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Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet]. York (UK): Centre for Reviews and Dissemination (UK); 1995-.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet].

Interventions for reducing adolescent alcohol abuse: a meta-analytic review

SJ Tripodi, K Bender, C Litschge, and MG Vaughn.

Review published: 2010.

Link to full article: [Journal publisher]

CRD summary

Treatments for adolescent substance abuse appeared to be effective in reducing alcohol use. The authors' conclusions reflected the evidence presented, but the conclusion's reliability should be viewed with caution given potential for publication bias, limitations of pooling studies with different outcomes, control groups and designs and overlapping results for groups.

Authors' objectives

To assess the effectiveness of substance abuse interventions for reducing adolescent alcohol use.

Searching

MEDLINE, PsycINFO, ERIC, Wilson Social Science Abstracts, Criminal Justice Abstracts, Social Work Abstracts, Social Science Citation Index, Dissertation Abstracts International, National Criminal Justice Research Service, Social Psychological Criminological Educational Trials register and the PsiTri databases were searched from 1960 to 2008. Search terms were reported. Relevant alcohol and drug treatment websites, bibliographies of identified articles, reference sections of relevant books and government documents were searched.

Study selection

Studies that evaluated a substance-abuse intervention aimed at reducing or eliminating adolescent (12 to 19 years) alcohol use were eligible for inclusion. Eligible comparisons were wait-list control and contrasting treatment. Studies that evaluated pharmacological therapies were included only if these were administered as part of an integrated treatment programme combined with one or more psychosocial interventions. Eligible outcomes were abstinence, frequency of alcohol use and quantity of alcohol use measured between one month and one year upon completion of treatment. Studies that evaluated prevention interventions were excluded.

Interventions in the included studies included behavioural treatment, brief motivational interviewing, triple modality social learning, assertive continuing care, multisystemic therapy, cognitive-behavioural therapy with or without active aftercare, integrated family and cognitive-behavioural therapy, multidimensional family therapy, brief strategic family therapy and brief interview either with or without one parent. Duration and number of sessions varied between studies. Outcomes included days or frequency of alcohol use, days to alcohol use, time absent from alcohol, severity of alcohol use and alcohol binge days. All the included studies were conducted in USA.

The authors did not state how many reviewers performed the selection.

Assessment of study quality

Validity was assessed with published criteria developed specifically for evaluating alcohol dependence treatment outcome studies. The 13-item scale assessed experimental or quasi-experimental design, replicability of study, reporting of baseline characteristics, quality control, length of follow-up, withdrawals and dropouts, collateral and objective verification, and number of centres (single or multi). A maximum of 16 points indicated exceptionally high quality.

The authors did not state how many reviewers performed validity assessment.

Data extraction

Data were extracted for mean post-test scores of alcohol use for intervention and comparison groups and used to calculate effect size (ES) and 95% confidence intervals (CIs). Effect size was standardised mean difference calculated using Hedge's g.

Two reviewers independently extracted data onto a standard form. Discrepancies were resolved through discussion.

Methods of synthesis

Pooled effect sizes and corresponding 95% CIs were calculated with a random-effects model and tested with a mixed-effects model. Heterogeneity was assessed using the Cochran Q and I2 statistics. Stratified analysis of studies by type of intervention (individual or family) and length of follow-up was conducted. Duval and Tweedie's trim-and-fill method was used to examine studies based on any asymmetric pattern. Publication bias was assessed using Egger's test and visual examination of funnel plots.

Results of the review

Sixteen studies were included in the review: 14 described as randomised controlled trials (RCTs) appeared to use randomisation; and two reported to use a quasi-experimental design with no randomisation. Nine studies had a duration of follow-up that ranged from six to 11 months. Only six studies reported a follow-up completion rate of 85% to 100%.

Interventions significantly reduced overall adolescent alcohol use (ES -0.62, 95% CI -0.83 to -0.40). Stratified analyses revealed larger effects for individual treatment (ES -0.75, 95% CI -1.10 to -0.40) compared with family-based treatments (ES -0.46, 95% CI -0.66 to -0.26). Overall intervention effects decreased as length of follow-up increased (six months or less ES -0.66, 95% CI -0.95 to -0.38 and longer than six months ES -0.50, 95% CI -0.68 to -0.32). Tests suggested that publication bias was minimal.

Authors' conclusions

Treatments for adolescent substance abuse appeared to be effective in reducing alcohol use. Individual-only interventions had larger effect sizes than family-based interventions. Effect sizes decreased as length of follow-up increased. Behaviour-oriented treatments demonstrated promise in attaining long-term effects.

CRD commentary

The review question was clearly defined with appropriate inclusion criteria. Several relevant sources were searched and efforts were made to reduce publication bias. It was unclear whether steps were taken to reduce language bias. Validity was assessed and results of the assessment were partially reported. Most of the included studies were RCTs. Adequacy of randomisation and concealment of allocation were not assessed and so study quality was unclear. Appropriate methods were used to reduce reviewer error and bias throughout the review process. Studies were combined in a meta-analysis. The authors appropriately identified a limitation of pooling studies that had differing outcomes, control groups and study designs. All the included studies were conducted in USA and the results may not be generalisable to other cultural settings. Caution should be noted with regard to the stated differences between individual and family interventions and between follow-up durations as the confidence intervals overlapped in both cases. The authors' conclusions reflected the evidence presented, but the conclusion's reliability should be viewed with caution given potential for publication bias, limitations of pooling studies with different outcomes, control groups and designs and overlapping results for groups.

Implications of the review for practice and research

Practice: The authors did not state any implications for practice.

Research: The authors stated that further research was required to assess the effectiveness of brief interventions on alcohol reduction for adolescents and understand mechanisms that produce change.

Funding

Donald D. Hammill Foundation.

Bibliographic details

Tripodi SJ, Bender K, Litschge C, Vaughn MG. Interventions for reducing adolescent alcohol abuse: a meta-analytic review. Archives of Pediatrics and Adolescent Medicine 2010; 164(1): 85-91. [PubMed: 20048247]

Indexing Status

Subject indexing assigned by NLM

MeSH

Adolescent; Alcohol Drinking /prevention & control; Alcoholism /prevention & control; Cognitive Therapy; Family Therapy; Humans; Treatment Outcome

AccessionNumber

12010000972

Database entry date

22/09/2010

Record Status

This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn.

CRD has determined that this article meets the DARE scientific quality criteria for a systematic review.

Copyright © 2014 University of York.

PMID: 20048247