Alcohol Intervention for Adolescents with FASD: Project Step Up, a Treatment Development Study. Mary J. O Connor, PhD, ABPP Living with FASD

Transcription

1 Alcohol Intervention for Adolescents with FASD: Project Step Up, a Treatment Development Study Mary J. O Connor, PhD, ABPP Living with FASD

2 Disclosure of Financial Relationships Mary J. O Connor, PhD, ABPP Disclosure: I have no relationship with entities producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients. Funded by the CDC: Grant # U84 DD April 2016

3 Specific Aims Aim 1. To adapt an established evidence-based alcohol intervention program for use with youth with FASD Aim 2. To evaluate the effectiveness of the intervention on alcohol users through a randomized treatment and control group design. To test for iatrogenic effects on non users Aim 3. To evaluate the sustainability of the intervention effects at 3-month follow-up Aim 4. To provide education to caregivers of youth with FASD who may be at risk or who are using alcohol

4 Adaptations for Teens with FASD The Project Options procedure, developed by Dr. Sandra Brown for typically developing youth, was modified with specific treatment adaptations to account for the neurocognitive challenges common among adolescents with FASD. These materials were reviewed by non participant adolescents with FASD and their parents and their suggestions incorporated into the final version of the treatment manual and workbook.

5 Intervention Strategies The intervention strategies that work best with individuals with FASD were used extensively in the development of the protocol and included: Modeling Coaching Behavioral rehearsal Performance feedback Concrete concepts and content Instruction both auditory and visual Repetition within and across sessions Breaks and activities

6 Treatment Manual and Workbook for Teens with FASD A Project Step Up Therapist Treatment Manual for Teens was developed along with a separate Project Step Up Teen Workbook in order to help the participants understand and remember important intervention concepts more easily.

7 Intervention Overview Adolescents aged years IQ > 70 6 weekly sessions, 60 minutes each Group size = 6-8 adolescents Caregivers and teens attended separate groups, concurrently Teen groups led by one male and one female therapist

8 Intervention Overview Teen Involvement Normative Feedback Regarding Peer Alcohol Use Education on Standard Drink Size, Alcohol Content Alcohol Expectancies Adaptive Coping Skills Alcohol Refusal Skills Communication skills Parental Involvement Education about FASD Modeling Monitoring Teen Activities

9 Teen Sessions Session 1: Perceptions of peer EtOH use, normative information regarding peer EtOH use, standard drink size, amount of EtOH in common beverages Session 2: EtOH beliefs/expectations, EtOH expectancy challenge video Session 3: Adaptive coping without using EtOH Session 4: Types of drinkers, negative consequences of drinking, resisting peer pressure to drink Session 5: Practicing resistance and refusal skills, planning for how to handle situations where EtOH is present Session 6: Practicing communication skills to avoid risky/negative situations or problems with others

10 PROJECT STEP UP HEALTH AND BEHAVIOR WORKBOOK UCLA CENTER FOR HEALTH SCIENCES

11 HOW MANY STUDENTS OUT OF 10 IN YOUR SCHOOL DRINK ALCOHOL? CROSS OUT THE NUMBER YOU GUESS

12 THE ACTUAL NUMBER OF HIGH SCHOOL STUDENTS WHO DRINK ALCOHOL THE NUMBER OF HIGH SCHOOL STUDENTS WHO DO NOT DRINK ALCOHOL

13 How much alcohol is in a standard drink? Smirnoff Ice Bottle Shot Glass of Wine (12oz)/5% alcohol (1.5 oz)/40% alcohol (5oz)/10-12% alcohol Mike s Hard Lemonade Budweiser Beer Can Bud Light Beer Can (12oz)/5.2% alcohol (12 oz)/4-5% alcohol (12 oz)/4-5% alcohol All of these drinks contain the SAME amount of alcohol

14 How many drinks does it really equal? = = =

15 Remember Your Comeback Responses When Someone Offers You a Drink! No thanks, I ll have a soda My mom always checks my breath when I get home I want a clear head tonight Thanks but I ll pass No thanks, I don t really feel like drinking right now Alcohol has too many calories

16 What Do You Do When a Comeback Does Not Work? Try a different comeback Be persistent Leave the situation

17 How to Handle Situations Where You Might be Tempted to Drink Alcohol: Step #1: Make a Plan Step #2: Ask yourself: Is it a Good Plan? What might go wrong? BE PREPARED!

18 Caregiver Sessions Session 1: PAE and development, FASD criteria, reframing teen behaviors, executive functioning and memory challenges Session 2: EtOH and teens, EtOH and teens with FASD, protective factors, signs of misuse Session 3: Importance of structure for teen, benefits of strong parentteen relationship, supervision and communication Session 4: Monitoring your teen, handling common scenarios, parent modeling of drinking in the home Session 5: How to talk to your teen about EtOH, facts and myths about drinking Session 6: Action steps, parent self-care, additional resources

19 Recommendations for Supervision and Communication Parent Handout Provide a safe, structured environment and clear, predictable routines. Provide clear expectations and clear consequences for behaviors. Supervision should not decrease in adolescence. Carefully monitor social activities and structuring of leisure time. Encourage your adolescent s talents to increase positive use of leisure time. Be creative in your approach to supervision. Your teen needs to feel as independent as other teens. Plan activities that keep you close (e.g. stay within ear-shot or periodically check on teen). Enlist others to help with supervision (e.g. aunts, older siblings, grandparents). Oversee use of electronic equipment such as cell phones and computers (e.g.. block certain websites, television channels, phone numbers). Be aware of alcohol in the home such as where it is stored and how much you have. Adapted from the following: Parenting Children Affected by Fetal Alcohol Syndrome: A Guide for Daily Living. Ministry for Children and Families Edition. By the Society of Special Needs Adoptive Parents in cooperation with the B.C. Ministry for Children and Families Child Protection Division.

20 Talking Points About Alcohol Parent Handout Drinking is illegal. Because alcohol use under the age of 21 is illegal, getting caught may mean trouble with the authorities. Even if getting caught doesn t lead to police action, the parents of your adolescent s friends may no longer permit them to associate with you. Drinking is dangerous. One of the leading causes of adolescent deaths is motor vehicle crashes involving alcohol. In a survey of high school students, it was found that 28% of reported riding in a car with a driver who had been drinking. Drinking makes adolescents more vulnerable to sexual assault and unprotected sex. Alcohol is linked to approximately 50% of sexual assaults of teenagers. Binge drinking by girls is related to 50% of unwanted pregnancies. Drinking impairs judgment. While an adolescent may believe he or she wouldn t engage in hazardous activities while drinking, because alcohol impairs judgment a drinker is very likely to think such activities won t be dangerous. Alcohol affects young people differently than adults. Drinking while the brain is still maturing may lead to long-lasting intellectual effects and alcohol dependence later in life. Alcohol is a powerful drug that slows down the body and mind. Alcohol impairs coordination and slows reaction time. For example, a study of college-aged young adults found that reaction time is significantly impaired even at low doses of alcohol, before any motor impairment is noticeable.

21 Outcome Measures Alcohol Use Disorders Identification Test (AUDIT) screens for excessive drinking and provides framework for intervention to help harmful drinkers reduce or cease alcohol use. A score of 2 or above has been validated for teens 14 to 18 years indicating need for brief intervention. Rutgers Alcohol Problem Index (RAPI) indicates the frequency of experiencing negative consequences due to alcohol use passing out, problems in school, getting into fights, withdrawal symptoms, etc.

22 Data Analysis Participants divided into those who were abstinent/infrequent and those who were light/moderate drinkers Treatment (SUI vs Control) ANCOVAs controlling for initial levels. Post Intervention and 3-Month Follow-up time periods

23 Results 54 teens participated in the randomized controlled study 55.6 % female (SD = 1.74) years of age 56% identified themselves as White, Non- Hispanic, 7.4% as Black Non-Hispanic, 33.3% as Hispanic, and 3.7% as Native American or Asian IQ (SD = 12.99) Approximately 68.5% of sample parents were married or living with a partner 73% adolescents were adopted, 21% were in foster or family guardian care, and 6% were living with their biological mother or with their biological father

24 Alcohol and Other Drug Use 33% (18) of adolescents reported a history of lifetime alcohol use (light/moderate group) 67% (36) of adolescents reported abstinence or infrequent use (abstinent/infrequent group) The percentage of any illicit drug use was low at 1.9% 13% of respondents acknowledging the use of marijuana.

25 Treatment Outcomes No increase in alcohol use as a function of intervention at post intervention or at 3-month follow up for the abstinent/infrequent group. This group remained at an average score of 0 on the AUDIT and RAPI. Decrease in alcohol use and negative consequences for the light/moderate group as a function of intervention at post intervention. This positive result persisted at 3-month follow up on the RAPI. Large effect.

26 A U D I T

27 R A P I

28 Participant Satisfaction High adolescent and parent satisfaction with the intervention in total sample. Ninety six percent of teens felt they were better able to avoid risky situations with alcohol Ninety-six percent of parents thought that their teens would be better able to resist alcohol because of the intervention

29 Conclusions Results suggest that a manualized treatment using a standardized motivational approach adapted for the neurocognitive deficits of teens with FASD and administered by therapists trained in treatment delivery, resulted in the prevention of the onset of drinking and a reduction in risky drinking and its negative consequences in adolescents with FASD. Frequent booster sessions may be necessary to sustain gains.

30 Acknowledgments Katrina Dipple, MD, MPH Lindsey Sterling, PhD Mina Parks, PhD Jennifer Gerdts, PhD Lauren Elder, PhD Justin Quattlebaum, PhD Rachael Montague, PhD Marlene Castaneda, BA Larissa Portnoff, BA Michael Coleman, BA Stephanie Cordel, BA CDC Grant # U84 DD000504

31 Thank You!