Reaching soldiers with untreated substance use disorder: lessons learned in the development of a marketing campaign for the Warrior Check-Up study.

The Warrior Check-Up, a confidential telephone-delivered intervention, is designed to reach active-duty soldiers with untreated substance-use disorder at a large U.S. military base. This paper describes the development and successful implementation of the study's marketing strategies at the recruitment period's midpoint (2010-2012). Qualitative analyses of focus groups (n = 26) and survey responses (n = 278) describe the process of campaign design. Measures of demographics, media exposure, post-traumatic stress, anxiety and depression gathered from callers (n = 172) are used in quantitative analysis assessing the campaign's success in reaching this population. Implications, limitations, and suggestions for future research are discussed. Department of Defense provided study funding.

A Self-Determination Model of Childhood Exposure, Perceived Prevalence, Justification, and Perpetration of Intimate Partner Violence.

The present research was designed to evaluate self-determination theory as a framework for integrating factors associated with intimate partner violence (IPV) perpetration. The proposed model suggests that childhood exposure to parental violence may influence global motivational orientations which, in turn result in greater cognitive biases (overestimating the prevalence of IPV and justification of IPV) which, in turn, contribute to an individual's decision to use abusive behavior. Participants included 124 men who had engaged in abusive behavior toward an intimate partner. Results provided reasonable support for the proposed model and stronger support for a revised model suggesting that controlled orientation, rather than autonomy orientation, appears to play a stronger role in the association between childhood exposure to parental violence and cognitive biases associated with abusive behavior.

What's In It for Me? Motivating the Untreated Abuser to Consider Treatment.

This paper presents findings of a second trial evaluating telephone-based motivational enhancement therapy (MET) to motivate untreated and unadjudicated men who abuse their intimate partners to explore treatment options. Participants' perceptions of how their abuse is negatively affecting them personally are a highlight of the paper. One hundred forty-one adult men were recruited through social marketing and randomly assigned to the intervention (MET) or comparison (Mail) group. The MET condition consisted of two feedback sessions guided by a personalized feedback report on participants' intimate partner violence (IPV) and substance use. The Mail condition included a mailed educational brochure on IPV and substance use. Results supported the likely effectiveness of MET in short-term reduction of IPV behavior, marijuana use, and increasing motivation for treatment seeking particularly for participants who reported more adverse consequences of IPV to themselves. Findings emphasize the importance of including a focus in interventions on IPV's impact on the abusers themselves. The study's virtual participation and success in reaching and retaining a diverse population of male abusers can contribute to transformative justice and communities looking for alternative early interventions for men of color prior to encountering the criminal justice system.

A Telephone Intervention for Substance-Using Adult Male Perpetrators of Intimate Partner Violence.

OBJECTIVE: To preliminarily evaluate telephone-delivered motivational enhancement therapy (MET) in motivating unadjudicated and nontreatment seeking intimate partner violence (IPV) perpetrators, who also use substances, to self-refer into treatment. METHOD: 124 adult men were recruited via a multimedia marketing campaign and were randomly assigned to the intervention (MET) or comparison group following a baseline assessment. Participants in the MET condition received a personalized feedback report on their IPV and substance-use behaviors, consequences, and social norms beliefs. RESULTS: Results supported the likely effectiveness of MET in short-term reduction of IPV behavior, increasing motivation for treatment seeking, and changing perceived norms for IPV and substance abuse (SA). CONCLUSIONS: Applications for brief MET interventions to facilitate voluntary treatment entry among substance-using IPV perpetrators are discussed.

Reaching nontreatment-seeking cannabis users: Testing an extended marijuana check-up intervention.

Some adult cannabis users report negative consequences of use but do not seek treatment. Nonjudgmental, brief interventions incorporating motivational interviewing techniques may be able to reach users who otherwise would not seek treatment and increase their motivation to change use. Previous studies have shown brief interventions with this population are efficacious in reducing use, but the absolute amount of change has not clearly translated into meaningful reductions in associated negative consequences. The current study used a marijuana check-up (MCU) model to attract nontreatment-seeking adults who used cannabis at levels that may have caused negative consequences. The study randomly assigned participants to 2-session (n = 93) and 6-session (n = 93) versions of the intervention and followed them for 12 months. The study designed the extended 6-session condition to build on the efficacy of the previously tested 2-session intervention. The study hypothesized that the opportunity to continue to consider the consequences of cannabis use would have the greatest impact on those who were in earlier stages of readiness for change. We used cognitive behavioral techniques to assist with change efforts when indicated. Results showed significant reductions in the frequency and daily duration of cannabis use at all follow-ups in both intervention conditions. The extended 6-session condition produced greater change only on a measure of the number of periods of the day in which cannabis was used. Reductions in dependence symptoms and problems related to cannabis use occurred in both conditions, but there was no effect of intervention condition. Participants who were less ready to make changes at the outset decreased use and negative consequences the least. Results suggested that some benefit of the extended session format of the check-up in reducing daily use, but the lack of a corresponding reduction in consequences suggested that the original 2-session MCU may be more cost effective.

Treating cannabis use disorder: Exploring a treatment as needed model with 34-month follow-up.

Research has demonstrated that motivational enhancement (MET) and cognitive behavioral therapy (CBT) are some of the most effective interventions for adults with cannabis use disorder (CUD). As few as two sessions of combined MET and CBT has produced abstinence and reductions in cannabis use greater than delayed treatment controls. Despite their efficacy, outcomes in previous studies yielded abstinence rates from cannabis in the range of 20-30% at follow-ups of 6 to 12 months, and CUD remained a chronic condition for many. Additional models of providing treatment "as needed" (PRN), rather than as a single fixed-dose, are necessary to meet the different needs of adults with CUD and reengage those who do not respond to treatment initially or who relapse later. In the current study, 87 adults who met DSM-IV criteria for cannabis dependence were randomly assigned to receive either a fixed-dose of nine sessions of MET/CBT or to a PRN condition that provided a smaller initial dose of treatment, but allowed repeated access to treatment for 28 months. Cannabis use and associated problems were assessed every six months throughout a 34-month period. More than one-third of participants in the PRN condition accessed additional treatment episodes, but the total number of treatment sessions that participants utilized was comparable across conditions. Both treatments yielded significant reductions in cannabis use and associated problems at each follow-up. Contrary to hypotheses, the PRN condition did not yield better outcomes at the longer-term follow-ups. The fixed-dose condition produced greater rates of abstinence at the first follow-up, but otherwise there were no between group differences in outcomes. Future studies should test active approaches to reengaging participants with treatment when initial outcomes are less than optimal.

Motivation to reduce HIV risk behaviors in the context of the Information, Motivation and Behavioral Skills (IMB) model of HIV prevention.

The Information-Motivation-Behavioral Skills (IMB) model of health behavior was tested in a sample of 391 men who have sex with men at high-risk for HIV transmission. Prospective analyses of IMB predictors of unprotected anal intercourse (UAI) confirmed a good fit. Self-rated motivation was a significant predictor of UAI, as were behavioral skills. However, the lack of information and motivational constructs that predicted behavior suggests that the IMB model is limited as a theory and has its greatest utility as a framework for guiding HIV risk reduction interventions for men who have sex with men at high-risk for HIV infection.

The men's domestic abuse check-up: a protocol for reaching the nonadjudicated and untreated man who batters and who abuses substances.

Batterer intervention programs primarily work with individuals mandated to participate. Commonly, attrition is high and outcomes are modest. Motivational enhancement therapy (MET), most widely studied in the substance abuse field, offers a potentially effective approach to improving self-referral to treatment, program retention, treatment compliance, and posttreatment outcomes among men who batter and who abuse substances. A strategy for using a catalyst variant of MET (a "check-up") to reach untreated, nonadjudicated perpetrators is described in detail. Unique challenges in evaluating the success of this approach are discussed, including attending to victim safety and determining indicators of increased motivation for change.

Self-Determination Theory and Motivational Interviewing: Complementary Models to Elicit Voluntary Engagement by Partner-Abusive Men.

Research examining intimate partner violence (IPV) has lacked a comprehensive theoretical framework for understanding and treating behavior. The authors propose two complementary models, a treatment approach (Motivational Interviewing, MI) informed by a theory (Self-Determination Theory; SDT), as a way of integrating existing knowledge and suggesting new directions in intervening early with IPV perpetrators. MI is a client-centered clinical intervention intended to assist in strengthening motivation to change and has been widely implemented in the substance abuse literature. SDT is a theory that focuses on internal versus external motivation and considers elements that impact optimal functioning and psychological well-being. These elements include psychological needs, integration of behavioral regulations, and contextual influences on motivation. Each of these aspects of SDT is described in detail and in the context of IPV etiology and intervention using motivational interviewing.

Changing social norms: The impact of normative feedback included in motivational enhancement therapy on cannabis outcomes among heavy-using adolescents.

INTRODUCTION: Heavy cannabis use is a problematic behavior, particularly among some adolescents. Adolescents are particularly prone to social influence. As such, injunctive norms (perceptions of others' approval of cannabis use) and descriptive norms (perception of frequency of others' cannabis use) influence cannabis behavior. Given that norms are not always accurate, motivational enhancement therapy aims to reduce cannabis use through normative feedback and correction of normative misconceptions. The purpose of this study was to evaluate the relationships between perceived norms (descriptive and injunctive) and cannabis-related outcomes (use, cannabis-related problems, and cannabis use disorder symptoms) in a heavy cannabis-using adolescent population receiving motivational enhancement therapy. METHODS: Heavy cannabis-using individuals (n=252, 68% male, mean age 13.38, 59% Caucasian) were recruited from six Seattle high schools for a motivational enhancement therapy-based intervention involving normative feedback. RESULTS: Participants perceived higher rates of cannabis use among close friends than other same age teens and reported a higher perception of approval for cannabis use from close friends as compared to perceived approval of other same aged peers. Personal approval and the perceived approval of other same age teens were reduced following the intervention but there was no evidence of change in normative perceptions for close friends following the normative feedback interventions. Changes in normative perceptions were related to decreases in cannabis use and -related outcomes. CONCLUSIONS: Results suggest the importance of normative feedback in changing behavior in adolescent cannabis users, but also highlight the ongoing influence of close friends.

The Implications of Cannabis Policy Changes in Washington on Adolescent Perception of Risk, Norms, Attitudes, and Substance Use.

There is increasing interest in the effect of legalization (particularly recreational legalization) of cannabis on prevalence of use and related problems. However, there is no consensus about the impact of policy change on cannabis use, particularly among adolescents. Legalization may increase adolescent use through mediating factors such as perceived risk and normative beliefs regarding the use of cannabis. Washington State enacted Initiative 502 on December 2012, which legalized and taxed recreational cannabis for adults aged ⩾21 years. This paper used data from a randomized, controlled intervention trial for cannabis-using adolescents that was recruiting participants in Seattle before and after the policy change to evaluate the following goals: assess differences in substance use, problems, and symptomatology pre- and post-policy change; evaluate several proposed risk factors that may be associated with such differences; and describe participants' understanding of the law and how this understanding may relate to rates of use. Analyses revealed no significant differences pre- to post-policy in rate of substance use. However, there were significant post-policy increases in problems and use disorder symptoms. Despite these differences, there were no significant increases in norms, attitudes, or perceptions of risk. Participants were able to answer most questions regarding policy changes correctly, indicating a good understanding of the policy. Results provided no evidence that policy change influenced heavy-using adolescents' rates of use nor the proposed risk factors associated with problematic use patterns.

The Marijuana Check-up: promoting change in ambivalent marijuana users.

AIMS: To evaluate the efficacy of a two-session assessment and feedback intervention designed to reach and increase motivation for change in marijuana users who were experiencing negative consequences but were ambivalent about change. DESIGN: Random assignment to one of two types of feedback conditions or a delayed feedback control (DFC) with follow-up assessments at 7 weeks, 6 months and 12 months. Setting University of Washington research center in Seattle, Washington. PARTICIPANTS: A total of 188 adult male and female marijuana users who responded to advertisements. Interventions A personalized feedback (PF) condition utilizing motivational interviewing was compared to an educational control condition labeled multi-media feedback (MMF). MEASUREMENTS: Marijuana use, dependence symptoms, other associated negative consequences and motivational constructs were assessed at all time-points. FINDINGS: PF participants reported fewer days of use per week, fewer periods of use per day and fewer dependence symptoms at 7 weeks than those in the MMF and DFC conditions. PF participants also reported fewer days of use per week compared to MMF participants at the 12-month follow-up and fewer dependence symptoms at both the 6- and 12-month follow-ups compared to MMF participants. CONCLUSIONS: The PF intervention, delivered in the context of a check-up, shows potential as a way of reaching and motivating change in marijuana users with a diagnosable disorder who otherwise are not ready to approach treatment. Ways of augmenting the modest absolute levels of change are discussed.

Randomized trial of motivational interviewing plus feedback for soldiers with untreated alcohol abuse.

OBJECTIVE: Alcohol use disorders (AUDs) are prevalent in the military and are a major public health concern. Although efficacious AUD interventions exist, few service members seek treatment. Army-specific barriers to AUD treatment include treatment being recorded on health records, command being notified of participation, and perceptions that seeking treatment would interfere with promotion or retention in the military. This study evaluated a telephone delivered motivational interviewing plus feedback (MIF) intervention designed to attract self-referral and reduce substance use from active-duty military with untreated AUD. METHOD: A randomized controlled trial enrolled 242 Army personnel who met criteria for AUD according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed.) and who were not engaged in AUD treatment. Participants were screened and assessed at baseline, 1-week, and 3- and 6-month follow-ups. Participants were randomly assigned to receive 1 session of MIF or psychoeducation (control). All participation occurred over the telephone. Primary outcomes included number of drinks per week, substance use disorder (SUD) diagnosis and consequences, and treatment-seeking behavior. RESULTS: Generalized linear models were used to test group differences in drinking behaviors and substance use problems. Results indicated that all participants significantly reduced their drinking over time. MIF participants reported significantly fewer drinks per week than did control participants. Similarly, alcohol dependence diagnosis was marginally lower among MIF participants than control participants at the 6-month assessment. SUD treatment seeking significantly increased for both conditions. CONCLUSIONS: This novel adaptation of MIF shows promise for decreasing drinking and alcohol dependence among this high-risk sample of non-treatment-seeking soldiers and may complement existing AUD services already provided by the Army. (PsycINFO Database Record

Abstinence and moderate use goals in the treatment of marijuana dependence.

AIMS: The purpose of this study was to examine the influence of personal goals (abstinence or moderation) on treatment outcomes for marijuana use. Hypotheses regarding self-efficacy for goal attainment were tested. DESIGN: Adult marijuana users seeking treatment were assigned randomly to three treatment conditions: (1) cognitive-behavioral relapse prevention support group; (2) individualized brief motivational enhancement; and (3) delayed treatment control group. Follow-up assessments were conducted at 4, 7, 13 and 16 months. SETTING: University research offices. PARTICIPANTS: Participants were 291 adult marijuana users. Measurements Marijuana use, personal treatment goals and self-efficacy for achieving one's goal were assessed across the 16-month follow-up. FINDINGS: Greater marijuana related problems and dependence symptoms were associated with an initial goal of abstinence. Participants were more likely to achieve outcomes consistent with their personal goals. Participants with abstinence goals reported greater self-efficacy for goal achievement than those with moderation goals after participating in the abstinence oriented treatment; self-efficacy for goal success predicted goal achievement for both moderate use and abstinence goals. CONCLUSIONS: Marijuana users approaching an abstinence-oriented treatment varied in the extent to which they were actively seeking abstinence as the outcome. Differences in goals were predictable from severity of problems related to use. Goal preference and self-efficacy for achieving goals predicted outcomes. Future research should incorporate personal goals into treatment and assess their effects on outcomes.

Motivational enhancement therapy for adolescent marijuana users: a preliminary randomized controlled trial.

This study's aims were (a) to investigate the feasibility of a school-based motivational enhancement therapy (MET) intervention in voluntarily attracting adolescents who smoke marijuana regularly but who are not seeking formal treatment and (b) to evaluate the efficacy of the intervention in reducing marijuana use. Ninety-seven adolescents who had used marijuana at least 9 times in the past month were randomly assigned to either an immediate 2-session MET intervention or to a 3-month delay condition. Two thirds of the sample characterized themselves as in the precontemplation or contemplation stages of change regarding marijuana use. Participants' marijuana use and associated negative consequences were assessed at baseline and at a 3-month follow-up. Analyses revealed that both groups significantly reduced marijuana use at the 3-month follow-up ( p = .001); however, no between-group differences were observed. Despite the absence of a clear effect of MET, this study demonstrated that adolescents could be attracted to participate in a voluntary marijuana intervention that holds promise for reducing problematic levels of marijuana use.

Correlates of nonparticipation in an HIV prevention program for MSM.

Providing HIV prevention services to high-risk individuals remains challenging. We assessed factors associated with nonparticipation among high-risk, sexually active MSM found eligible to participate in a brief, telephone-delivered HIV prevention trial designed to evaluate the efficacy of motivational enhancement therapy (the Sex Check). Two levels of nonparticipation are evaluated: eligible participants who did versus those who did not complete their baseline/enrollment interview, and enrolled participants who did versus those who did not attend any of their counseling sessions. Nonenrollers were younger, less educated, more closeted, and were more likely to report sex with an injection drug using partner. Enrolled participants who did not engage in their counseling session(s) were less educated, reported greater use of alcohol and drugs during sex and use of injection drugs. Innovative methods to reduce barriers to engaging high-risk, sexually active MSM in risk reduction counseling are needed.

Marketing the 'Sex Check': evaluating recruitment strategies for a telephone-based HIV prevention project for gay and bisexual men.

Designing effective marketing and recruitment strategies for HIV prevention research requires attention to cultural relevance, logistical barriers, and perceived psychosocial barriers to accessing services. McGuire's communication/persuasion matrix (1985) guided our evaluation, with particular attention to success of each marketing "channel" (i.e., strategy) vis-à-vis the number of all callers, eligible callers, and enrolled callers, as well as reaching so-called "hard-to-serve" individuals. Nearly all channels offered success in reaching specific subgroups. Latinos responded favorably to posters, bisexuals responded favorably to paid media in an alternative (non-gay) publication, and precontemplators responded to referrals by family and friends. Although multiple recruitment strategies were used, three were crucial to the success of the project: (a) recruiters' presence in gay venues, (b) referrals by family and friends (snowball technique), and (c) paid advertisements in alternative (non-gay) local newspapers. Resource allocation and costs are also presented for each channel.

Internet-based intervention for mental health and substance use problems in disaster-affected populations: a pilot feasibility study.

Early interventions that reduce the societal burden of mental health problems in the aftermath of disasters and mass violence have the potential to be enormously valuable. Internet-based interventions can be delivered widely, efficiently, and at low cost and as such are of particular interest. We describe the development and feasibility analysis of an Internet-delivered intervention designed to address mental health and substance-related reactions in disaster-affected populations. Participants (n = 285) were recruited from a cohort of New York City-area residents that had been followed longitudinally in epidemiological research initiated 6 months after the terrorist attacks of September 11, 2001. The intervention consisted of 7 modules: posttraumatic stress/panic, depression, generalized anxiety, alcohol use, marijuana use, drug use, and cigarette use. Feasibility data were promising and suggest the need for further evaluation.

A preliminary evaluation of synthetic cannabinoid use among adolescent cannabis users: Characteristics and treatment outcomes.

Little is known regarding the use of synthetic cannabinoids (SC), particularly use among adolescent substance users who may be at higher risk. The present exploratory study seeks to describe SC use and subjective effects among cannabis-using adolescents as well as compare the characteristics of cannabis users who do and do not use SC. Exploratory analyses evaluated cannabis treatment outcomes among SC users and non-users. Participants enrolled in a randomized, controlled intervention for cannabis-using high school students aged 14-19 (N=252) completed questionnaires regarding their use of SC and other substances. Those who used SC in the past 60days reported subjective effects of SC, consequences, and SC use disorder symptoms. Baseline characteristics, alcohol and other drug use, and treatment outcomes of SC users were compared to participants who never tried SC. Within this sample 29% had tried SC, and 6% used SC recently. Although most reported use at a relatively low rate, 43% of recent SC users reported SC use-disorder symptoms. Positive and negative subjective effects of SC were endorsed, with positive subjective effects reported more often. SC use was associated with more cannabis use, but not more alcohol or other (non-SC and non-cannabis) drug use. SC users did not differ from non-users on cannabis treatment outcomes. This exploratory study described SC use, and compared characteristics and treatment outcomes among SC users and non-users. Negative subjective effects of SC were reported as occurring less often, but SC use was associated with use disorder psychopathology. SC use was associated with more problematic cannabis use at baseline, but was not associated with use of other substances or differences in treatment outcome.

Augmenting brief interventions for adolescent marijuana users: The impact of motivational check-ins.

OBJECTIVE: Brief interventions for adolescent marijuana users offered in schools reach users who would not otherwise present for treatment. The current study builds on previous trials of a school-based, 2-session motivational enhancement therapy (MET) intervention by adding periodic, brief motivational check-ins to reinforce gains and bolster motivation. METHOD: Adolescent participants were randomly assigned to a motivational check-in (MCI; n = 128) or assessment-only check-in (ACI; n = 124) comparison condition. Both conditions received 2 sessions of MET. Participants in the MCI condition then attended 3 MET-based check-in sessions at 4, 7, and 10 months after baseline, whereas the ACI condition participants attended assessment-only check-ins at the same time points. Optional cognitive behavior therapy (CBT) sessions were available as needed for 12 months from baseline in both conditions. RESULTS: Outcomes were assessed at 6, 9, 12, and 15 months after baseline. Participants (59% Caucasian; 68% male; mean age = 15.84) reported using marijuana on an average of 37 of the last 60 days, and 70% met diagnostic criteria for a marijuana use disorder. Both conditions were associated with reduced use and negative consequences that were sustained throughout the 15 months of follow-up. The MCI condition resulted in greater reductions at the 6 months follow-up, but differences between conditions were not found at later follow-ups, and MCI participation did not increase engagement in CBT as predicted. CONCLUSIONS: Results replicated the efficacy of the brief intervention for adolescent marijuana use and provided mixed evidence on the utility of adding repeated check-in sessions. (PsycINFO Database Record