Search

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

PURPOSE: To describe patterns and predictors of HIV risk behaviors among ethnically diverse, low-income adolescents. METHODS: Computer-assisted surveys were administered to 1172 adolescents between the ages of 12 and 17 years living in 15 low-income housing developments in three urban areas in the United States to characterize and identify predictors of HIV risk behavior. Data were analyzed using multinomial logistic regression to identify variables predictive of 'no risk,' 'lower risk,' and 'higher risk' group classification. RESULTS: Most adolescents were not yet sexually active; nonetheless, a subset of youth reported high rates of HIV risk-related behaviors. HIV risk was highest among adolescents who were older, had weaker intentions to reduce risk, stronger beliefs that their sexual partners did not favor risk-reduction, lower risk-reduction behavioral skills, higher risk-reduction outcome expectation, and higher rates of substance use. CONCLUSIONS: HIV prevention efforts are needed that are tailored to ethnically diverse communities of adolescents, including those in early adolescence and those at highest risk. [ABSTRACT FROM AUTHOR]

Successfully meeting recruitment goals is critical in completing clinical research, but it is often one of the most difficult challenges in conducting a study. This paper describes the recruitment effort for a randomized controlled trial of a brief intervention targeting ambivalent marijuana smokers. The project successfully recruited 188 heavy marijuana smokers, the majority of whom were precontemplators or contemplators in respect to their motivation to make changes. A theoretical model of social marketing is utilized in discussing the development and evaluation of this study's recruitment efforts. The model is potentially useful in the planning and initial implementation phases of recruitment strategies, both in efficacy studies and in community treatment settings. [ABSTRACT FROM AUTHOR]

A sizable number of individuals at risk of becoming HIV infected or infecting others either do not access or drop out of AIDS prevention programs. Attrition is a relevant concern for HIV prevention research and practice alike as nonparticipation (enrolling in but never attending an intervention) and dropout (beginning but not completing an intervention) can affect internal and external validity, detrimentally impact the service provider's morale and standing with funders, and potentially lead to poor outcomes for target populations. Understanding how individual factors including demographic and developmental characteristics and programmatic factors such as intervention dosage and venue are related to attrition and how to attract and retain individuals in proven interventions is crucial to prevention efficacy in the third decade of HIV prevention. In this paper, we provide an overview of factors associated with attrition from HIV counseling interventions, offer remedies for practitioners and researchers, and provide a case analysis of a brief motivational enhancement counseling intervention that was designed, in part, to avoid some of the traditional reasons individuals do not enroll in or drop out of HIV prevention programs. [ABSTRACT FROM AUTHOR]

We conducted a randomized controlled pilot intervention to evaluate the efficacy of a telephone-based brief counseling intervention to reduce sexual risk taking among men who have sex with men (MSM) in Seattle, Washington. The study targeted individuals who were currently engaging in unsafe sex but were not committed to making changes toward safer behaviors. Counselors used motivational interviewing strategies in a single 90-min session to enhance readiness for change, promote greater intentions to use condoms, and to support safer sex practices. Results are based on 89 MSM randomly assigned to Immediate counseling or a Delayed counseling control condition. Among minority participants, Immediates were significantly less likely to have engaged in unprotected anal intercourse at follow-up, compared to Delays. Immediate participants reported significantly less ambivalence about practicing safer sex at follow-up, and tended to report greater increases in intentions to use condoms. These findings support the potential efficacy of a brief intervention based upon motivational enhancement principles for promoting safer sex practices among at-risk MSM. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Women in impoverished inner-city neighborhoods are at high risk for contracting HIV. A randomized, multisite community-level HIV prevention trial was undertaken with women living in 18 low-income housing developments in 5 US cities. METHODS: Baseline and 12-month follow-up population risk characteristics were assessed by surveying 690 women at both time points. In the 9 intervention condition housing developments, a community-level intervention was undertaken that included HIV risk reduction workshops and community HIV prevention events implemented by women who were popular opinion leaders among their peers. RESULTS: The proportion of women in the intervention developments who had any unprotected intercourse in the past 2 months declined from 50% to 37.6%, and the percentage of women's acts of intercourse protected by condoms increased from 30.2% to 47.2%. Among women exposed to intervention activities, the mean frequency of unprotected acts of intercourse in the past 2 months tended to be lower at follow-up (mean = 4.0) than at baseline (mean = 6.0). These changes were corroborated by changes in other risk indicators. CONCLUSIONS: Community-level interventions that involve and engage women in neighborhood-based HIV prevention activities can bring about reductions in high-risk sexual behaviors. [ABSTRACT FROM AUTHOR]

Although AIDS rates have leveled among older gay men in large original epicenters, HIV seroincidence remains high among young men who have sex with men (MSM) in many areas of the country. This research examined patterns of risk behavior among young (age 25 years or less) and older (age 26 years and over) MSM. Nearly 2,000 men entering gay bars in 16 small U.S. cities completed an anonymous survey of their sexual practices in the past 2 months and of psychosocial risk-related characteristics. Young men were more likely than older men to have engaged in unprotected anal intercourse and, specifically, receptive intercourse in the past 2 months. Younger men also reported more frequent occurrences of unprotected anal intercourse. A progressive decline in risk behavior levels was associated with increasing age. Young men less often personally knew someone who had died of AIDS, and deaths were not primarily within their close social networks. Continued HIV prevention efforts directed toward young MSM are needed, including cities traditionally considered as second tier with respect to AIDS. [ABSTRACT FROM AUTHOR]

Objectives. Women who have sex with women are a relatively hidden group that has been overlooked in most AIDS research and prevention efforts, primarily because the efficiency of HIV transmission between female partners is believed to be low. Although data are scant, it is commonly assumed that members of this population are not at high risk for HIV infection. However, a recent study of lesbian and bisexual women living in the San Francisco Bay area reported a relatively high seroprevalence rate and has raised additional questions about this group's HIV risk. The present study, the first to focus on lesbian and bisexual women living outside major AIDS epicenters, provides additional evidence. It describes risk factors for HIV transmission among lesbian and bisexual women living in small cities in four geographic regions of the United States. Methods. On three consecutive evenings in 1992, members of the research team distributed anonymous structured written surveys to women patrons as they entered gay bars in each of 16 small cities. Results. Almost 17% of bisexual respondents and 0.5% of lesbians reported having had unprotected vaginal or anal sex with a male during the two months prior to the survey. Almost 10 percent of bisexual women and 8.8% of lesbians in the sample reported a history of injection drug use. Among those women surveyed who said they had been tested, 1.4% reported they were infected with HIV. Conclusions. Self-identified sexual orientation was highly consistent with recent sexual behavior. HIV risk related to sexual behavior was concentrated among self identified bisexual women. The prevalence of injection drug use was substantial among both bisexual and lesbians. Developers of HIV risk behavior programs should take the prevalence of these risk behaviors into consideration in the design of effective HIV prevention interventions tailored to the needs of this hidden population. [ABSTRACT FROM AUTHOR]

The prevalence of increases in human immunodeficiency virus infection and illness rates among urban disadvantaged women underscore the urgent need for acquired immunodeficiency syndrome prevention interventions for high-risk women. Few studies, however, have examined the factors contributing to risk in this population or predictors of risk taking and risk reduction. A total of 148 women, most of them of racial minorities, living in low-income public housing developments completed measures designed to assess risk for human immunodeficiency virus infection and to analyze factors related to risk taking, including knowledge about acquired immunodeficiency syndrome, behavior change self-efficacy, intention to use condoms, and social norm perception about safer sex practices. History of sexually transmitted diseases, low rates of condom use, and relationships with men who were injection drug users or who were not sexually exclusive were commonly reported. Women were divided into high- or low-risk categories based on behavior during the two preceding months. Women at low risk believed more strongly in personal efficacy of behavior change, were more committed to using condoms, and perceived risk reduction steps as more socially normative than high-risk women. Culturally tailored human immunodeficiency virus prevention interventions that address these dimensions are needed. [ABSTRACT FROM AUTHOR]

Despite considerable self-initiated HIV risk reduction among men who have sex with men, little is known about how to design interventions that will effectively assist individuals from this population in maintaining safer sex behaviors over time. The present study evaluated the effectiveness of a 17-session group counseling intervention that incorporated components based on a cognitive-behavioral model of relapse. Differential behavioral outcomes following treatment included an increase in the percentage of sexual activities that were protected and a decrease in unprotected oral sex. However, considerable risk reduction (e.g., increased condom use, decreased unprotected sex, and decreases in the number of male partners and in the total number of sexual acts) occurred in both treated and untreated participants. Measures of mediating attitudinal variables drawn from relapse prevention theory largely predicted behavioral changes. Over time, several of the risk reduction behaviors achieved at posttreatment were not maintained, suggesting the importance of further developing effective strategies for supporting behavior change maintenance. [ABSTRACT FROM AUTHOR]

A 14-session cognitive-behavioral group counseling intervention designed to assist gay and bisexual males in reducing their risk of HIV transmission was evaluated in an experimental design. To overcome psychological and geographic barriers to serving individuals at risk, the counseling sessions and all data collection interviews were conducted via telephone. Participants had the option of enrolling anonymously, and a toll-free number was made available. At reassessment, treatment group participants were 80% less likely than controls to report any unprotected anal sex, and were nearly twice as likely to report some condom use with anal and oral sex. Treated participants also reported a significantly greater decline than controls in the proportion of anal sex acts that were unprotected by condoms. While those who were treated maintained a lower risk level over the year following treatment, their initial increase in condom utilization was not maintained. Delivering counseling interventions via the telephone, when coupled with the option for participating anonymously, holds considerable promise in overcoming barriers to reaching and effectively facilitating risk reduction in high-risk populations. [ABSTRACT FROM AUTHOR]

Among 340 gay and bisexual males who enrolled in a 14-session HIV-prevention group counseling program delivered by telephone, 21.2% (n = 72) failed to attend any counseling sessions, 10% (n = 34) dropped out early, 18.9% (n = 64) dropped out late, and 50% (n = 170) completed counseling. Those who did not complete counseling tended to be younger, have lower levels of income, be less gay-identified, and experience logistical barriers to participation. Entering a new committed relationship after enrolling in the program was also associated with earlier attrition from treatment. Individuals with higher baseline levels of high-risk sexual behaviors, and those with lower motivation or confidence in changing, were not differentially vulnerable to attrition from the intervention. However, treatment completers reported more positive outcomes at follow-up relative to those who left the program. This finding underscores the importance of greater tailoring of preventive interventions in order to more successfully retain the non-gay-identified individual, and to reduce logistical impediments to participation. Other important implications pertain to countering possibly inaccurate risk perceptions concerning the absence of HIV transmission risk within committed relationships. [ABSTRACT FROM AUTHOR]

OBJECTIVES. This study describes the prevalence and predictors of human immunodeficiency virus (HIV) risk behaviors among women living in low-income, inner-city housing developments. METHODS. Anonymous questionnaires were administered to 671 women living in 10 inner-city, low-income housing developments in five US cities to determine their levels of HIV risk behavior and predictors of HIV risk practices. RESULTS. Approximately one third of women were at high risk for HIV because of the risk behavior of their sexual partners. HIV risk was highest among women who accurately perceived themselves to be at increased HIV risk, held strong beliefs about barriers to condom use, and reported weak behavioral intentions to reduce risk. Women at higher risk were also younger and reported higher rates of alcohol and substance use. CONCLUSIONS. HIV prevention efforts are needed for inner-city women. Interventions should focus on overcoming women's barriers to condom use, strengthening their intentions to change behaviors, and managing the risk related to their use of substances. [ABSTRACT FROM AUTHOR]

Background: Community-level interventions may be helpful in population-focused HIV prevention. If members of populations at risk of HIV infection who are popular with other members can be engaged to advocate the benefits of behaviour change to peers, decreases in risk behaviour may be possible. We assessed a community-level intervention to lower the risk of HIV infection, focusing on men patronising gay bars in eight small US cities.Methods: We used a randomised community-level field design. Four cities received the intervention and four control cities did not. Participants were men from each city who went to gay bars. Men completed surveys about their sexual behaviour on entering the bars during 3-night periods at baseline and at 1-year follow-up. In the control cities, HIV educational materials were placed in the bars. In the intervention cities, we recruited popular homosexual men in the community and trained them to spread behaviour-change endorsements and recommendations to their peers through conversation.Findings: Population-level of risk behaviour decreased significantly in the intervention cities compared with the control cities at 1-year follow-up, after exclusion of surveys completed by transients and men with exclusive sexual partners in a city-level analysis, in the intervention cities we found a reduction in the mean frequency of unprotected anal intercourse during the previous 2 months (baseline 1.68 occasions; follow-up 0.59: p = 0.04) and an increase in the mean percentage of occasions of anal intercourse protected by condoms (baseline 44.7%; follow-up 66.8%, p = 0.02). Increased numbers of condoms taken from dispensers in intervention-city bars corroborated risk-behaviour self-reports.Interpretation: Popular and well-liked members of a community who systematically endorse and recommend risk-reduction behaviour can influence the sexual-risk practices of others in their social networks. Natural styles of communication, such as conversations, brought about population-level changes in risk behaviour. [ABSTRACT FROM AUTHOR]

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., Competing Interests: Conflict of InterestAuthors declare they have no conflicts of interest., (© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022.)

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., (Copyright © 2021 Elsevier Inc. All rights reserved.)

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., (Copyright © 2020 Elsevier Inc. All rights reserved.)

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., Competing Interests: Declaration of conflicting interests:The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

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., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

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, ((c) 2017 APA, all rights reserved).)

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., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

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, ((c) 2016 APA, all rights reserved).)

Background: Heavy cannabis use has been associated with negative outcomes, particularly among individuals who begin use in adolescence. Motives for cannabis use can predict frequency of use and negative use-related problems. The purpose of the current study was to assess change in motives following a motivational enhancement therapy (MET) and cognitive behavioral therapy (CBT) intervention for adolescent users and assess whether change in motives was associated with change in use and self-reported problems negative consequences., Methods: Participants (n=252) were non-treatment seeking high school student cannabis users. All participants received two sessions of MET and had check-ins scheduled at 4, 7, and 10 months. Participants were randomized to either a motivational check-in condition or an assessment-only check-in. Participants in both conditions had the option of attending additional CBT sessions. Cannabis use frequency, negative consequences, and motives were assessed at baseline and at 6, 9, 12, and 15 month follow-ups., Results: There were significant reductions in motives for use following the intervention and reductions in a subset of motives significantly and uniquely predicted change in problematic outcomes beyond current cannabis use frequency. Change in motives was significantly higher among those who utilized the optional CBT sessions., Conclusions: This study demonstrates that motives can change over the course of treatment and that this change in motives is associated with reductions in use and problematic outcomes. Targeting specific motives in future interventions may improve treatment outcomes., Competing Interests: No conflict declared., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Motives for marijuana use are important predictors of problematic outcomes associated with marijuana use. Most measures, to date, were developed by adapting alcohol motives measures. However, the Comprehensive Marijuana Motives Questionnaire (CMMQ) was created using a bottom-up approach to evaluate twelve distinct motives for use. The CMMQ was developed and validated in a normative college population. As such, no known study has evaluated the factor structure and utility of the CMMQ in a heavy-using, high school student population. The current study utilized a sample of 252 heavy marijuana-using high school students recruited for a combination motivational enhancement/cognitive behavioral intervention. Results from baseline measures indicated that the factor structure of the CMMQ was maintained in this population. Results from multiple regression analyses revealed distinct relationships with measures of negative consequences of use, including indices of marijuana use, marijuana-related problems, self-efficacy, and internalizing and externalizing symptoms. In particular, the Coping motive was associated with several negative outcomes, which is consistent with previous marijuana and alcohol motives literature. Results suggest that the CMMQ may be useful in assessing marijuana motives among heavy marijuana-using adolescents., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

General causality orientations are motivational styles that are indicative of a person's belief about personal change and their motivation to change. The purpose of the current study was to investigate whether causality orientations were associated with marijuana treatment outcomes in a sample of marijuana-dependent individuals. A total of 74 participants (66% male) were recruited from the Seattle, Washington area and randomly assigned to receive a combination of motivational enhancement and cognitive behavioral therapy or the combination treatment plus additional "check-up" sessions. Follow-up assessments evaluated frequency of use, use-related problems, and marijuana use disorder symptoms through 9months. Causality orientations were relatively stable over time. Posttreatment Autonomy orientations were associated with lower frequency of use and Controlled orientations were associated with a reduction in use, problems, and marijuana use disorder symptoms. Autonomy and Controlled orientations were associated with readiness to change. Results suggest that both autonomous and controlled orientations have implications for response to treatment; perhaps for different reasons. Causality orientations may be a promising avenue of research to predict treatment response and outcome., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background: Motives for use have been identified as important predictors of substance use and related problems; however, little is known about how motives for use change following an intervention and how this change may impact future substance use behaviors. The present study sought to describe change in motives following an intervention for marijuana-dependent adults. Furthermore, investigators examined change in motives as a predictor of treatment outcome., Method: The study randomized 74 adults to one of two conditions: both of which received 9-sessions base treatment of cognitive behavioral therapy and motivational enhancement therapy and had access to additional sessions of cognitive behavioral treatment on an as-needed basis. The experimental condition received two additional "check-ups" during the course of follow-up., Results: Significant decreases in reported frequency of motives used were observed following treatment. Changes in Expansion and Coping were associated with differential treatment outcomes. Decreases in Expansion were associated with poorer treatment outcome, while decreases in Coping were associated with better treatment outcome., Conclusions: The relationship between expansion motives and outcomes was paradoxical. Although there were some inconsistencies in the findings, the results regarding the coping motive were consistent with hypotheses and may have important implications for treatment., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Research and theory strongly support the importance of situational determinants of substance use as targets for intervention, but few studies have systematically examined situational use characteristics in marijuana dependent adults. The present study describes situational use of marijuana in a population of 87 marijuana dependent adults and reports relationships with outcomes of treatment. Use in negative affective situations was independently associated with psychological distress, maladaptive coping strategies, lower self-efficacy, and poorer outcomes post-treatment. The findings were consistent with research on using drugs to cope with negative affect providing evidence of convergence between two different methods of assessing high risk situations for substance use. The results support continued emphasis on coping with negative affect as a target in treatments for marijuana dependence., (© 2013.)

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.

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.

The association between childhood exposure to domestic violence and later intimate partner violence (IPV) perpetration in adulthood has been well established in the literature. However, the literature examining the factors of exposure that contribute to perpetration in adulthood is fraught with mixed findings, with some studies finding a direct link between childhood domestic violence exposure and later IPV perpetration and others ruling out a link after controlling for other contextual barriers such as community violence and socioeconomic status. This study examined 124 non-treatment-seeking and unadjudicated adult male IPV perpetrators and found exposure to domestic violence in childhood contributes to the normalization of violence, which could predict future adult IPV perpetration. Practice implications are discussed, namely primary and secondary prevention of intimate partner violence.

Adolescence is a time in which individuals are particularly likely to engage in health-risk behaviors, with marijuana being the most prevalent illicit drug used. Perceptions of others' use (i.e., norms) have previously been found to be related to increased marijuana use. Additionally, low refusal self-efficacy has been associated with increased marijuana consumption. This cross-sectional study examined the effects of normative perceptions and self-efficacy on negative marijuana outcomes for a heavy using adolescent population. A structural equation model was tested and supported such that significant indirect paths were present from descriptive norms to marijuana outcomes through self-efficacy. Implications for prevention and intervention with heavy using adolescent marijuana users are discussed.

The present investigation examined the relationships between motives for cannabis use and negative consequences associated with cannabis use following a brief intervention. The sample consisted of 205 adolescent cannabis users (66.3% male), who were recruited in high schools and randomly assigned to a brief two-session motivational enhancement therapy (MET) or an educational feedback control (EFC). Results supported the hypothesis that using cannabis to cope with negative affect would predict the number of problems and dependence symptoms related to cannabis use, after controlling for age, gender, years and frequency of cannabis use, and internalizing and externalizing behavior problems. Significant interactions between internalizing behavior problems and the coping motive showed that using to cope was associated with a higher number of cannabis dependence symptoms among adolescents reporting lower levels internalizing behavior problems. Findings support the potential utility of conducting further research to explore the coping motive as an important indicator of problematic cannabis use., ((c) 2011 APA, all rights reserved.)

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.

Aims: The Marijuana Treatment Project, a large multi-site randomized clinical trial, compared a delayed treatment control condition with a brief (two-session) and extended (nine-session) multi-component treatment among 450 marijuana-dependent participants. In this report we present treatment process data, including the fidelity of treatment delivery in the three community-based treatment settings as well as the relationships between treatment process and outcome., Design: Independent evaluations of clinician adherence and competence ratings were made based on 633 videotaped sessions from 163 participants. Relationships between clinician adherence and competence, ratings of the working alliance and marijuana treatment outcomes were evaluated., Findings: Protocol treatments were implemented with strong fidelity to manual specifications and with few significant differences in adherence and competence ratings across sites. In the brief two-session treatment condition, only the working alliance was associated significantly with frequency of marijuana use, but in the extended treatment therapist ratings of working alliance predicted outcomes, as did the interaction of alliance and curvilinear adherence., Conclusions: Behavioral treatments for marijuana use were delivered in community settings with good fidelity. Participant and therapist working alliance scores were associated significantly with improved marijuana use outcomes in a brief behavioral treatment for adults with marijuana dependence. In extended treatment the therapist ratings of working alliance were associated with more positive outcome. However, in that treatment there was also a significant interaction between alliance and curvilinear adherence., (© 2010 The Authors, Addiction © 2010 Society for the Study of Addiction.)

Surprisingly, little is known about how IPV perpetrators perceive the conse quences of their violent behavior. This article describes the development and evaluation of the Perceived Consequences of Domestic Violence Questionnaire (PCDVQ). The PCDVQ is a 27 item self report instrument designed to assess the consequences of intimate partner violence (IPV) as perceived by the perpetrator. Data from 124 nontreatment seeking, male, IPV perpetrators recruited from the community provided support for the internal consistency of the PCDVQ. Participants reported an average of 9.97 (SD = 4.57) consequences. Scores on the PCDVQ significantly predicted motivation for change, beta =.19, t(113) = 2.03, p < .05, and treatment seeking, chi(2)(df = 1) = 10.79, p < .01, odds ratio = 1.27 (95% CI: 1.10 1.46). Clinical implications of this instrument are discussed.

This research was designed to evaluate the applicability of social norms approaches to interventions with male perpetrators of intimate partner violence (IPV). Participants included 124 nonadjudicated IPV perpetrating men recruited from the general population who completed assessment of their own IPV behaviors via telephone interviews and estimated the prevalence of behaviors in other men. Results indicated that IPV perpetrators consistently overestimated the percentage of men who engaged in IPV and that their estimates were associated with violence toward their partner over the past 90 days. Findings provide preliminary support for incorporating social norms approaches into clinical applications.

Although voluntary enrollment by abusive men in domestic violence perpetrator treatment programs occurs, most men enter treatment only after they have injured a partner or family member and have been arrested, convicted and sentenced. This leaves a serious gap for those who engage in abusive behavior but who have not been served by the legal or social service systems. To address this gap, the researchers applied social marketing principles to recruit abusive men to a telephone-delivered pre-treatment intervention (the Men's Domestic Abuse Check-Up-MDACU), designed to motivate non-adjudicated and untreated abusive men who are concurrently using alcohol and drugs to enter treatment voluntarily. This article discusses recruitment efforts in reaching perpetrators of intimate partner violence, an underserved population. Informed by McGuire's communication and persuasion matrix, the researchers describe three phases of the MDACU's marketing campaign: (1) planning, (2) early implementation, and (3) revision of marketing strategies based on initial results. The researchers' "lessons learned" conclude the paper.

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.

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.

Background: Brief and low-burden HIV risk reduction counseling interventions are needed for populations at greatest risk for HIV infection., Purpose: This randomized controlled trial tested a brief theory-based counseling intervention delivered entirely over the telephone for men who engage in unprotected intercourse with men., Methods: Participants received either risk reduction counseling that included information, motivational enhancement and behavior skills building, or brief HIV education counseling. A total of 319 participants completed follow-up assessments over a 10-month period. Descriptive and random effects mixed models are used to evaluate findings., Results: Results demonstrate that a brief telephone intervention can reach and engage high-risk men in risk reduction counseling. Nearly one third of participants identified as men of color; the median age was 33 years. Participants in both counseling conditions increased their motivation and behavioral skills to practice safer sex and reduced their number of sex partners and frequencies of engaging in unprotected anal sex over the study observation period. However, there were few differences between intervention conditions., Conclusions: The effects of repeated measurement reactivity and brief interpersonal consciousness raising may account for the lack of differences between counseling conditions and the decrease in risk for all participants over time.

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.

Countless barriers come between people who are struggling with substance abuse and those charged with providing substance abuse treatment. The check-up, a form of motivational enhancement therapy, is a harm reduction intervention that offers a manner of supporting individuals by lowering specific barriers to reaching those who are untreated. The check-up was originally developed to reach problem drinkers who were neither seeking treatment nor self-initiating change. The intervention, marketed as an opportunity to take stock of one's experiences, involves an assessment and personalized feedback delivered with a counseling style termed motivational interviewing. Check-ups can be offered in care settings to individuals who, as a result of screening, manifest risk factors for specific disorders such as alcoholism. They can also be free-standing and publicized widely to the general public. This paper will discuss illustrations of in-person, computerized, in-school, and telephone applications of the free-standing type of check-up with reference to alcohol consumers, adult and adolescent marijuana smokers, and gay/bisexual males at risk for sexual transmission of HIV. The paper's major focus is to highlight how unique features of each application have the potential of reducing barriers to reaching specific at-risk populations. Also considered are key policy issues such as how check-up services can be funded, which venues are appropriate for the delivery of check-up interventions, pertinent competency criteria in evaluating staff who deliver this intervention, how marketing can be designed to reach contemplators in untreated at-risk populations, and how a check-up's success ought to be defined.

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.

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.

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., (Copyright 2006 APA, all rights reserved.)

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.