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

This program uses psycho–social and present-moment awareness techniques to target adolescents’ alcohol-related cognitions and prevent their alcohol use. The program is rated Promising. Adolescents who received the intervention had reduced growth of alcohol consumption, compared with adolescents in the control group. There were no statistically significant differences between the groups in both negative and positive alcohol expectancies and drinking refusal self-efficacy.

A Promising rating implies that implementing the program may result in the intended outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

A Promising rating implies that implementing the program may result in the intended outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

Program Goals

Research has found that adolescent alcohol use is associated with numerous negative outcomes such as decreased cognitive abilities, increased social problems, and high school noncompletion (Nguyen–Louie et al. 2015; Jennings et al. 2015; Kelly et al. 2015). Brief interventions that meet the unique needs of youth during adolescence have been developed to reduce these consequences. Cognitive Behavioral Therapy (CBT) Plus Mindfulness Meditation for Adolescent Alcohol Consumption was an in-school program that incorporated techniques from both approaches (CBT and mindfulness meditation) to target adolescents’ individual and general risk factors for alcohol use. The goal was to reduce the growth of alcohol consumption in adolescents.

Program Components/Target Population

Mindfulness meditation involves deliberate attention on the present with nonjudgmental acceptance of present-moment experiences (Papies, Barsalou, and Custers 2012). In the program, mindfulness techniques complemented a universal CBT program, which involved the cognitive model of the interplay between and among thoughts, emotions, and behaviors (Beck 1976) and techniques for students to address “unhelpful” cognitions.

The intervention was intended for students in 9th and 10th grades (around 13 to 15 years old) to reach this population before the average age of onset of alcohol use—15.7 years for Australian adolescents (Australian Institute of Health and Welfare 2014). It was designed to be a total of 110 minutes and was delivered over three sessions. The first session involved psychoeducation and an introduction to mindfulness as a technique to reduce inattention and to increase present-moment awareness, with content on mindful eating and mindfulness of the breath and body. The second session introduced students to the cognitive model of the interplay between and among thoughts, emotions, and behavior. Participants were taught techniques to identify, challenge, and change “unhelpful” cognitions, and they participated in Sitting Mindfulness of Thoughts practice. The first two sessions also involved home practice outside of school. The techniques were applied first to general stress and negative emotions. In the third session, they were applied specifically to alcohol use with a hypothetical party exercise.

Key Personnel

The program was delivered by one or two facilitators in class groups of from 8 to 23 students. The intervention was delivered by students completing master’s- or doctoral-level psychology programs who were trained in the intervention by a doctoral-level instructor (Patton et al. 2019).

Program Theory

The biosocial cognitive theory of substance use posits that elevated reward drive (also referred to as trait reward drive, approach motivation, or sensation seeking) may lead to positive alcohol expectancies (positive beliefs about the likely outcomes of alcohol consumption [Connor, Haber, and Hall 2016; Magill et al. 2015]), which leads to increases in alcohol use (Gullo et al. 2010). Further, high rash impulsivity (or trait rash impulsiveness, disinhibition, or lack of premeditation) undermines drinking-refusal self-efficacy (which refers to individuals’ belief in their ability to refuse alcohol), which may also lead to increased use (Gullo et al. 2010). CBT targets alcohol-related cognitions directly and may be able to interrupt the link between impulsivity and cognitions (Loree, Lundahl, and Ledgerwood 2015) and may also affect drinking-refusal self-efficacy through altering alcohol expectancies (Connor, Haber, and Hall 2016; Patton et al. 2019). The mindfulness meditation technique is theoretically consistent with managing rash, inattentive impulses (Papies, Barsalou, and Custers, 2012) and was added to the intervention to increase the efficacy of cognitive behavioral therapy.

Study

Patton and colleagues (2019) conducted a randomized controlled trial to assess the effect of Cognitive Behavioral Therapy Plus Mindfulness Meditation on adolescents’ alcohol consumption, cognitions, and drinking refusal self-efficacy after 6 months.

Twenty-five schools in urban South East Queensland, Australia, were contacted initially for possible inclusion; six of these schools agreed to participate. A total of 468 students in 9th and 10th grades (13 to 17 years old) at the participating schools provided informed consent, and these students were randomized by a cluster randomization procedure using an online random number generator to either 1) the cognitive behavioral therapy plus progressive muscle relaxation intervention, 2) the cognitive behavior therapy plus mindfulness meditation intervention, or 3) the control condition, within class clusters in each school. The CrimeSolutions review of this study focused on the outcomes for the cognitive behavioral therapy plus mindfulness meditation group (n = 130 students, eight classes) that received the intervention as described in the Program Description, compared with the assessment-only control group (n = 133 students, seven classes) that completed the assessment measures only, at Time 4 (6 months postintervention). Assessment measures were completed before the intervention (Time 1), immediately postintervention (Time 2), 3 months postintervention (Time 3), and 6 months postintervention (Time 4).

The outcomes of interest were alcohol use, drinking refusal self-efficacy, and alcohol expectancies. Alcohol use was measured using items from the Alcohol Use Disorders Identification Test that assessed frequency of alcohol use, rated on a five-point scale from 0 (never) to 4 (4 or more times a week); typical quantity of drinks in a single occasion, rated on a five-point scale from 0 (1 or 2) to 4 (10 or more); and frequency of binge drinking (6+ standard drinks), rated on a five-point scale from 0 (never) to 4 (daily or almost daily). Positive and negative alcohol expectancies were measured using the Drinking Expectancy Questionnaire — Adolescent version that comprised two positive expectancy subscales (increased confidence [six items] and tension reduction [five items]) and two negative expectancy subscales (cognitive and motor impairment [five items] and negative mood [four items]). Items were measured on a five-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). Drinking-refusal self-efficacy was measured using the Drinking Refusal Self-Efficacy Questionnaire—Revised Adolescent version, which used a six-point Likert scale ranging from 1 (“I am very sure I could not resist drinking”) to 6 (“I am very sure I could resist drinking”) on a subscale related to the social pressure drinking refusal self-efficacy context (five items).

There were no statistically significant differences between adolescents in the intervention condition and the control condition on demographic, predictor, and outcome measures at baseline. Before the intervention, adolescents in the intervention condition had mean scores of 0.88 for alcohol use; 26.52 for social pressure drinking refusal self-efficacy; 24.37 for positive alcohol expectancies; and 21.57 for negative alcohol expectancies. Adolescents in the control condition had mean scores of 0.97 for alcohol use; 24.36 for social pressure drinking refusal self-efficacy; 25.48 for positive alcohol expectancies; and 22.41 for negative alcohol expectancies at the preintervention assessment. Information on baseline demographic characteristics for the intervention and control conditions was not provided.  

To examine the effect of the intervention on the outcomes of interest, scores for adolescents in the cognitive behavioral therapy plus mindfulness meditation intervention group were compared to scores for adolescents in the assessment-only control group at Time 4 (6 months postintervention). No subgroup analysis was conducted.

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

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

Australian Institute of Health and Welfare. 2014. National Drug Strategy Household Survey Detailed Report: 2013. Canberra, Australian Capital Territory, Australia.

Beck, Aaron T. 1976. Cognitive Therapy and the Emotional Disorders. New York, New York: International University Press.

Connor, Jason P., Paul S. Haber, and Wayne D. Hall. 2016. “Alcohol Use Disorders.” Lancet 387:988–98.

Gullo, Matthew J., Sharon Dawe, Nicolas Kambouropoulos, Petra K. Staiger, and Chris J. Jackson. 2010. “Alcohol Expectancies and Drinking Refusal Self-Efficacy Mediate the Association of Impulsivity With Alcohol Misuse.” Alcoholism: Clinical and Experimental Research 34(8):1386–99.

Jennings, Wesley G., Alex R. Piquero, Michael Rocque, and David P. Farrington. 2015. “The Effects of Binge and Problem Drinking on Problem Behavior and Adjustment Over the Life Course: Findings From the Cambridge Study in Delinquent Development.” Journal of Criminal Justice 43:453–63.

Kelly, Adrian B., Tracy J. Evans–Whipp, Rachel Smith, Gary C.K. Chan, John W. Toumbourou, George C. Patton, Sheryl A. Hemphill, Wayne D. Hill, and Richard F. Catalano. 2015. “A Longitudinal Study of the Association of Adolescent Polydrug Use, Alcohol Use, and High School Noncompletion.” Addiction 110:627–35.

Loree, Amy M., Leslie H. Lundahl, and David M. Ledgerwood. 2015. “Impulsivity as a Predictor of Treatment Outcome in Substance Use Disorders: Review and Synthesis.” Drug and Alcohol Review 34(2):119–34.

Magill, Molly, Brian D. Kiluk, Barbara S. McCrady, J. Scott Tonigan, and Richard Longabaugh. 2015. “Active Ingredients of Treatment and Client Mechanisms of Change in Behavioral Treatments for Alcohol Use Disorders: Progress 10 Years Later.” Alcoholism: Clinical and Experimental Research 39(10):1852–62.

Nguyen–Louie, Tam T., Norma Castro, Georg E. Matt, Lindsay M. Squeglia, Ty Brumback, and Susan F. Tapert. 2015. “Effects of Emerging Alcohol and Marijuana Use Behaviors on Adolescents’ Neuropsychological Functioning Over 4 Years.” Journal of Studies on Alcohol and Drugs 76:738–48.

Papies, Esther K., Lawrence W. Barsalou, and Ruud Custers. 2012. “Mindful Attention Prevents Mindless Impulses.” Social Psychological and Personality Science 3(3):291–99.

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

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.

Evidence Ratings for Outcomes

	Drugs & Substance Abuse - Alcohol
	Drugs & Substance Abuse - Marijuana

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