A family-focused middle school intervention can effectively reduce substance use initiation in the short-term, as well as reduce later rates of alcohol use disorders (AUDs) and alcohol misuse in Mexican American adolescents at increased risk for problem drinking, according to the results of a randomized clinical trial published in JAMA Psychiatry.
Nancy A. Gonzales, PhD, of the Department of Psychology and REACH Institute, Arizona State University, Tempe, Arizona, and colleagues conducted a study in Mexican American 7th graders and recruited 3 annual cohorts of families from the rosters of 4 middle schools and randomly assigned them to the 9-session Bridges/Puentes family-focused group intervention or a workshop control condition. Recruitment, screening, pretest, and randomization occurred in the same academic year for each cohort: 2003 to 2004, 2004 to 2005, and 2005 to 2006. Follow-up assessments for late-adolescent alcohol misuse and abuse were conducted from September 2009 to September 2014. The primary outcome was diagnostic assessment of lifetime AUD in the 12th grade, 5 years following the intervention.
Of the 420 adolescents who participated, 51.2% were girls. The intervention reduced the risk of having an AUD (β = −0.93; P =.047; odds ratio [0R], 0.39). Baseline substance abuse moderated intervention associations with past-year alcohol use frequency, binge drinking, and drunkenness. The intervention also reduced the frequency of alcohol use (β = −0.51; P =.04; Cohen d = 0.43) and drunkenness (β = −0.51; P =.049; Cohen d = 0.41) in adolescents who reported any substance use at baseline (T1 initiators) but not in adolescents who had not initiated any substance use (T1 abstainers) at baseline. The effects of the intervention on past-year binge drinking did not reach statistical significance in either T1 initiators or abstainers.
The investigators noted that the power to test whether the intervention had stronger associations with disorder diagnoses for early initiators was limited and would have been strengthened by a larger sample. The Mexican American focus, while addressing the gap in research in this population, limits the generalizability to other populations. However, the researchers argue that because even moderate reductions in adolescent drinking and AUD have the potential to reduce short- and long-term public health harms, these findings support broad implementation of the program.
Gonzales NA, Jensen M, Tien JY, Wong JJ, Dumka LE, Mauricio AM. Effect of middle school interventions on alcohol misuse and abuse in Mexican American high school adolescents: five-year follow-up of a randomized clinical trial [published online March 21, 2018]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2018.0058