Peggy L. Peterson

Assessing Correlates of Onset, Escalation, Deescalation, and Desistance of Delinquent Behavior

This article evaluates the utility of social development model constructs toassess the correlates of onset, escalation, deescalation, and desistance ofdelinquent behavior, from age 12 to age 15, using a dynamic classificationapproach. Dynamic classification places individuals into categories basedon changes in levels of delinquent behavior over time. These analyses assessthe extent to which specific constructs are associated with changes in thedelinquency status of individuals. Constructs of the social developmentmodel (SDM), including opportunities for conventional involvement, skillsfor conventional involvement, rewards for conventional involvement,proactive family management, bonding to conventional society, opportunitiesfor antisocial involvement, antisocial interactions, perceived rewards forantisocial involvement, and norms against drug use, were significantlyassociated with change in delinquent behavior over time. Many of theconstructs were particularly salient in distinguishing between youths whoremained involved in delinquency and youths who deescalated or desisted fromdelinquent behavior during this period. Implications for preventiveinterventions and criminological theory are discussed.

Short-term effects of a brief motivational intervention to reduce alcohol and drug risk among homeless adolescents

The short-term results of a randomized trial testing a brief feedback and motivational intervention for substance use among homeless adolescents are presented. Homeless adolescents ages 14-19 (N = 285) recruited from drop-in centers at agencies and from street intercept were randomly assigned to either a brief motivational enhancement (ME) group or 1 of 2 control groups. The 1-session motivational intervention presented personal feedback about patterns of risks related to alcohol or substance use in a style consistent with motivational interviewing. Follow-up interviews were conducted at 1 and 3 months postintervention. Youths who received the motivational intervention reported reduced illicit drug use other than marijuana at 1-month follow-up compared with youths in the control groups. Treatment effects were not found with respect to alcohol or marijuana. Post hoc analyses within the ME group suggested that those who were rated as more engaged and more likely to benefit showed greater drug use reduction than did those rated as less engaged. Limitations of the study are discussed as are implications for development of future substance use interventions for this high-risk group.

Outpatient Treatment for Cocaine Abuse: A Controlled Comparison of Relapse Prevention and Twelve-Step Approaches

This study sought to assess the efficacy of treatment for cocaine abuse and to compare the relative effectiveness of a cognitive-behavioral relapse prevention treatment with that of a Twelve-Step recovery support group in an outpatient group treatment setting. One hundred ten subjects seeking treatment were alternately assigned to relapse prevention or Twelve-Step treatment. Self-report data were collected at baseline, posttreatment, and 6-month follow-up. There were no differential effects of treatment type on cocaine or marijuana use over time. However, subjects in both treatment conditions reduced cocaine and marijuana use at posttreatment. Subjects in both groups reduced their alcohol use from pretreatment to posttreatment. Subjects receiving Twelve-Step treatment showed greater increases from posttreatment to 6-month follow-up in alcohol use than did relapse prevention participants. Treatment attendance was negatively related to cocaine use at posttreatment and cocaine and marijuana use at 6-month follow-up. Difficulties in conducting cocaine treatment outcome research are discussed as are treatment and research implications of the findings.

Adolescent Change Language Within a Brief Motivational Intervention and Substance Use Outcomes

Homeless adolescents who used alcohol or illicit substances but were not seeking treatment (n = 54) were recorded during brief motivational interventions. Adolescent language during sessions was coded on the basis of motivational interviewing concepts (global ratings of engagement and affect, counts of commitment to change, statements about reasons for change, and statements about desire or ability to change), and ratings were tested as predictors of rates of substance use over time. Results indicate that statements about desire or ability against change, although infrequent (M = 0.61 per 5 min), were strongly and negatively predictive of changes in substance use rates (days of abstinence over the prior month) at both 1- and 3-month postbaseline assessment (ps < .001). Statements about reasons for change were associated with greater reductions in days of substance use at 1-month assessment (p < .05). Commitment language was not associated with outcomes. Results suggest that specific aspects of adolescent speech in brief interventions may be important in the prediction of change in substance use. These relationships should be examined within larger samples and other clinical contexts.

Rationale and design of a brief substance use intervention for homeless adolescents

The rationale and design for a brief feedback and motivational intervention for substance use among homeless adolescents is described. Homeless adolescents use substances at extremely high rates compared to other youth, and experience considerable negative consequences as a result. Yet homeless adolescents are not reached by, or are not responsive to, traditional prevention and treatment programs for substance use and abuse. The rationale for the use of brief feedback interventions is reviewed, and one such program that was designed to reduce substance use risk among homeless youth is described. The intervention is consistent with tenants of harm reduction in its effort to encourage engagement via its structure, minimal demands, and flexible clinical strategies and goals. Modifications made to the intervention based on lessons learned from an initial trial are described, and highlight the importance of tailoring harm reduction programs to facilitate engagement based on clients’ life circumstances, availability, and motivation.

Homeless youths’ perceptions of services and transitions to stable housing

Use of available services is low among homeless youths, and how youth make decisions to access services or seek housing is unclear. This study explored perspectives of current and former street youth about these processes. Recruited from the streets and a drop-in center, 27 youth ages 16-24, participated in individual qualitative interviews. Findings from consensual qualitative analyses indicated choices to use services were embedded within developing autonomy and identification with street lifestyles. Themes of self-reliance, substance use, and relationships with street and housed persons were expressed as critical for both using services and transitioning to stable housing. Agency-related factors such as caring staff, a nonjudgmental atmosphere, and flexible policies were perceived as important for service use while youth-related factors such as experiencing major events, being internally motivated, and embracing mainstream values were seen as conducive to transitioning off the streets. Implications for service providers and future research are discussed.

Evaluating Comprehensive Community Drug Risk Reduction Interventions

Comprehensive community interventions pose several challenges to rigorous evaluation design. This article summarizes the recommendations for a feasible and rigorous design that were formulated by a 1991 conference on the evaluation of comprehensive community interventions. One such comprehensive intervention strategy for drug risk reduction called Communities That Care illustrates the points discussed. Conference participants recommended a multisite experimental trial of matched community pairs randomized into intervention and comparison conditions. In this design, randomization occurs at the community level. The implications of this design for community selection, sample size, and power are discussed

Preventing Fetal Alcohol Exposure: A Cognitive Behavioral Approach

Fetal alcohol exposure is a serious social and public health problem. However, most prevention programs in this area are solely informational. Important gaps in both understanding processes which underlie alcohol consumption during pregnancy and in the design of interventions to prevent fetal alcohol exposure are discussed. We argue that an important group missed by current interventions are women for whom abstinence is difficult, but who are not physically addicted. Cognitive behavioral interventions are proposed as appropriate for this target group. Recommendations for future directions in the area of fetal alcohol exposure are discussed.