Brief Intervention For Adolescents Who Start Abusing Alcohol And Other Drugs

In recent decades, an increase in the amount and frequency of alcohol and illicit drug consumption has been observed among Mexican adolescents.  Brief intervention programs effectively reduce substance use and abuse in various populations.  To determine the persuasiveness of the Brief Intervention Program for Adolescents who Begin the Abusive Substancrs of Alcohol and Other Drugs (PIBA) and the maintenance of the change in the young people who attended.

Alcohol Consumption

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When comparing pre-intervention vs. During the follow-up, it was found that the adolescents who participated in the PIBA maintained a reduction in their consumption pattern (amount, frequency, and abstinence time) of alcohol, marijuana, and inhalants; problems associated with consumption decreased; and increased their level of perceived self-efficacy.

The improvement was greater in those who completed the brief intervention than in those who did not complete all the sessions.

Substance Abuse Intervention

The use of psychoactive substances modifies young people’s physical, mental, and behavioral capacities. Each Drug causes specific reactions in the psyche and the organism; consumers seek it for its pleasurable effects or to lessen unpleasant feelings.

social consequences

However, its abuse carries a potential for short- and long-term damage and negative psychological and social consequences in the lives of consumers and their families.

cognitive-behavioral

Brief interventions are cognitive-behavioral psychological therapies of short duration and high effectiveness, with low costs and favorable results in clinical practice.

addictive behaviors

The cognitive-behavioral approach considers that addictive behaviors are over-learned habits that can be modified through self-control techniques.

Self-efficacy

Self-efficacy plays a relevant role in the initiation of drug use, the course of treatment, the maintenance of abstinence, and the prevention of relapses.

Brief interventions based on social learning theory, which also use components of motivational interviewing, relapse prevention, and self-management techniques, have been shown at the international and national levels to be effective for people with problematic drinking patterns who have not yet developed dependence.

 Self-efficacy expectations refer to the individual’s beliefs about her ability to successfully face a situation; they are established, in part, by the individual’s repertoire of coping skills and by the assessment of relative effectiveness, concerning the specific demands of the situation.

They determine whether coping behavior is initiated, the effort required to exert it, and when a coping attempt must be continued in the face of obstacles and aversive experiences.

Self-efficacy influences individual behavior through the motivational, cognitive, and emotional systems.

If a person has low self-efficacy due to a lack of necessary skills, it is expected that they will have negative or distorted thinking and reduced motivation to try to cope.

Planning And Evaluation Of Treatments And Effective Drug Intervention

The results and conclusions derived from the monitoring can contribute to the plan and evaluation of treatments and effective intervention techniques and improve its main components. However, only some studies report follow-ups carried out after a year or more after the conclusion of the brief intervention. Due to the above, the objective of this study was to determine the efficacy of a brief intervention aimed at the adolescent population that begins to abuse alcohol and other drugs through the evaluation of the maintenance of change, carried out through follow-up.

Pre-intervention assessments and follow-ups were performed on each participant. The variables used to determine the program’s effectiveness were:

  • The amount of use.
  • Frequency per week.
  • Negative consequences associated with use.
  • Perceived self-efficacy in quitting substance use.

A novel aspect of the present study was that it allowed us to corroborate the positive results of the PIBA in a setting for training therapists at the master’s level: the Center for Prevention in Addictions of the Faculty of Psychology of the UNAM, whose mission is to promote the professional training of student and, in this way, have an impact on the field of drug use prevention.

The proposed hypothesis was that the adolescents who completed the brief intervention would maintain greater positive changes in the dependent variables evaluated, in contrast to those who dropped out of the brief intervention.

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Instruments, Measurement Techniques

  1. A) Pre-Intervention Measurement Instruments:

  2. Initial Interview

Developed by Saucedo and Salazar in 2004 ( cited in Martínez et al., 2012 ), the initial interview is an instrument that allows obtaining information on various indicators, such as the pattern of substance use, history of use, willingness to change, social situation and family, leisure time management, sexuality, work situation, physical health and adverse consequences associated with the use of substances.

Ii. Problems In Adolescent Screening Questionnaire (Posit)

Developed by the authors Mariño, González-Forteza, Andrade, and Medina-Mora in 1997, the POSIT consists of 81 items that cover seven areas of operation; For this program, only the 17 items from the substance use/abuse area were used. The internal reliability of the instrument is .90, obtained through Cronbach’s α. The purpose of its application is the identification of adolescents who present at least one negative consequence associated with the consumption of psychoactive substances.

  1. B) Measurement Instruments Applied In Monitoring:
  2. Retrospective Baseline (LIBARE)

Developed by Sobell and Sobell in 1979, the LIBARE is used to measure the pattern of substance use (amount and frequency) before, during, and after treatment; With it, three months of consumption are measured at the beginning of the treatment. It

Ii. Situational Confidence Questionnaire Short Form (Ccs)

This instrument was developed by Annis and Davis (1988), who was based on Bandura’s concept of self-efficacy. Users are asked to indicate, on a scale from 0 to 100%, how confident or secure they feel at the present moment to resist the temptation to use a drug in the imaginary situation that arises. The summary of the Situational Confidence Questionnaire consisting of eight items ( Echeverría & Ayala, 1997 ) was used; In this version adapted to the Mexican population, the validity of the construct was adequate when correlating each category with measures of consumption, which made it possible to predict relapse situations.

Iii. Follow-Up Interview

This instrument aims to identify the adolescent’s progress in achieving his goal after the intervention has concluded. The follow-up interview that was used for this research was developed at the CPAHAV, based on the efficacy indicators of brief interventions ( Echeverría & Ayala, 1997 ) and includes the main characteristics that should be evaluated in a follow-up ( Hester & Miller, 1989 ). This research measured the following dimensions: consumption pattern and adverse consequences associated with consumption.

  1. C) Measurement Instruments Applied In Monitoring: 
  1. Collateral Interview

This instrument is complementary to the follow-up interview. It is useful to contrast the information provided by the adolescent with that reported by one of her relatives; It investigates the amount and frequency of the user’s substance use, as well as their relationship and the frequency of meeting the adolescent with her collaterals.

Ii. Informed Consent

Informed consent is a document the user signs if they agree to participate in the research. He explains that the follow-up is intended to support the change process after the intervention, and it discloses the confidentiality of the data reported by the user.

Ethical Considerations

In this study, the activities for data collection complied with the guidelines established by the Psychologist’s Code of Ethics and the American Cognitive Association. The candidates signed an informed consent form in which the characteristics of the intervention are described, the confidential nature of the information is indicated, and the signatories are given the freedom to abandon the treatment at any time they wish without this having an impact on their rights and obligations; The participants, for their part, grant those who carry out the study the possibility of using the data collected for research purposes. The parents or guardians also signed the consent form if the participants were minors.…

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Family Intervention

Family intervention is understood as a set of professional actions carried out when caring for minors by their parents or legal guardians is not sufficiently guaranteed.

Its purpose is to promote in all family members the acquisition of basic skills and behavioral habits necessary to overcome the crisis and vulnerability risk that has given rise to the intervention.

The work is carried out in the natural environment of coexistence to create in the family the ideal conditions for the development of all its members.

The General Objectives Of The Family Intervention Are The Following:

  • Support the family system to reduce the risk indicators detected and promote protectors, thus ensuring adequate care for minors, covering their physical, emotional, cognitive, and social needs.
  • Provide parents, tutors, or guardians with sufficient strategies and tools to acquire/improve their parenting skills.
  • Encourage minors to acquire skills that can enhance their self-protection.
  • Strengthen and establish normalized support networks and systems for the family.
  • The specific objectives, however, are set in each intervention and depend on the type of intervention program in which the minor is included and the Case Plan stipulated based on the diagnosis made about and together with the family unit.
  • Family Intervention Programs
  • The Family Intervention Programs aim not only to end the behavior of child abuse/neglect but also to rehabilitate the family nucleus. Most of these programs agree that their care unit is the family as a whole, and they share objectives.

The Actions To Be Carried Out Are:

  • To improve the family environment, with the collaboration of fathers and mothers and the child or adolescent himself.
  • Eliminate, neutralize, or reduce risk factors by training fathers and mothers to meet the needs of their sons and daughters adequately.
  • Eliminate the factors that negatively affect children and adolescents and their families personal and social adjustment.

Situations Of Moderate Lack Of Protection 

  • Improve the family environment with the collaboration of parents, tutors or guardians, and the child or adolescent.
  • Adequately satisfy the basic needs of the child or adolescent, preferably through normalized services and resources.
  • Train fathers and mothers to adequately meet the needs of their sons and daughters, providing them with the technical and economic means that allow them to stay at home.
  • Complement the performance of fathers and mothers.

The Basic Characteristics That They Present Can Be Specified In:

They are a Guaranteed and free provision of the Public System of Social Services.

They are a Community Resourcce and, therefore, the competence of the SSAPs.

They intervene in Any Unprotection for children as long as the consequences of the situation of vulnerability do not imply the departure of the child or adolescent from the family home or the risk of this occurring is high.

Its interventions are based on Collaboration with families, enhancing the capacities and abilities of fathers and mothers and providing them with the necessary support to care for their sons and daughters adequately.

They allow the Daily supervision of children and adolescents, avoiding or reducing the causes that lead to the appearance of situations of child vulnerability.

These are services and programs focused on families. However, They focus their intervention on children or adolescents , providing them with the necessary support resources to develop adequately despite living in a dysfunctional family environment.

The scope of application is Always in and from the family home, promoting the generalization of learned behaviors and based on the professional figure of family educators.

They have a Socio-educational nature (focused on teaching skills and strategies) and support the whole family, including all the people who are part of the family unit, not just the fathers and mothers.

They are Flexible in the frequency of the intervention (depending on the type of case and the moment in which the family is) And in the durationdepending on its evolution).…

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Drug Abuse Intervention

The problem of drug use, like any social problem, is susceptible to various epistemological interpretations. It is a complex and multifactorial social problem for its causes and consequences and its components and implications. In this way, it can be viewed from different perspectives, each emphasizing certain aspects and proposing a particular approximate position.

The multiple elements involved determine the complexity of aspects that must be considered to understand and address this social problem fully. All drug use implies the presence of a person who makes a behavioral choice. Still, it also supposes a peculiar reaction of the organism before the action of a chemical substance, as well as social scenarios with many conditioning variables. We discuss a phenomenon with multiple implications: psychological, medical, biochemical, sociological, ethnological, legal, economic, political, educational, historical, ethical…

This complexity should invite us to contemplate the drug use problem without any reductionism or partial interpretation. However, the specific training of the researchers and professionals who deal with it has created different interpretive models –sometimes formulated in an irreconcilable way, unfortunately– which, in any case, also provide interpretative richness, provided that the researcher can maintain away from the reductionism as mentioned above since this will prevent exploring all the implications of the phenomenon.

In general terms, we can distinguish nine major interpretative contributions that we will analyze separately in this article: legal model, consumption distribution model, traditional medical model, harm reduction model, social deprivation model, model of socio-structural factors, model health education, individualistic psychological model and socio-ecological model. The latter is presented with a certain vocation for synthesis since it intends to collect the other interpretations’ relevant findings and propose overcoming its shortcomings and limitations. In any case, the socio-ecological perspective comes fundamentally from the social sciences, and, despite the vocation mentioned above for integration and overcoming reductionism, its explanation can only be understood by attending to the contributions of the other models. For this reason, we will systematize the characteristics of the aforementioned theoretical interpretations in this work to present a vision as exhaustive as possible of the problem of drug use.

However, before fulfilling the main purpose of this work, it is necessary to establish some basic questions about the concepts we will deal with to delimit them conceptually.

We will start from the classic definition of a psychoactive drug provided by the World Health Organization (WHO), which is understood as any substance that, when introduced into the body, modifies any of the functions of the central nervous system (Kramer and Cameron, 1975). In other words, a psychoactive drug will be a chemical substance capable of affecting the psyche, regardless of its sociological classification.

The Concept Of The Sociological Situation Of Drug

The preceding leads us to consider the concept of the sociological situation of drugs in industrialized societies and to differentiate three possibilities (Berjano and Musitu, 1987):

  • Institutionalized Substances: 

They maintain a status of controlled legality in their production, distribution, advertising, and consumption, in addition to receiving mostly uncritical evaluations from the social environment. This is the case with alcohol and tobacco.

  • Non-Institutionalized Substances:

 They maintain a status of illegality in the indicated items and receive mostly critical evaluations from the social environment.

  • Institutionalized Substances With The Possibility Of “Diverted” Use: 

Substances manufactured for medical purposes can be “diverted” from their original purpose to be consumed for recreational purposes.

The WHO highlights that tobacco and ethyl alcohols are the widely consumed psychoactive drugs in industrialized societies and those that are associated with the greatest public health problems, which is why they should not be separated from the generic consideration of drugs nor contemplated. to a lesser degree of harmfulness concerning non-institutionalized substances (World Health Organization, 2000).

It will also be necessary to differentiate concepts related to drug consumption levels and addiction. The term “use” refers to the ingestion of a substance by a person at a given time. It is, therefore, a generic concept and should be understood as such. Drug use will not always be addictive; the latter refers to a pattern of behavior definable in clinical terms, characterized by the prioritization of the consumption of a particular substance over other daily behaviors, by the appearance of withdrawal symptoms in the face of deprivation and by the impossibility of the person to control their consumption (American Psychiatric Association, 2002).

Addiction is not the only form of drug use related to health damage. Abusive consumption, even without necessarily being addictive, represents a type of health risk, both due to the morbidity associated with the toxicity of the substances and due to the interference that the psychoactive effect can exert on certain behaviors. Thus, it will be possible to differentiate between two forms of abusive consumption (Pons, 2007):

  • Quantitative abusive consumption: the consumption of a particular substance in an amount and frequency that exceeds the tolerable limits for maintaining the health of the consuming person.
  • Qualitative abusive use: using a particular substance associated with particular circumstances and regardless of frequency: driving, work use, child use, among others.
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Interpretive Models Of Drug Use

The different interpretive models that seek to understand and explain the problem of drug use are analyzed. To do this, nine theoretical interpretations that come close to explaining this issue are studied:

  • Legal model
  • Consumption distribution model
  • Traditional medical model
  • Harm reduction model
  • Social deprivation model
  • Model of socio-structural Factors
  • Health education model
  • Individualistic psychological model
  • Socio-ecological model

In each case, its particular interpretive perspective is exposed, its most relevant contributions, and a discussion about its limitations. The socio-ecological model is presented as a plausible alternative to explain the problem of drug use from the social sciences and to intervene effectively in it,

The Legal Model

This perspective views drug use from the point of view of its legal and criminal implications. The focus of interest is the product itself and its legal situation. The legal model assumes that drugs not classified as legal are a source of serious physical, mental, and social damage and, therefore, must remain out of the reach of citizens on the other side of the barrier erected by law. In other words, it intends to protect individuals and society from the ills derived from non-institutionalized drugs.

Special attention is paid to the actions associated directly or indirectly with that type of substance use that can be considered a crime or cause of crime and the legal sanctions that seek to reduce them. The consequence is that the individual consumer of non-legalized drugs, dependent or not, will be perceived as a deviant or even as a candidate to become a criminal, and they will only be interested in those behaviors related to the legal implications of substance use. (Pinazo, 1993).

The Consumption Distribution Model

This model mainly affects the analysis of the supply and availability of a given substance within a given population or society. It refers, above all, to institutionalized drugs and emphasizes the importance of the product’s availability in the social environment as an explanatory factor of its consumption. The problem of the consumption of alcohol and other drugs can be understood by considering the greater or lesser ease of access to them that citizens have. This fact is analyzed without studying personal or other social determinants that could contribute to the consumption of toxic substances. Its main contribution is to analyze the relationships between supply and consumption in a given social environment.

The Traditional Medical Model

Consider drug dependence a disease characterized by a loss of individual control over consumption. This means that drug dependence is considered a phenomenon linked exclusively to the subject’s internal processes, and to understand it, it will suffice to appeal to the interaction between human biology and the pharmacological characteristics of drugs. Drug addiction is considered as one more medical problem, one more disease that affects an individual and is caused by the action of a psychoactive substance on an individual’s internal–biological– processes. From this point of view, a disease is considered an attribute of the person who possesses it (Vuori, 1980; Gil-Lacruz, 2007).

This interpretative perspective has provided the following:

  • Numerous advances in the knowledge of the psychoactive characteristics of drugs.
  • The biochemical process of physical addiction.
  • Different medical-pharmacological procedures have effectively treated addictions.

In addition, its main epistemological novelty is found in considering the addict as a patient and not a social deviant. The labeling of the addict as “deviant,” “vicious,” or “delinquent” is unfair and degrading, as well as inappropriate as a social and scientific definition; therefore, this consideration should be included among the relevant contributions of this model. However, the very label of “sick” deserves some critical reflection that we will expose in the following paragraph.

The Harm Reduction Model

Defining a concept such as harm reduction is complex. It covers fields as diverse as drug addiction therapy, the meaning and social role of drugs, or the moral consideration of their consumption. Heather et al. (1993) refer to it as an attempt to lessen the adverse health, social or economic consequences of drug use without necessarily requiring a reduction in consumption. The concept of “responsible consumption” emerges as a fundamental proposal from this interpretive perspective.

Harm reduction can be seen as a goal of a treatment program – for example, methadone maintenance programs – but also as an ethical and pragmatic approach to the social problem of drugs, which emphasizes reducing the consequences. Negative consequences of substance use rather than promoting abstinence. In both cases, one of the key points is that the consumption of drugs by each specific person is accepted as a fact that arises from their particular decision. The objective will be that said consumption has the minimum possible negative effects on people and society.

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