Sonja Bröning

Selective prevention programs for children from substance-affected families: a comprehensive systematic review

Children from substance-affected families show an elevated risk for developing own substance-related or other mental disorders. Therefore, they are an important target group for preventive efforts. So far, such programs for children of substance-involved parents have not been reviewed together. We conducted a comprehensive systematic review to identify and summarize evaluations of selective preventive interventions in childhood and adolescence targeted at this specific group. From the overall search result of 375 articles, 339 were excluded, 36 full texts were reviewed. From these, nine eligible programs documented in 13 studies were identified comprising four school-based interventions (study 1–6), one community-based intervention (study 7–8), and four family-based interventions (study 9–13). Studies’ levels of evidence were rated in accordance with the Scottish Intercollegiate Guidelines Network (SIGN) methodology, and their quality was ranked according to a score adapted from the area of meta-analytic family therapy research and consisting of 15 study design quality criteria. Studies varied in program format, structure, content, and participants. They also varied in outcome measures, results, and study design quality. We found seven RCT’s, two well designed controlled or quasi-experimental studies, three well-designed descriptive studies, and one qualitative study. There was preliminary evidence for the effectiveness of the programs, especially when their duration was longer than ten weeks and when they involved children’s, parenting, and family skills training components. Outcomes proximal to the intervention, such as program-related knowledge, coping-skills, and family relations, showed better results than more distal outcomes such as self-worth and substance use initiation, the latter due to the comparably young age of participants and sparse longitudinal data. However, because of the small overall number of studies found, all conclusions must remain tentative. More evaluations are needed and their quality must be improved. New research should focus on the differential impact of program components and delivery mechanisms. It should also explore long-term effects on children substance use, delinquency, mental health, physical health and school performance. To broaden the field, new approaches to prevention should be tested in diverse cultural and contextual settings.

Web-based screening and brief intervention for poly-drug use among teenagers: study protocol of a multicentre two-arm randomized controlled trial

BackgroundMid to late adolescence is characterised by a vulnerability to problematic substance use since the consumption of alcohol and illicit drugs is frequently initiated and increased in this life period. While the detrimental long- and short-term effects of problematic consumption patterns in adolescence pose a major public health concern, current prevention programs targeting alcohol- and other substance-using adolescents are scarce. The study described in this protocol will test the effectiveness of a web-based brief intervention aimed at reducing problematic alcohol use and promoting abstinence from illegal drugs in adolescents with risky substance use aged 16 to 18 years old in four EU-countries.Methods/designTo determine the effectiveness of our web-BI, we apply a two-arm randomized controlled trial (RCT) study design, with baseline assessment at study entry and a three month follow-up assessment. Adolescents aged 16 to 18 years from Belgium, the Czech Republic, Germany, and Sweden will be randomly assigned to either the fully electronically delivered brief intervention group (N = 400) or an assessment only control group (N = 400) depending on their screening for risky substance use (using the CRAFFT). Recruitment, informed consent, randomization, intervention and follow-up will be implemented online. Primary outcomes are reductions in frequency and quantity of use of alcohol and drugs other than alcohol over a 30 day period, as well as consumption per typical occasion. Secondary outcomes concern changes in substance use related cognitions including the constructs of the Theory of Planned Behaviour, implementation intentions, and stages of change. Moreover the study addresses a number of moderator variables, including age of first use, general psychopathology and quality of parent–child relationship.DiscussionThe trial is expected to contribute to the growing literature on theory- and web-based brief interventions for adolescents. We will explore the potential of using web-based technologies as means of delivering preventive interventions. In doing so we are among the first to target the relevant group of young poly-drug users in Europe.Trial registrationCurrent Controlled Trials ISRCTN95538913

Implementing and evaluating the German adaptation of the “Strengthening Families Program 10 - 14“– a randomized-controlled multicentre study

BackgroundSubstance use problems in childhood and adolescence can severely impact youth’s physical and mental well-being. When substance use is initiated early, the risk for moving from hazardous substance use to substance use disorders (SUD) is particularly high to developmentally induced biological and psychological vulnerability towards chronic trajectories in youth. Thus, risk factors for developing SUD should be addressed early in life by adequate preventive measures reaching out to children, adolescents, and their families. The study described in this protocol will test the effectiveness of the German adaptation of the Strengthening Families Program for Parents and Youth 10–14 (SFP 10–14) aimed at ten to 14 year old adolescents and their caregivers.Methods/DesignThe study is conducted in four large German cities by counselling centres in the areas of youth welfare, social work and addiction aid. The effectiveness of the manualised group programme “Familien Stärken” consisting of seven sessions and four booster-sessions is tested among N = 288 children and participating parents in a multicentre randomised controlled trial with standardised assessment instruments. The control condition receives a minimal 2-hour intervention on parenting delivered in a school setting. Data are collected shortly before and after as well as six and 18 months after the intervention. We expect to replicate the favourable effects of the SFP 10–14 programme in the United States in the area of substance use initiation, family functioning and individual psychosocial adjustment.DiscussionThe trial is expected to contribute to the growing literature on family-based preventive interventions, their effectiveness and feasibility. It is in line with several other current European efforts aimed at strengthening families against the detrimental effects of substance abuse in youth. The results of these trials will expand our knowledge on adapting evidence-based interventions and delivering them in diverse cultures and settings.Trial registrationCurrent Controlled Trials ISRCTN90251787

A Review on Attachment and Adolescent Substance Abuse: Empirical Evidence and Implications for Prevention and Treatment

BACKGROUND This paper reviews research on the relation of attachment and substance use disorders (SUD) in adolescence. Based on a theoretical introduction, we review evidence for a possible general link between SUD and insecure attachment, for links between specific forms of SUD and specific patterns of attachment, and for studies on family patterns of attachment in adolescence. METHODS Using medical and psychological databases, we identified 10 studies on adolescent SUD and another 13 studies on adult SUD. RESULTS Empirical evidence strongly supports the assumption of insecure attachment in SUD samples. With regard to specific patterns of attachment, results mainly point towards fearful and dismissing-avoidance, whereas single studies report preoccupied and unresolved patterns. Results indicate different patterns of attachment in different groups of substance abusers, that is, fearful-avoidant attachment in heroin addicts and more heterogeneous results in abusers of other substances. Explorative data suggest different types of insecure family attachment patterns, which might imply different functions of substance abuse and lead to different treatment recommendations. Methodological problems such as poor assessment of SUD and the use of different measures of attachment limit comparability. CONCLUSIONS Although a lot of research is still needed to address the unknowns in the relation between attachment and SUD, there is strong evidence for a general link between SUD and insecure attachment. Data on connections between different patterns of attachment and different pathways towards SUD are less conclusive but mainly point to disorganized and externalizing pathways. Evidence suggests that fostering attachment security might improve the outcome of state-of-the-art approaches in both early interventional treatment and prevention. Implications for individual and family approaches are outlined.

Gender-related consequences of Internet use perceived by parents in a representative quota sample of adolescents

Only few studies have investigated gender differences in consequences of adolescent Internet use in a general population sample. In this study, we surveyed a representative German quota sample of N=1744 adolescents aged between 14 and 17 years and their caregivers with standardised questionnaires. Parents’ reports showed significant differences between male and female youth in 8 out of 10 problem areas (summarised in a ‘difficulties index’, Cronbachs alpha=0.89) caused by adolescent Internet use. According to parents’ assessment, male adolescents neglected school obligations and friendships outside the Internet more frequently than female adolescents. Compared to girls, boys spent more time and money using the Internet, regarded media use as more important, set wrong priorities in selecting online content, and rather ran into cost traps or legal consequences. More parents of boys than of girls observed adverse effects on adolescents’ physical and mental development. Both parents and adolescents consistently reported excessive media use more frequently for boys. By conducting a multiple linear regression analysis for the full sample, approximately one-third (34%) of the variance in the ‘difficulties index’ was explained by frequency of excessive Internet use. The results highlight the importance of gender-related analyses regarding the consequences of adolescent Internet use.

Evaluation of a German version of the Strengthening Families Programme 10-14: a randomised controlled trial.

BACKGROUND The purpose of this study is to evaluate the effects of a German adaptation of the Strengthening Families Programme 10-14 (SFP 10-14; Familien Stärken). METHODS A multi-centre randomised controlled trial comparing the German SFP version consisting of seven sessions and four booster-sessions with a minimal intervention on parenting as control condition. Outcomes comprise measures of adolescent substance use (initiation) and behaviour problems and are assessed at baseline, after programme delivery and at 6- and 18-month follow-ups. Primary outcomes were lifetime tobacco, alcohol and cannabis use at 18 months. Data of n = 292 families were analysed using baseline adjusted logistic regressions and mixed models. RESULTS We observed reduced rates of lifetime tobacco use in analyses with follow-up respondents, but not in data using the complete intention to treat sample with multiple imputation estimates for missing data. Parents reported fewer adolescent behaviour problems in analyses with the total sample and multiple imputed data, but not in data with follow-up respondents only. There were no other significant effects of SFP 10-14. CONCLUSION Overall the medium size effects found in previous US trials could not be replicated in a German context.

Brief Intervention in Alcohol Intoxicated Adolescents-A Follow-up Study in an Access-to-Care Sample

In the present study, N=88 children, adolescents and young adults were examined in the emergency unit of three municipal hospitals, who were receiving inpatient treatment there in the year 2008 due to acute alcohol intoxication (AAI). The sample consisted of 49% female (MD=16 years old) and 51% male patients (MD=17 years old). With regard to twelve months prevalence, it was the first AAI for 71% of the patients up to 16 years old, whereas for 47% of patients older 19 years it was at least the tenth AAI. All patients received a brief motivational intervention (BMI) which was designed to encourage them to seek youth-specific counselling after receiving hospital standard care. Of 88 youth, 15 (17%) accepted this offer, and 78 of 88 adolescents (89%) took part in a telephone-based 6-month follow-up. In an intent-to-treat analysis, alcohol prevalence (g/l for the last 30 days) decreased from t1 (M=544, SE=102) to t2 (M=2, SE=0.12). Therefore, the BMI under study appears to be effective in principle, is currently being manualised, and will be tested in a randomised-controlled study.

Targeting children of substance-using parents with the community-based group intervention TRAMPOLINE: A randomised controlled trial - design, evaluation, recruitment issues

BackgroundChildren of substance-abusing parents are at risk for developing psychosocial development problems. In Germany it is estimated that approx. 2.65 million children are affected by parental substance abuse or dependence. Only ten percent of them receive treatment when parents are treated. To date, no evaluated programme for children from substance-affected families exists in Germany. The study described in this protocol is designed to test the effectiveness of the group programme TRAMPOLINE for children aged 8-12 years with at least one substance-abusing or -dependent caregiver. The intervention is specifically geared to issues and needs of children from substance-affected families.Methods/DesignThe effectiveness of the manualised nine-session group programme TRAMPOLINE is tested among N = 218 children from substance-affected families in a multicentre randomised controlled trial. Outpatient counselling facilities across the nation from different settings (rural/urban, Northern/Southern/Eastern/Western regions of the country) will deliver the interventions, as they hold the primary access to the target group in Germany. The control condition is a group programme with the same duration that is not addiction-specific. We expect that participants in the intervention condition will show a significant improvement in the use of adaptive coping strategies (in general and within the family) compared to the control condition as a direct result of the intervention. Data is collected shortly before and after as well as six months after the intervention.DiscussionIn Germany, the study presented here is the first to develop and evaluate a programme for children of substance-abusing parents. Limitations and strengths are discussed with a special focus on recruitment challenges as they appear to be the most potent threat to feasibility in the difficult-to-access target group at hand (Trial registration: ISRCTN81470784).

Familienbasierte Prävention von Sucht- und Verhaltensstörungen. Evaluation der deutschen Version „Familien stärken“ des US-amerikanischen „Strengthening Families Program SFP 10 - 14“

Einleitung: „Familien starken“ ist ein universelles familienbasiertes Praventionsprogramm fur Heranwachsende im Alter von 10 – 14 Jahren. Ziel ist eine Anhebung des Einstiegsalters beim Konsum psychotroper Substanzen, der Ruckgang expansiver kindlicher Verhaltensauffalligkeiten sowie die Verbesserung der Familienfunktion. Das zugrunde liegende „Strengthening Families Program 10 – 14“ wurde 1993 an der Iowa State University/USA entwickelt und erfolgreich auf seine Wirksamkeit hin untersucht. In Deutschland besteht bezuglich der familienbasierten Pravention eine Lucke, die durch die Einfuhrung von “Familien starken“ geschlossen werden soll. Seit April 2010 lauft eine vom Bundesministerium fur Bildung und Forschung (BMBF) geforderte randomisiert-kontrollierte Multicenter-Studie zur Evaluation des Programms an 4 Projektstandorten in sozial benachteiligten Stadtteilen in Deutschland. Evaluationsergebnisse der Katamneseuntersuchungen sechs Monate nach Interventionsende werden prasentiert. Methode: Im Rahmen einer kultursensiblen Adaptation wurden die Materialien ubersetzt und ein Neudreh der Schulungsvideos durchgefuhrt. Fur die Evaluation wurden 292 Familien vor der Intervention mithilfe verschiedener Fragebogen befragt, 151 Familien nahmen an insgesamt 17 „Familien starken“-Trainings von Oktober 2010 bis Marz 2012 teil. Datenerhebungen finden vor und nach der Intervention, sowie 6 und 18 Monate nach Interventionsende statt. Diskussion/Ergebnisse: Die Ergebnisse umfassen die Wirksamkeit des Programms im Vergleich zur Kontrollintervention anhand des Einstiegsalters in den Alkohol- Tabak- und Cannabiskonsum der Jugendlichen sowie der von den Jugendlichen angegebenen Konsummengen. Hierbei werden Aussagen uber den Zeitraum bis zu 6 Monate nach Interventionsende gemacht. Des Weiteren wird dargestellt, inwiefern sich „Familien starken“ auf kindliche Verhaltensauffalligkeiten auswirkt. Auserdem werden mogliche Effekte des Programms auf den Erziehungsstil der Eltern prasentiert. Schlussfolgerung: Es werden Ergebnisse zur mittelfristigen Wirksamkeit der deutschen Version des Strengthening Families Program vorgestellt. Es wird erlautert, inwieweit „Familien starken“ effektiv ist bei der Anhebung des Einstiegsalters in den Substanzkonsum, der Reduzierung von Verhaltensaufalligkeiten bei Jugendlichen und der Verbesserung des elterlichen Erziehungsverhaltens.