BACKGROUND: Justice-involved youth report high rates of substance use and related problems that are associated with treatment needs; however, data on screening and linkage to treatment within the justice system is lacking. To further inform the juvenile justice behavioral health cascade of care, this study examined factors associated with identified problematic substance use and treatment referral using two screening tools. METHOD: As part of a family court intake process, 348 justice-involved youth received two screening measures, the MAYSI-2 alcohol/drug use subscale and the CRAFFT. Both tools are designed to indicate early warning signs of substance use problems and signal referral for further clinical evaluation or treatment. Chart review analysis examined whether demographic variables (sex & race), severity of use, and type of substance used were associated with positive screens on either or both measures and subsequent treatment referral. RESULTS: Half (51.2%) of youth were identified as having problematic substance use (a positive screen) on at least one of the screeners. Overall, 38.5% positively screened on the CRAFFT with only 0.3% positively screening on just the MAYSI-2 alcohol/drug scale. Cannabis only users were less likely to positively screen on the MAYSI-2 compared to youth who reported use of both alcohol and cannabis. Positively screening on one versus both screeners was not associated with referral, yet many (28%) who positively screened were not referred for services. CONCLUSIONS: The CRAFFT may be more accurate at identifying youth specifically at risk for problematic cannabis use compared to the MAYSI-2 alcohol/drug subscale. Regardless of tool used, treatment referral was low, highlighting the need for accurate identification of treatment needs of substance-using, justice-involved youth. Interventions to facilitate referrals for youth with problematic substance use are needed.

Motivational interviewing (MI) is often incorporated into screening, brief intervention, and referral to treatment (SBIRT) interventions in critical care settings to address alcohol and other drug use. However, cognitive status has been linked to differential response to MI sessions in emergency department (ED) settings. The current study examined one possible explanation for this differential response: whether higher versus lower mental status impacts patient response to clinician statements during MI sessions conducted in an ED. Participants were 126 patients receiving an MI-based single-session alcohol brief intervention, and 13 therapists who provided treatment. Participants completed a mental status exam (MSE) as part of the screening process. Intervention sessions were audio-taped, and transcribed and coded using the Motivational Interviewing Skills Code (MISC 2.0; Miller, Moyers, Ernst, & Amrhein, 2003). The MISC 2.0 coded therapist behaviors that are related to the use of motivational interviewing, and patient language reflecting movement toward (change talk) or away from (sustain talk) changing personal alcohol use. Overall, patients responded in a similar manner to therapist MI behaviors regardless of high versus low level of mental functioning at the time of the intervention. Group differences emerged on patient response to only three specific therapist skills: giving information, open questions, and complex reflection. Thus, the differential effects of SBIRT in critical care settings do not appear to be a result of differences in the therapist and patient communication process.

Objective

Longitudinal research examining college students' alcohol use during the summer months, especially in at-risk individuals, is limited. The current study evaluated changes in mandated college students' alcohol use and related consequences over the summer.

Method

Participants (n = 305, 67% male) who had violated campus alcohol policy and were subsequently mandated to treatment completed follow-up assessments at 3, 6, and 9 months. For the majority of students, one of these follow-up assessments occurred over the summer. Hierarchical linear modeling was used to examine changes in alcohol use and related consequences during the school year and summer.

Results

Participants reported consuming significantly fewer drinks per occasion, reaching lower peak blood alcohol concentrations, and experiencing fewer alcohol-related consequences during the summer months. All outcomes were mediated by summer housing, indicating that summer influenced alcohol use indirectly through participants' tendency to live at home.

Conclusions

Despite small but significant decreases in alcohol consumption and related consequences when living with a parent/guardian, mandated college students continue to exhibit risky drinking and consequences during the summer months. Given these findings, summer may be an appropriate time to implement prevention and intervention strategies with mandated and other at-risk populations.

Background

Pregaming is a common phenomenon among college students and is associated with increased risks such as heavy drinking, alcohol-related consequences, and violating campus alcohol policies. However, the mechanism by which pregaming increases student risk is unclear.

Objectives

The current study aimed to delineate the role of personal endorsement of pregaming, duration of an entire drinking episode on the night of an alcohol violation, and movement from one location to another in predicting alcohol use and violation-related cognitions.

Methods

Participants (N = 113) were college students who had received an alcohol violation. Hierarchical multiple regressions were conducted to investigate the predictive value of pregaming endorsement, duration of drinking, and movement on drinking behaviors [number of drinks consumed and estimated blood alcohol content (eBAC)] on the night of the alcohol violation as well as violation-related cognitions (responsibility, aversiveness).

Results

Pregaming and duration of drinking were significant predictors of alcohol consumption and eBAC on the night of the violation, whereas movement was not. Duration of the drinking episode was significantly related to increased perceived responsibility for the alcohol violation.

Conclusions/importance

Self-reported pregaming and the duration of the drinking episode appear to be better targets than movement for prevention and intervention efforts addressing pregaming on college campuses. Interventions should continue focusing on reducing pregaming and its associated consequences, especially for those who report a longer duration of drinking following a pregaming episode.

Background

Both drinking location and pregaming have been associated with heavy alcohol use among college students, yet the manner by which they uniquely contribute to alcohol intoxication remains unclear.

Objective

The current study examined the unique utility of drinking location and pregaming in predicting alcohol intoxication among college students who violated campus alcohol policy.

Method

Between 2011 and 2012, mandated college students who reported drinking prior to their referral events (N = 212, 41% female, 80% White, Mage = 19.4 y) completed a computerized assessment of drinking location and related behaviors as part of larger research trial. Chi-squared statistics, t-tests, one-way analyses of covariance, and regression were used to examine study aims.

Results

Participants were most likely (44%) to report drinking in off-campus housing prior to the referral event, and approximately half (47%) reported pregaming. Alcohol intoxication on the night of the referral event differed significantly as a function of both drinking location and pregaming, but pregaming did not moderate the association between drinking location and alcohol intoxication among mandated students. Female birth sex, pregaming, and drinking at either fraternities or off-campus housing predicted greater levels of alcohol intoxication on the night of the referral incident, while drinking in a residence hall/dorm predicted lower intoxication.

Conclusions/importance

Drinking location and pregaming are distinct predictors of alcohol intoxication among mandated college students. Future interventions may benefit from targeting both where and how college students consume alcohol.

Background

Pregaming, also known as frontloading or predrinking, is a common but risky drinking behavior among college students. However, little is known about the way in which a brief motivational intervention (BMI) addressing general alcohol use and consequences may impact pregaming frequency.

Objectives

This study examined whether mandated students reduced frequency of pregaming following a BMI when pregaming was spontaneously discussed and whether gender moderated these effects.

Methods

Participants (n = 269, 32% female) were mandated college students who had received a campus-based alcohol citation and continued to exhibit risky alcohol use six weeks after receiving a brief advice session. Participants were randomized to a brief motivational intervention (BMI, n = 145) or assessment only (AO, n = 124) and completed follow-up assessments at 3, 6, and 9 months postintervention. Hierarchical Linear Modeling (HLM) was used to examine both between-person (Level 2) effects (i.e., condition) and within-person (Level 1) effects (i.e., time) on pregaming frequency. Analyses examining discussions of pregaming within the BMI were conducted using a subsample of the BMI sessions which had been transcribed (n = 121).

Results

Participants in the BMI group did not significantly reduce the frequency of pregaming compared to those in the AO group, even when pregaming was explicitly discussed during the BMI. Moreover, the BMI was equally ineffective at reducing pregaming frequency for both males and females. Conclusion/Importance: Pregaming frequency appears to be resistant to conventional intervention efforts, but recent research suggests several innovative strategies for addressing pregaming in the college student population.

Objective

Concurrent use of marijuana and alcohol among college students is highly prevalent and associated with negative consequences. It remains unclear whether marijuana use is influenced by or lessens the efficacy of alcohol interventions delivered within a stepped-care approach.

Method

Participants were 530 college students who violated campus alcohol policy and were mandated to an alcohol-focused brief advice (BA) session. Participants who reported continued risky alcohol use (4+ heavy drinking episodes and/or 5+ alcohol-related consequences in the past month) six weeks following the BA session were randomized to a brief motivational intervention (BMI; n=211) or assessment only (AO; n=194) condition. Follow-up assessments were conducted 3, 6, and 9months' post-intervention.

Results

Multiple regression analyses revealed that marijuana user status did not influence drinking outcomes following the BA session. However, hierarchical linear models suggested that marijuana users who were randomized to BMI or AO reported higher levels of binge drinking, pBAC and consequences compared to non-users, regardless of condition. Despite this, heavy drinking marijuana users and nonusers had equivalent reductions on alcohol use outcomes following the BMI sessions. Marijuana users who received a BMI did not significantly reduce marijuana use frequency compared to participants in the AO group.

Conclusion

Use of marijuana did not lessen the efficacy of the BA session on alcohol use or consequences. Findings suggest that marijuana users respond similarly to alcohol interventions as do non-users and can benefit from brief or more intensive alcohol interventions. A marijuana-focused intervention may be warranted to facilitate changes in marijuana use.

Youth involved in the juvenile justice system are at elevated risk for suicide and co-occurring mental health symptoms. This study aims to examine the suicide risk and treatment needs of court-involved, non-incarcerated (CINI) youth, and to understand the acceptability and effectiveness of implementing a mental health screening procedure at time of first court contact. By embedding a forensic mental health screening tool into the intake process of a family court diversionary program, a total of 891 youth (aged 12-18) were assessed using the Massachusetts Youth Screening Instrument-2 (MAYSI-2). Analysis of screening responses revealed 12.5% of youth indicated risk for suicide with risk levels differentiated by youth sex, race and ethnicity. Suicide ideation was also significantly associated with flagging, an indication of clinical risk, on all other scales of the MAYSI-2, as well as subsequent referrals to treatment. Screening for suicide at first point of court contact within an existing diversionary program may serve as a critical and effective point of intervention for youth in need.

College students frequently engage in drinking games (DGs) and experience a variety of consequences as a result. It is currently unknown whether brief motivational interventions (BMIs) that provide feedback on DG participation can reduce this high risk behavior. This study examined outcome data from 2 randomized clinical trials to examine whether BMIs facilitate change in DG frequency and how these changes may occur. Mandated college students (Trial 1, N = 198, 46% female; Trial 2, N = 412; 32% female) were randomized to BMI or comparison control conditions. Hierarchical linear modeling (HLM) was used to compare the BMI and comparison groups to determine whether the BMI reduced DG participation over time. Percent change talk (PCT) during the discussion of DG during the session was examined as a predictor of change in DG frequency, and gender was examined as a moderator of treatment effects. Controlling for regular drinking frequency, participants who received a BMI did not significantly reduce their DG frequency relative to the comparison group in either sample, and the BMI was equally ineffective at reducing DG behavior for men and women. DG-related PCT during the BMI was associated with lower DG frequency at the second follow-up in both trials. In Trial 1, PCT during the BMI was associated with less steep increases in DG frequency across the course of all follow-ups. Effects of PCT on DG behavior were not moderated by gender. Findings did not support hypothesized reductions in DG participation following a BMI. Future research should explore whether targeted DG-specific interventions could reduce DG participation and the role of in-session client language in facilitating such change. (PsycINFO Database Record

Stepped care approaches for mandated college students provide individual brief motivational interventions (BMI) only for individuals who do not respond to an initial, low-intensity level of treatment such as Brief Advice (BA). However, how BMIs facilitate change in this higher-risk group of mandated students remains unclear. Perceived descriptive norms and alcohol-related expectancies are the most commonly examined mediators of BMI efficacy but have yet to be examined in the context of stepped care. Participants were mandated college students (N = 598) participating in a stepped care trial in which mandated students first received BA. Those who reported continued risky drinking 6 weeks following a BA session were randomized to either a single-session BMI (N = 163) or an assessment-only comparison condition (AO; N = 165). BMI participants reduced alcohol-related problems at the 9 month follow up significantly more than AO participants. Multiple mediation analyses using bootstrapping techniques examined whether perceived descriptive norms and alcohol-related expectancies mediated the observed outcomes. Reductions in perceptions of average student drinking (B = -.24; 95% CI [-.61, -.04]) and negative expectancies (B = -.13; 95% CI [-.38, -.01]) mediated the BMI effects. Furthermore, perceived average student norms were reduced after the BMI to levels approximating those of students who had exhibited lower risk drinking following the BA session. Findings highlight the utility of addressing perceived norms and expectancies in BMIs, especially for students who have not responded to less intensive prevention efforts.