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Keane, Martin (2009) Assessment of early interventions for at-risk youth. Drugnet Ireland, Issue 29, Spring 2009, p. 17.

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This article reports findings from a recent Rapid Evidence Assessment (REA) of effective early interventions for youth at risk of future poor outcomes.1 The REA is a review of reviews including systematic reviews and meta-analysis. This review had two objectives: (1) to identify the risk factors related to poor outcomes, and (2) to identify the interventions that work to reduce these risk factors and improve outcomes. This article will focus on the review findings in relation to risk factors and effective interventions for alcohol and drug use among 13-19-year-olds. 

 Review findings on risk factors
The review identified risk factors in four areas, as shown in Table 1.  
 
Table 1   Risk factors associated with alcohol and drug use
Family risk factors
School risk factors
Individual and peer risk factors
Community risk factors
Poor parental discipline
Weak family cohesion
Parental drug and alcohol use
Parental attitudes to drugs
Poor parental monitoring and supervision
Sibling drug use
Sibling sources of drug supply
Siblings co-drug-users
Early-life trauma
Family breakdown and mode of family interactions
Low income and poor housing
Experience of authority care
Low achievement at school
Lack of commitment (absences, truancy)
School exclusions
Non-compliance with school rules
Lack of educational attainment
Truancy (when experienced during middle childhood, 9–11 years, and adolescence, 12–18 years)
Personal attitudes condoning problem behaviour (malleable)
Friends involved in problem behaviour during adolescence (malleable)
Poor self-esteem and depression (malleable)
Age (fixed)
Gender (fixed) (female school truants more likely to abuse than males)
Ethnic background (fixed)
 
Drug availability
Exposure to drug-using peer groups
Increased chance of being targeted as new consumer

Source: Adapted from Thomas et al. 2008

 Review findings on effective interventions
  • Behaviour therapy, culturally sensitive counselling in residential settings, family therapy, and the 12-step Minnesota programmes were most successful in reducing drug use.
  • Family therapy was most successful in reducing psychological problems of young drug users.
  • Family therapy, family teaching, non-hospital day programmes, residential care services, and school-based life-skills interventions were most successful in improving family and social outcomes.
  • Drug education was associated with lower drug use; however, the interventions had only a small impact and the gains dissipated over time.
  • School-based life-skills training programmes had some success in preventing drug use in high-risk subgroups; success rates improved when targeted interventions were nested within the universal programmes.
 Strengths and weaknesses of this review
This is a wide-ranging review of the literature, covering many topic areas and, because its conclusions are based on systematic reviews, the evidence behind its findings can, on the whole, be considered to be high quality and robust. However, the authors advise caution in interpreting the findings for two reasons. First, while the vast majority of studies reviewed show correlations between risk factors and poor outcomes, the results do not usually justify the inference of a causal link between a given risk factor and an outcome.  Second, an intervention which works for one group of clients may have no comparable effect on another group because of moderating variables that may be present, e.g. genetic factors.
 
Discussion
Eleven reviews were identified which targeted alcohol and drug use. Many of these reviews included multi-component interventions delivered in a range of settings, including school, community, and family. The vast majority of interventions operate at the individual or family level. According to the authors, this may reflect the greater importance of these levels in determining behaviour. Equally, this may reflect the greater emphasis placed on individualism and personal responsibility by policymakers and scientists alike. The findings suggest that multidimensional family therapy and cognitive-behavioral group treatment are effective in reducing risk factors among at-risk youth. This is an interesting finding as it suggests that group-based interventions may be more effective in responding to the needs of at-risk youth than interventions targeted at the individual.
 
1. Thomas J, Vigurs C, Oliver K, Suarez B, Newman M, Dickson K and Sinclair J (2008) Targeted youth support: Rapid Evidence Assessment of effective early interventions for youth at risk of future poor outcomes. In Research Evidence in Education Library. London: EPPI-Centre, Social Science Research Unit, Institute of Education, University of London.
Item Type
Article
Publication Type
Irish-related, Open Access, Article
Drug Type
All substances
Intervention Type
Prevention
Issue Title
Issue 29, Spring 2009
Date
2009
Page Range
p. 17
Publisher
Health Research Board
Volume
Issue 29, Spring 2009
EndNote
View
Accession Number
HRB (Available)
Subjects
T Demographic characteristics > Adolescent / youth (teenager / young person)
VA Geographic area > Europe > Ireland
J Health care, prevention, harm reduction and treatment > Risk and protective factors
J Health care, prevention, harm reduction and treatment > Prevention approach > Early intervention (young children)
F Concepts in psychology > Behaviour > Risk-taking behaviour

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