Reports of past alcohol and drug use following participation in a motivation enhancing intervention: implications for clinical assessment and program evaluation.

BACKGROUND: There is significant interest in the value of motivational approaches that enhance participant readiness to change, but less is known about clients' self-reports of problematic behavior when participating in such interventions. METHODS: We examined whether participants in a motivationally-based intervention for DUI offenders changed their reports of substance use at postintervention (when reporting on the same 30 days that they reported on at preintervention). Specifically, Study 1 (N = 8,387) tested whether participants in PRIME For Life (PFL) changed their reports about baseline substance levels when asked at postintervention versus at preintervention. Study 2 (N = 192) compared changes in self-reported baseline drinking between PFL and intervention as usual (IAU) participants. RESULTS: Many participants in Study 1 did not change their reports about how much they used substances during the 30-day period before baseline. Among those who did, the most common change was an increase in reported amounts of baseline drug use, and typical and peak alcohol use. This sample also showed changes in reports of their baseline pattern of high-risk-use (consistent versus occasional). At postintervention, participants who were younger, single, or endorsing more indicators of alcohol dependence were more likely to later report greater frequency of baseline drug use, and greater peak and typical number of baseline drinks. Gender, education, and race were also associated with reporting inconsistency on some behaviors. In Study 2, PFL participants showed greater increases in reports of peak alcohol use compared to IAU, but both conditions showed similar increases for drugs and typical alcohol use. CONCLUSIONS: In both research and clinical settings, a segment of participants may initially report less substance use than they do when asked later about the same baseline period. These preliminary findings suggest clinicians and researchers may find postintervention evaluations yield reports of greater baseline alcohol or drug use for some people. For some behaviors, this may occur more often in interventions that target client motivation. Future research should attempt to identify which reports - preintervention vs. postintervention - better reflect actual baseline substance use.

Short-term outcomes of a motivation-enhancing approach to DUI intervention.

OBJECTIVE: We compared a group-delivered, theory-based, motivation-enhancing program (PRIME For Life(®) - PFL, n=450) to an intervention as usual (IAU, n=72). METHOD: Individuals convicted of a substance related offense in North Carolina, typically first offense alcohol and drug-impaired driving, participated in a PFL or IAU group. We compare the interventions on program satisfaction and changes made from preintervention to postintervention, and examined the moderating effects of demographics and alcohol dependence level. RESULTS: When significant, findings varied in magnitude from small to medium effects. Participants in both interventions showed intentions to use statistically significantly less alcohol and drugs in the future compared to their previous use, and differences between the groups were not statistically significant. Otherwise, findings favored PFL. PFL exhibited greater benefit than IAU on understanding tolerance, perceived risk for addiction, problem recognition, and program satisfaction. Additionally, IAU perceived less risk for negative consequences postintervention than they had at preintervention. Moderation analyses showed that the between-condition findings occurred regardless of gender, age, education, and number of alcohol dependence indicators. Additionally, younger people and those with more dependence indicators - groups of particular concern - showed the greatest change. CONCLUSIONS: Findings suggest that a motivation-enhancing approach can be effective in producing short-term change in factors that can help facilitate and sustain behavioral change. This is consistent with previous research on the use of motivational approaches, and extends such findings to suggest promise in group-based settings and with people across demographic categories and dependence levels. Future research should focus on larger studies looking at long-term behavioral change, including recidivism.

A comparison of two measures of low response to alcohol among heavy drinking male college students: implications for indicated prevention.

Low response (LR) to alcohol is a risk factor that strongly predicts later problems. This study compares subjective measures of high tolerance (HT) to measures of LR, using the Self-Rating of Effects of Alcohol (SRE) form. First-year heavy drinking students (N = 250) at an all-male college completed a survey during a mandatory class that included the SRE, past month peak consumption, 2-week heavy episodic use, family history, self-reported high tolerance, and whether it takes more alcohol to become impaired compared to others. The SRE identified LR for 96.7% of those reporting HT and 100% of those reporting both HT and that it takes comparatively more alcohol to become impaired. The measure of HT correlated more with heavy drinking than did that of LR (peak of 14.5 drinks and 4.3 occasions of heavy episodic drinking vs. 12.6 and 3.7) whereas those identified as not LR drank less than those who reported no HT (peak of 6.1 drinks and 1.3 occasions of heavy episodic drinking vs. 9.6 and 2.4). Those reporting uncertainty about HT averaged peaks of 10 drinks and 3.13 occasions of heavy episodic drinking; 73.6% scored LR on the SRE. These data suggest that, at least in a heavy drinking group, the SRE may be most effective as a selected follow-up to an initial two-question screening. Self-reporting a high tolerance provides as much information as the 12-question SRE and is associated with heavier use. The SRE may provide corrective feedback to those who report uncertainty about HT or who give conflicting responses to the two screening questions.