all ps < .05). Effect sizes were small-medium. The results reported here inform the burgeoning development of mindfulness-based addiction treatment and provide additional psychometric validation of the FFMQ.

Forced Smoking Abstinence Not Enough for Smoking Cessation

IMPORTANCE Millions of Americans are forced to quit smoking as they enter tobacco-free prisons and jails, but most return to smoking within days of release. Interventions are needed to sustain tobacco abstinence after release from incarceration. OBJECTIVE To evaluate the extent to which the WISE intervention (Working Inside for Smoking Elimination), based on motivational interviewing (MI) and cognitive behavioral therapy (CBT), decreases relapse to smoking after release from a smoke-free prison. DESIGN Participants were recruited approximately 8 weeks prior to their release from a smoke-free prison and randomized to 6 weekly sessions of either education videos (control) or the WISE intervention. SETTING A tobacco-free prison in the United States. PARTICIPANTS A total of 262 inmates (35% female). MAIN OUTCOME MEASURE Continued smoking abstinence was defined as 7-day point-prevalence abstinence validated by urine cotinine measurement. RESULTS At the 3-week follow-up, 25% of participants in the WISE intervention (31 of 122) and 7% of the control participants (9 of 125) continued to be tobacco abstinent (odds ratio [OR], 4.4; 95% CI, 2.0-9.7). In addition to the intervention, Hispanic ethnicity, a plan to remain abstinent, and being incarcerated for more than 6 months were all associated with increased likelihood of remaining abstinent. In the logistic regression analysis, participants randomized to the WISE intervention were 6.6 times more likely to remain tobacco abstinent at the 3-week follow up than those randomized to the control condition (95% CI, 2.5-17.0). Nonsmokers at the 3-week follow-up had an additional follow-up 3 months after release, and overall 12% of the participants in the WISE intervention (14 of 122) and 2% of the control participants (3 of 125) were tobacco free at 3 months, as confirmed by urine cotinine measurement (OR, 5.3; 95% CI, 1.4-23.8). CONCLUSIONS AND RELEVANCE Forced tobacco abstinence alone during incarceration has little impact on postrelease smoking status. A behavioral intervention provided prior to release greatly improves cotinine-confirmed smoking cessation in the community. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01122589.

Effects of Motivational Interviewing for Incarcerated Adolescents on Driving Under the Influence after Release

Motivational Interviewing (MI) to reduce alcohol and marijuana-related driving events among incarcerated adolescents was evaluated. Adolescents were randomly assigned to receive MI or Relaxation Training. Follow-up assessment showed that, as compared to RT, adolescents who received MI had lower rates of drinking and driving, and being a passenger in a car with someone who had been drinking. Effects were moderated by levels of depression. At low levels of depression, MI evidenced lower rates of these behaviors; at high levels of depression, effects for MI and RT were equivalent. Similar patterns were found for marijuana-related risky driving, but effects were non-significant.

Readiness to change as a mediator of the effect of a brief motivational intervention on posttreatment alcohol-related consequences of injured emergency department hazardous drinkers.

Brief motivational interventions (BMIs) are usually effective for reducing alcohol use and consequences in primary care settings. We examined readiness to change drinking as a mediator of the effects of BMI on alcohol-related consequences. Participants were randomized into three conditions: (a) standard care plus assessment (SC), (b) SC plus BMI (BI), and (c) BI plus a booster session (BIB). At 12-month follow-up BIB patients had significantly reduced alcohol consequences more than had SC patients. Patients receiving BI or BIB maintained higher readiness scores 3 months after treatment than did patients receiving SC. However, readiness mediated treatment effects only for those highly motivated to change prior to the intervention but not for those with low pre-intervention motivation. BI and BIB for these patients decreased alcohol consequences in part because they enhanced and maintained readiness for those highly motivated prior to the intervention, but not for those with low motivation. Results are opposite of what would be expected from MI theory. An alternative explanation is offered as to why this finding occurred with this opportunistically recruited Emergency Department patient population.

Response Distortion in Adolescents Who Smoke: a Pilot Study

A wide range of data are obtained with self-report. Information obtained from persons using substances is generally reliable and valid, however, many studies show that some proportion of self-reports regarding substance use are inaccurate. This study examines self-reported response distortion in adolescents who received a brief intervention to reduce their smoking. Findings indicate that age and ethnicity of respondent may influence reported response distortion. Factors that appear to influence under- and over-reporting include social desirability and fear of repercussion. Response distortion does not appear to affect rated usefulness of the intervention, nor does intervention type appear to influence whether respondents thought the researcher wanted them to report less use. Results point to the need for further research regarding adolescents and response distortion.

Comparative validity of MMPI-2 scores of African American and Caucasian mental health center clients

The comparative validity of Minnesota Multiphasic Personality Inventory—2 (MMPI-2) scores for African American (« = 123) and Caucasian (n = 561) clients from a community mental health center was investigated by contrasting mean MMPI-2 scores and correlations between those scores and conceptually related therapist rating scales for the 2 groups. The African American men scored significantly higher on the Lie scale and Fears content scale than did their Caucasian counterparts, and the African American women scored higher than Caucasian women on Hypomania. Caucasian women scored higher on the Low Self Esteem content scale. Correlations between MMPI—2 scores and patient description form ratings were not significantly different between racial groups, indicating that the differences in MMPI-2 mean scale score elevations reflect actual differences in client psychopathology. There was no evidence of test bias in the current study. Suggestions are made for additional research.

Prevalence of alcohol and drug use in an adolescent training facility

This study investigates substance use and crimes among incarcerated adolescents. Chart reviews were conducted between 1997–2000 with 186 adolescent, male offenders, including information on demographics, substance use, and crimes. Results indicate that use of alcohol (88.7%) and marijuana (95.7%) was highly prevalent. The most widely committed crimes included possession of a controlled substance (31.8%), receiving stolen goods (17.8%), and violation of probation (17.2%). Significant differences were observed across racial/ethnic groups; White nonHispanic adolescents were more likely to use cocaine, hallucinogens, and heroin than adolescents of other races. Future research examining relationships between criminal behavior, substance use, and cultural variations in use patterns and delinquency will allow more relevant intervention and prevention strategies in this population.

Working Inside for Smoking Elimination (Project W.I.S.E.) study design and rationale to prevent return to smoking after release from a smoke free prison.

BackgroundIncarcerated individuals suffer disproportionately from the health effects of tobacco smoking due to the high smoking prevalence in this population. In addition there is an over-representation of ethnic and racial minorities, impoverished individuals, and those with mental health and drug addictions in prisons. Increasingly, prisons across the U.S. are becoming smoke free. However, relapse to smoking is common upon release from prison, approaching 90% within a few weeks. No evidence based treatments currently exist to assist individuals to remain abstinent after a period of prolonged, forced abstinence.Methods/DesignThis paper describes the design and rationale of a randomized clinical trial to enhance smoking abstinence rates among individuals following release from a tobacco free prison. The intervention is six weekly sessions of motivational interviewing and cognitive behavioral therapy initiated approximately six weeks prior to release from prison. The control group views six time matched videos weekly starting about six weeks prior to release. Assessments take place in-person 3 weeks after release and then for non-smokers every 3 months up to 12 months. Smoking status is confirmed by urine cotinine.DiscussionEffective interventions are greatly needed to assist these individuals to remain smoke free and reduce health disparities among this socially and economically challenged group.Trial RegistrationNCT01122589

Randomized Clinical Trial of Motivational Enhancement of Substance Use Treatment Among Incarcerated Adolescents: Post-Release Condom Non-Use

ABSTRACT Evaluated impact of motivational enhancement (ME) of substance abuse treatment compared to relaxation training (RT) on sex without condoms (overall and involving substance use) 3 months following release among incarcerated adolescents. This randomized clinical trial involved 114 incarcerated adolescents from the Northeast. Regression analyses determined if treatment condition, baseline levels of depressive symptoms, and their interaction predicted condom non-use 3 months post-release, controlling for baseline condom non-use. Among those who reported fewer baseline depressive symptoms, those in ME condition reported significantly less condom non-use, in general and involving marijuana use compared with those in RT condition. Periods of incarceration represent opportunities to help juvenile detainees reduce behaviors that impact their health and the health of those with whom they interact in the Community.