Practice Profile: School-Based Brief Interventions for Substance Use Among Youth

This practice consists of time-limited, low-dose therapeutic programs delivered in a school or educational setting that teach skills and encourage motivation to change or prevent substance use in youth participants. This practice is rated Effective for reducing alcohol use but was rated Ineffective for reducing marijuana use.

Practice Goals/Target Population

Brief substance use interventions are time-limited, low-dose therapeutic programs that teach skills and encourage motivation to change or prevent risky substance-use behaviors in youth participants. School-based, brief substance-use interventions are delivered to youths in a middle, high, or secondary school setting or vocational education and training setting. The interventions can be used as universal, selective, or indicated prevention (CSAT, 1999).

Practice Theory

Brief interventions were developed on the assumption that people are not always ready to change their patterns of substance use (Carey et al., 2016). The theoretical basis for this practice is grounded in the transtheoretical model of behavior change. The transtheoretical model of behavior change argues that readiness for change develops along a series of stages rather than as a fixed event that either occurs or does not occur. These steps are precontemplation, contemplation, preparation, action, and maintenance. Individuals usually move through these stages before reaching termination (Prochaska, 1993). From this perspective, motivation is seen as a state that can be altered rather than as a fixed trait in an individual.

Practice Components

Brief interventions are targeted, time-limited, low-threshold services that aim to reduce substance use and its associated risks and to prevent progression to more severe levels of use and potential negative consequences (Babor et al., 2007). Interventions are delivered in person and provide information or advice, increase motivation not to use substances, and teach behavior change skills with the aim of reducing substance use.

Brief interventions vary in length and delivery format but typically last from one to five sessions (Moyer et al., 2002; Tevyaw and Monti, 2004). Although most brief interventions include a screening of potential participants, this element is typically not included in school-based interventions (Hallfors et al., 2006). In addition to advice-giving, the common elements of a successful intervention are referred to by the acronym FRAMES, which stands for the following:

• Feedback on behavior and its consequences to the client
• Responsibility for change as the responsibility of the individual
• Advice for change
• Menu of options for change
• Empathy
• Self-efficacy for change (Bien, Miller, and Tonigan, 1993)

Brief interventions are offered through a variety of modalities. The most common brief intervention program modalities for substance use involve cognitive–behavioral/skills training, motivational enhancement, and/or psychoeducational therapy. Cognitive–behavioral/skills training modalities focus on how individuals’ cognitions affect their actions and might involve, for instance, teaching and practicing skills for identifying and dealing with risky drinking situations. Motivational enhancement modalities use a motivational interviewing approach to concentrate on enhancing participants’ motivations to self-evaluate and self-regulate their behavior and often involve goal-setting or contracting and decisional balance exercises. Psychoeducational prevention modalities, in contrast, tend to be less interactive, and are typically didactic presentations focused on providing information and education about alcohol and alcohol-related harmful behavior.

Hennessy and Tanner–Smith (2015) conducted moderator analyses to examine the delivery format of school-based brief substance-use interventions on youth alcohol use. Delivery format was measured as individually-delivered (individual with provider) or group delivered (group with provider). The results showed that individually delivered, school-based, brief substance-use interventions had a statistically significant effect on reducing youth alcohol use, compared with group format interventions, which did not have a statistically significant effect on reducing alcohol use with youth.

These sources were used in the development of the practice profile:

These sources were used in the development of the practice profile:

Babor, Thomas F., Bonnie G. McRee, Patricia A. Kassebaum, Paul L. Grimaldi, Kazi Ahmed, Jeremy W. Bray. 2007. “Screening, Brief Intervention, and Referral to Treatment (SBIRT).” Substance Abuse 28(3):7–30.

Bien, Thomas H., William R. Miller, and J. Scott Tonigan. 1993. “Brief Interventions for Alcohol Problems: A Review. Addiction 88(3):315–36.

(CSAT) Center for Substance Abuse Treatment. 1999. Brief Interventions and Brief Therapies for Substance Use. Treatment Improvement Protocol (TIP) Series 34. Rockville, Md.: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment. DHHS Publication No. SMA 99–3353.

Hallfors, Denise Dion, Hyunsan Cho, Paul Henry Brodish, Robert L. Flewelling, and Shereen Khatapoush. 2006. “Identifying High School Students ‘At Risk’ for Substance Use and Other Problems: Implication for Prevention.” Substance Use and Misuse 41:1–15.

Miller, William R., and Stephen Rollnick. 2002. Motivational Interviewing: Preparing People to Change Addictive Behavior, Second Edition. New York, N.Y.: Guilford Press.

Moyer, Anne, John W. Finney, Carolyn E. Swearingen, and Pamela Vergun. 2002. “Brief Interventions for Alcohol Problems: A Meta-Analytic Review of Controlled Investigations in Treatment-Seeking and Nontreatment Seeking Populations.” Addiction 97:279–92.

Prochaska, James O., Carlo C. DiClemente, and John C. Norcross. 1993. “In Search of How People Change: Applications to Addictive Behaviors.” Journal of Addictions Nursing 15(1):2–16.

Tanner-Smith, Emily E., and Mark W. Lipsey. 2015. “Brief Alcohol Interventions for Adolescents and Young Adults: A Systematic Review and Meta-Analysis.” Journal of Substance Abuse Treatment 51:1–18. 

Tevyaw, Tracy O’Leary, and Peter M. Monti. 2004. “Motivational Enhancement and Other Brief Interventions for Adolescent Substance Abuse: Foundations, Applications, and Evaluations.” Addiction 99:63–75.

Following are CrimeSolutions-rated programs that are related to this practice:

Cognitive Behavioral Therapy Plus Mindfulness Meditation for Adolescent Alcohol Consumption (Australia)

Brief Alcohol Screening and Intervention of College Students (BASICS)

STARS (Start Taking Alcohol Risks Seriously) for Families

Why might a practice's outcome ratings differ from the ratings of specific programs encompassed by that practice?