title: Motivational counseling reduces future police charges in court referred youth.
abstract: By the age of 18, between 16 and 27% of adolescents in the U.S. have been arrested for an offense and by the age of 23 this increases to a staggering 25-41%. Most youth that get into legal trouble have a substance abuse problem and many youth report high risk driving behaviors. Adjudication of adolescents for an offense may provide an opportunity to provide a secondary prevention program for such high risk behaviors. In this regard the primary aim of the present study was to test two hypotheses: (1) that interventions involving group motivational interviewing would decrease future legal charges beyond those achieved by the combination of sanctions and remedial actions otherwise mandated by the court; and (2) that the addition of a trauma room exposure to the group MI intervention would increase the effectiveness of MI in decreasing these future legal charges. Court mandated youth who have had a high risk driving police charge and/or alcohol related police charge and who are drivers (n=992) were randomly assigned to one of the three 20h interventions; enhanced prototypic community service (CS), Motivational Intervention with typical community service (MI), and Motivational Intervention with exposure to a hospital trauma center (MI-H). As hypothesized, the probability of being charged with an offense within the 6 months post-treatment was significantly less for participants in the combined MI groups than those in the CS group. The combined MI groups also had significantly fewer overall number of police charge events than the CS group at 6 months. Mediation analyses revealed that the relationship between MI vs. CS interventions and subsequent police charges was partially accounted for by the youth's experience of the MI component of the intervention. Despite fewer police charges at 6 months the combined MI group reported (1) significantly more hazardous drinking and (2) a greater amount of speeding and distracted driving than the control group over this same 6-month period. Hypothesis 2, that MI-H would be more effective than MI in reducing police charges, was not supported. This was so despite evidence supporting the hypotheses that (1) trauma room exposure would increase participants' emotional arousal during the intervention and (2) increased arousal would be predictive of fewer police charges. Despite support for the theorized causal pathway, the combination of trauma room exposure and MI did not result in better outcomes than MI combined with traditional community service. Given this discrepancy between empirical supports for the theory in the face of the absence of incremental effectiveness of the MI-H treatment condition, a better understanding of the participant's hospital experience will be necessary if we are to successfully utilize the trauma room exposure to increase the effectiveness of MI interventions for this target group to achieve better outcomes.
authors: Department of Emergency Medicine, Alpert Medical School of Brown University, Providence, RI 02903, United States. tnirenberg@lifespan.org
authors: Ted
authors: T
authors: Nirenberg
authors: Janette
authors: J
authors: Baird
authors: Richard
authors: R
authors: Longabaugh
authors: Michael J
authors: MJ
authors: Mello
mesh_terms: D000063:Accidents, Traffic / Q000517:prevention & control* / Q000523:psychology; D000293:Adolescent; D000428:Alcohol Drinking / Q000331:legislation & jurisprudence / Q000517:prevention & control* / Q000523:psychology; D001334:Automobile Driving / Q000331:legislation & jurisprudence / Q000523:psychology; D003415:Crime / Q000331:legislation & jurisprudence / Q000517:prevention & control* / Q000523:psychology; D003617:Dangerous Behavior; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D062405:Motivational Interviewing; D016495:Police; D011615:Psychotherapy, Group; D055502:Secondary Prevention / Q000379:methods*; D012946:Social Welfare; D014193:Trauma Centers; D016896:Treatment Outcome; D055815:Young Adult
references: J Stud Alcohol. 2004 Jul;65(4):501-12
references: 15376825
references: Int J Adolesc Med Health. 2006 Jan-Mar;18(1):115-22
references: 16639865
references: J Behav Ther Exp Psychiatry. 1997 Mar;28(1):41-51
references: 9110238
references: Int J Addict. 1991 Nov;26(11):1173-85
references: 1743817
references: Psychol Addict Behav. 2005 Mar;19(1):79-87
references: 15783281
references: J Subst Abuse Treat. 1999 Oct;17(3):181-92
references: 10531624
references: Pediatrics. 2012 Jan;129(1):21-7
references: 22184650
references: Addict Behav. 2002 May-Jun;27(3):381-91
references: 12118626
references: J Abnorm Psychol. 1994 Feb;103(1):18-31
references: 8040477
references: Drug Alcohol Rev. 2004 Jun;23(2):157-66
references: 15370021
references: Drug Alcohol Depend. 2009 Aug 1;103(3):155-8
references: 19423240
references: Addiction. 1993 Jun;88(6):791-804
references: 8329970
references: J Am Coll Health. 2011;59(7):678-9; author reply 680-1
references: 21823966
references: J Subst Abuse Treat. 2004 Sep;27(2):123-34
references: 15450645
references: J Consult Clin Psychol. 1999 Dec;67(6):989-94
references: 10596521
references: Med Health R I. 2009 Jun;92(6):196-9
references: 19634619
references: Addiction. 2007 Aug;102(8):1234-43
references: 17565560
references: Res Nurs Health. 2008 Apr;31(2):180-91
references: 18183564
references: J Stud Alcohol. 1993 Sep;54(5):600-13
references: 8412150
references: J Stud Alcohol Drugs. 2010 May;71(3):384-94
references: 20409432
references: Traffic Inj Prev. 2013;14(6):572-7
references: 23859670
references: J Subst Abuse Treat. 2003 Jun;24(4):347-55
references: 12867209
references: Pediatrics. 2009 Jun;123(6):e975-81
references: 19482748
references: Am J Addict. 2006;15 Suppl 1:50-7
references: 17182420
references: Psychol Sci Public Interest. 2006 Sep;7(1):1-44
references: 26158695
references: J Subst Abuse Treat. 2008 Sep;35(2):184-201
references: 18083321
references: Alcohol Clin Exp Res. 2000 May;24(5):659-65
references: 10832907
references: Annu Rev Clin Psychol. 2005;1:91-111
references: 17716083