Substance Use
Conditions
Brief summary
This project will pilot test a computer-assisted social network intervention, using motivational interviewing techniques, that can help case managers work with formerly homeless young adults who recently transitioned to supportive housing to reduce substance use and increase permanent supportive connections during this critical transitional period.
Detailed description
The goal of this study is to conduct a pilot evaluation of a motivational network intervention (MNI) to reduce substance use and strengthen supportive connections for recently homeless 18-25 year-olds who have transitioned to a housing program. The goal of this pilot study is to evaluate, through a small randomized controlled trial (Stage 1b), the added benefit of incorporating the MNI into case management for transitional age youth (TAY) residents of housing programs. We hypothesized that residents receiving the MNI as part of case management would show more positive changes in their substance use behaviors and the composition and structure of their personal networks (i.e., greater proportion of network members who are low-risk) over a 3-month follow-up period compared to residents receiving usual case management only.
Interventions
BEHAVIORALMotivational Network Intervention
Every 2 weeks, residents attend meetings with their case manager. These meetings are customized to the needs of the resident at the time of the meeting. Participants randomized into the Motivational Network Intervention arm are offered an additional discussion about their social networks. Case managers ask participants to answer a series of standardized questions about people they know. After these questions are answered, case managers show participants a series of images representing these answers. While showing these images, case mangers engage the participant in discussions about what they notice using Motivational Interviewing techniques. The goal is to discuss what the participant wants to change and state strategies about achieving these changes.
OTHERUsual Care
Residents attend regular case management meetings with their case managers as a condition of their residency in the housing program. These sessions are customized do the needs of the resident at the time of the meeting. Participants randomized into the usual care arm will be offered these sessions every 2 weeks.
Sponsors
National Institute on Drug Abuse (NIDA)
RAND
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 25 Years
Healthy volunteers
Yes
Inclusion criteria
* Age 18-25 * In a housing program for homeless transition age youth * Past month substance use * Screen positive for past-year harmful substance use
Exclusion criteria
• Not able to speak/understand English
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Days Cannabis Used | 30 days | Count of days that respondent used cannabis in the past 30 days |
| Proportion of Risky Network Members | 4 weeks | Proportion of network members who engaged in substance use or the participant used more substances when they were with the network member. |
| Number of Drinks Consumed on Drinking Days | 30 days | Participants reported on the typical number of drinks they consumed on drinking days in the past month. |
| Number of Drinking Days | 30 days | Number of days in the past month (0-30) that participants reported engaging in any alcohol use. |
| Number of Days Consumed 5 (for Men) or 4 (for Women) Drinks on a Single Occasion | 30 days | Number of days in the past month (0-30) that participants reported engaging in heavy alcohol use (5 or more drinks for men and four or more drinks for women on a single occasion). |
Countries
United States
Participant flow
Recruitment details
Participants were recruited through a nonprofit agency in Los Angeles County that provides a comprehensive continuum of care to transitional age youth experiencing homelessness. The agency's case managers offered eligibility screening to all residents who had been at the facility for less than one year. Residents who consented to be contacted by the study team completed an eligibility screener and provided contact information and informed consent if eligible and willing to participate.
Pre-assignment details
Recruitment was delayed throughout the project due to COVID-19 social-distancing restrictions and frequent resident quarantines. These restrictions also limited the number of MNI sessions that could be scheduled and completed. During the final year of the project, the project team ended randomization and assigned all study participants to the CONNECT arm to adjust for recruitment/session delivery shortfalls.
Participants by arm
| Arm | Count |
|---|---|
| Intervention The intervention will consist of four sessions spaced two weeks apart that will last approximately 30 minutes each and consist of two parts: a network interview to capture network data about the time period since their last interview and a discussion of a resulting network visualization conducted in a motivational interviewing style. Participants will receive the intervention as part of existing case management.
Motivational Network Intervention: See earlier description | 24 |
| Usual Care As part of residency, participants receive regular case management meetings.
Usual Care: See earlier description | 12 |
| Total | 36 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 |
|---|---|---|---|
| Overall Study | Death | 1 | 0 |
| Overall Study | Lost to Follow-up | 5 | 2 |
Baseline characteristics
| Characteristic | Intervention | Usual Care | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 24 Participants | 12 Participants | 36 Participants |
| Age, Continuous | 21.2 years STANDARD_DEVIATION 2.4 | 21.7 years STANDARD_DEVIATION 1.7 | 21.3 years STANDARD_DEVIATION 2.17 |
| Average network centrality - risky alters | .328 average connections STANDARD_DEVIATION 0.401 | .167 average connections STANDARD_DEVIATION 0.3 | .271 average connections STANDARD_DEVIATION 0.372 |
| Average network centrality - supportive alters | 1.50 average connections STANDARD_DEVIATION 1.31 | 2.24 average connections STANDARD_DEVIATION 2.65 | 1.77 average connections STANDARD_DEVIATION 1.89 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 13 Participants | 4 Participants | 17 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 11 Participants | 8 Participants | 19 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Number of Days Cannabis Used | 4.79 days STANDARD_DEVIATION 5.76 | 5.67 days STANDARD_DEVIATION 8.67 | 5.08 days STANDARD_DEVIATION 6.75 |
| Number of Days Consumed 5 (for Men) or 4 (for Women) Drinks on a Single Occasion | 2.63 days STANDARD_DEVIATION 5.24 | 4.17 days STANDARD_DEVIATION 8.33 | 3.14 days STANDARD_DEVIATION 6.36 |
| Number of Drinking Days | 4.79 days STANDARD_DEVIATION 5.76 | 5.67 days STANDARD_DEVIATION 8.67 | 5.08 days STANDARD_DEVIATION 6.75 |
| Number of Drinks Consumed on Drinking Days | 3.75 drinks per day STANDARD_DEVIATION 5.45 | 3.58 drinks per day STANDARD_DEVIATION 2.78 | 3.69 drinks per day STANDARD_DEVIATION 4.68 |
| Proportion of Risky Network Members | .24 proportion STANDARD_DEVIATION 0.27 | .05 proportion STANDARD_DEVIATION 0.07 | .164 proportion STANDARD_DEVIATION 0.222 |
| Proportion of Supportive Network Members | .56 proportion STANDARD_DEVIATION 0.31 | .60 proportion STANDARD_DEVIATION 0.3 | .59 proportion STANDARD_DEVIATION 0.3 |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Asian | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Black or African American | 7 Participants | 2 Participants | 9 Participants |
| Race (NIH/OMB) More than one race | 4 Participants | 5 Participants | 9 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 11 Participants | 2 Participants | 13 Participants |
| Race (NIH/OMB) White | 2 Participants | 3 Participants | 5 Participants |
| Sex/Gender, Customized Female | 10 Participants | 5 Participants | 15 Participants |
| Sex/Gender, Customized Male | 12 Participants | 6 Participants | 18 Participants |
| Sex/Gender, Customized Unspecified | 2 Participants | 1 Participants | 3 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 1 / 24 | 0 / 12 |
| other Total, other adverse events | 0 / 24 | 0 / 12 |
| serious Total, serious adverse events | 0 / 24 | 0 / 12 |
Outcome results
Primary
Number of Days Cannabis Used
Count of days that respondent used cannabis in the past 30 days
Time frame: 30 days
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention | Number of Days Cannabis Used | 23.7 days | Standard Deviation 10.5 |
| Usual Care | Number of Days Cannabis Used | 7.36 days | Standard Deviation 11.2 |
t-test, 2 sided
Primary
Number of Days Consumed 5 (for Men) or 4 (for Women) Drinks on a Single Occasion
Number of days in the past month (0-30) that participants reported engaging in heavy alcohol use (5 or more drinks for men and four or more drinks for women on a single occasion).
Time frame: 30 days
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention | Number of Days Consumed 5 (for Men) or 4 (for Women) Drinks on a Single Occasion | 1.95 days | Standard Deviation 2.89 |
| Usual Care | Number of Days Consumed 5 (for Men) or 4 (for Women) Drinks on a Single Occasion | 2.91 days | Standard Deviation 8.35 |
t-test, 2 sided
Primary
Number of Drinking Days
Number of days in the past month (0-30) that participants reported engaging in any alcohol use.
Time frame: 30 days
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention | Number of Drinking Days | 7.45 days | Standard Deviation 8.47 |
| Usual Care | Number of Drinking Days | 6.09 days | Standard Deviation 9.35 |
t-test, 2 sided
Primary
Number of Drinks Consumed on Drinking Days
Participants reported on the typical number of drinks they consumed on drinking days in the past month.
Time frame: 30 days
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention | Number of Drinks Consumed on Drinking Days | 2.30 drinks per day | Standard Deviation 2.25 |
| Usual Care | Number of Drinks Consumed on Drinking Days | 3.64 drinks per day | Standard Deviation 5.54 |
t-test, 2 sided
Primary
Proportion of Risky Network Members
Proportion of network members who engaged in substance use or the participant used more substances when they were with the network member.
Time frame: 4 weeks
| Arm | Measure | Value (MEAN) | Dispersion |
|---|---|---|---|
| Intervention | Proportion of Risky Network Members | .242 proportion of network members | Standard Deviation 0.342 |
| Usual Care | Proportion of Risky Network Members | .0797 proportion of network members | Standard Deviation 0.106 |
t-test, 2 sided