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Am Fam Physician. 2010;82(5):532-534

Background: National studies indicate that 16 percent of eighth graders report having consumed alcohol within the past 30 days. Among 10th and 12th graders, the percentages are 33 and 44, respectively. Alcohol misuse is common among adolescents. More than one half of 12th graders report having been drunk, 30 percent report binge drinking, and 3 percent report drinking daily. Several different interventions have been proposed to reduce adolescent alcohol abuse, but no recent research has compared the effectiveness of the many common treatments. Tripodi and colleagues conducted a meta-analysis of substance abuse interventions applied to adolescent alcohol abuse.

The Study: The authors identified studies performed between 1960 and 2008 concerning treatment of alcohol abuse in patients 12 to 19 years of age. They systematically searched multiple databases from medical, mental health, criminal, and drug or alcohol abuse sources to identify eligible studies. Manual searches were also conducted of references from identified studies, pertinent textbooks, and government publications. The criteria for inclusion in the meta-analysis were active interventions targeting patients 12 to 19 years of age, quantified alcohol use in outcomes, use of a comparison group, and use of psychosocial interventions with or without pharmacologic therapies. Two researchers independently abstracted data from eligible studies. Each study was also rated for methodologic quality. The principal outcome measured was frequency of alcohol use by number of drinking days and number of drinks consumed.

Results: From 64 initially identified studies, 16 met criteria and were used in the meta-analysis. About 90 percent were published between 2000 and 2008. All studies involved U.S. participants younger than 19 years. Most (60 percent) of the studies tested individual-based therapies, and approximately one third evaluated family therapies. Two studies used a quasi-experimental design; the remainder used an experimental design. Follow-up was six to 11 months in 56 percent of studies. Only 38 percent of studies successfully maintained 85 percent or more of their study entrants.

All studies reported reductions in alcohol use, but only seven achieved highly significant statistical reductions (P < .001). The range of the standardized effect for reduction of alcohol use was –0.09 for brief motivational interviewing to –1.991 for cognitive behavior therapy integrated with the 12-step approach. The effects of interventions diminished over time. In studies that reported outcomes after 12 months or longer, behavioral treatment had more enduring effects than supportive counseling, and multidimensional family treatment was more effective than family education or group therapy.

Conclusion: The authors conclude that several interventions show evidence of effectiveness in reducing adolescent alcohol abuse. In this meta-analysis, individually-based interventions had larger effects than those based on family therapies, but effectiveness for all interventions decreased over time.

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