Project OPTIONS: Overview and preliminary findings

Project Options, is a voluntary, school-based brief intervention (BI) that targets hazardous drinking. Project Options provides students with the opportunity to explore alcohol and other drug-related decision making within a developmentally relevant framework. The program provides confidential space for teens to discuss their concerns while building independent problem solving skills and facilitating self-change efforts related to alcohol use (Brown et al., 2001; Brown et al., 2005). Project Options integrates empirically-supported cognitive-behavioral intervention techniques including normative feedback, exploring outcome expectancies, behavioral management, alternative activity exploration, coping skills, and communication training, with motivational-enhancement techniques (ME) (Brown, 2001; D’Amico et al., 2004).

EARLY SUCCESS   Project Options was first tested in San Diego County, CA. The program successfully recruited diverse samples of youth (gender, race, ethnicity, grade; Brown et al., 2005; D’Amico et al., 2006), and students at high-risk for negative developmental outcomes, including higher intensity of drinking in the past 30 days, more alcohol related problems, higher rates of solitary drinking, and greater experience with bullying and victimization, as compared to the general school population (McGee et al., 2011).  Importantly, Project Options was effective in fostering quit attempts among youth with the greatest alcohol experience, supporting its use as a targeted prevention paradigm (Brown et al., 2005).

EXPANDING THE TEST OF THE INTERVENTION   Project Options is now being tested in three new cities (Miami, Florida; Minneapolis, Minnesota; and Portland, Oregon) at six socioculturally and ethnically diverse schools. This multi-site study compares the previously developed intervention for adolescent alcohol problems that incorporates motivational enhancement techniques (ME) to an educational control condition (ED). Measures from the first session attended and again four and twelve weeks later determine effectiveness of the intervention to promote personal change efforts and arrest progression of alcohol problems. Project Options is currently in its fourth year.
Table 1.  Student characteristics (N= 1066)
Variable
M
SD
%
n
Age (years)
16.1
1.4
Sex (girls)
59.8
628
Grade
9th
26.6
280
10th
18.9
199
11th
20.9
220
12th
33.6
353
Race
White
25.6
272
Latino/Hispanic
35.3
375
Asian
25.6
273
Black/African American
4.7
50
Mixed Race & Other
8.8
93
Lifetime Alcohol Use
58.5
612
Lifetime Marijuana Use
41.5
415
REALLY, VOLUNTARY?   A unique feature of Project Options is that participation is voluntary and open to all students. A critical question is whether this approach will successfully engage and retain students from diverse backgrounds and levels of exposure to alcohol and other drugs.
This question has been examined in two conference presentations. In the first, we examined whether the likelihood of students returning to the intervention after the first session and students’ program satisfaction ratings from their initial session  differed by ethnicity, gender, and prior alcohol and marijuana use.  Overall, 82.3% of students attended at least one additional session, with African American students returning more frequently than White students (91.7% vs. 78.8%, p=.009).  Program satisfaction was significantly higher among African Americans and marijuana never-users. No significant differences on retention or satisfaction emerged for alcohol use or gender. Additional analyses examined retention and student satisfaction by intervention condition. Retention rates did not differ by condition, however mean composite satisfaction scores (from 1=low satisfaction to 9=high satisfaction) were significantly higher for the ME group (M =7.33, SD=1.34) than the ED group (M=7.01, SD=1.34).
WHO BENEFITS?   We have studied engagement and retention among the diverse students attending groups across all schools.  Overall, the intervention engaged and retained ethnically diverse students consistent with their school context. Group and school diversity characteristics did not impact participants’ return to the intervention. These findings provide evidence that Project Options can be adapted to a range of sociocultural contexts.
In concert, preliminary findings indicate that Project Options open and voluntary enrollment format is able to attract diverse students who are using alcohol and/or marijuana.  Further, these results demonstrate success in engaging and retaining participants across intervention conditions.
MOTIVATIONAL ENHANCEMENT MAY BE PARTICULARLY USEFUL FOR ADOLESCENTS  Delivery of Motivational Enhancement content in an adolescent group setting is another novel aspect of Project Options. There is limited research exploring the role of in-session behavior for motivational enhancement (ME) interventions in group formats. In a recently published paper we examined the reliability and validity of a group behavior coding system. Student group behavior was coded live at the specific utterance and global level; group leader behavior was also coded globally. Initial reliability estimates were excellent for the specific behavior codes.  Reliability of the global codes was mixed, with raters demonstrating good reliability on Support for Unhealthy Behavior, Opposition to Unhealthy Behavior, and Support for Healthy Behavior.  Reliability of the group leader codes was fair to poor.  A greater percent of healthy talk was associated with a lower percentage of group members reporting lifetime alcohol use.  The results of the current study suggest that some in-session behavior at the group level can be coded reliably via live observation and that in-session behavior at the group level is associated with alcohol use prior to attending the program.
PROMOTING POSITIVE DECISION MAKING
Project Options is based on a developmental cognitive social learning model of youth de-escalation of alcohol involvement. This model posits that purposeful change in adolescents’ alcohol use is mediated by alcohol-related cognitions (e.g., perceived drinking norms, expected effects of alcohol use as well as abstinence) in conjunction with internal motivation and beliefs about one’s self-efficacy to enact behavior change. To evaluate the intervention’s effect on these hypothesized mediating variables, we evaluated whether changes in youths’ motivation to cut down/quit drinking measured at four and twelve weeks post-intervention were predicted by BI format (ME vs. ED), drinking level (light, moderate, or heavy), and changes in alcohol-related cognitions. The ME condition predicted greater increases in motivation compared to the ED condition at the 4 week follow-up (z=2.97, p=.003), and the interaction between drinking level and alcohol cessation expectancies indicated that increased cessation expectancies predicted increased motivation in heavy drinkers compared to light (z=-2.12, p=.03) and moderate (z=-1.94, p=.05) drinkers. The cognitive social learning model was supported for alcohol expectancies related to using and abstaining from use. Estimates of peer drinking was not related to intentions to change. Preliminary analyses provide support for an effect of the ME intervention on several cognitive mediating variables.
Project co-PIs:
Dr. Mark Myers is a Professor in the Department of Psychiatry at the U.C. San Diego School of Medicine. He also serves as Lead Clinician for Tobacco Cessation and associate Director of the Tobacco Cessation Clinical Resource Center at the V.A. San Diego Healthcare System. Dr. Myers received his Ph.D. in clinical psychology in 1991 from the UCSD/SDSU Joint Doctoral Program in Clinical Psychology and completed a post-doctoral fellowship at the Brown University Center for Alcohol and Addiction Studies.
 
Sandra A. Brown, Ph.D. is Vice Chancellor for Research and a Distinguished Professor of Psychology and Psychiatry at UC San Diego. Her pioneering studies of cognitive features of youth addiction and adolescent development have led to 26 federally funded grants including the current National Consortium on Alcohol and Neurodevelopment in Adolescence (NCANDA) and Adolescent Brain Cognitive Development (ABCD), which is the largest longitudinal study of youth brain development ever funded by NIH. In addition to over 300 peer reviewed publications and one book (Adolescent Substance Abuse, Oxford Press), she has served as President of the Society of Addiction Psychology and on the Board of Directors of the American Psychological Association and Research Society on Alcoholism.
 
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