A randomized controlled trial of guided self-change with minority adolescents

Adolescent substance use and abuse is a pressing public health problem and is strongly related to interpersonal aggression. Such problems disproportionately impact minority youth, who have limited access to evidence-based interventions such as ecological family therapies, brief motivational interventions (BMIs), and cognitive behavioral therapies (CBTs). With a predominantly minority sample, our objective was to rigorously evaluate the efficacy of a school-based BMI/CBT, Guided Self-Change (GSC), for addressing substance use and aggressive behavior.

We conducted a school-based randomized, controlled trial with 514 high school students (mean age 16.24 years, 41% female, 80% minority) reporting using substances and perpetrating aggression. We used structural equation modeling to compare participants randomly assigned to receive GSC or standard care (SC; education/assessment/referral-only) at posttreatment and at 3 and 6 months posttreatment on alcohol use, drug use, and interpersonal aggression outcomes as assessed by the Timeline Follow-Back.

Compared with SC participants, GSC participants showed significant reductions (p < .05) in total number of alcohol use days (Cohen's d = 0.45 at posttreatment and 0.20 at 3 months posttreatment), drug use days (Cohen's d = 0.22 at posttreatment and 0.20 at 3 months posttreatment), and aggressive behavior incidents (Cohen's d = 0.23 at posttreatment). Moreover, treatment effects did not vary by gender or ethnicity.

With minority youth experiencing mild to moderate problems with substance use and aggressive behavior, GSC holds promise as an early intervention approach that can be implemented with success in schools.