A Brief Intervention for Young Adult Substance Users With Interpersonal Trauma

Description

Alcohol is the most commonly used substance in the United States, with emerging adults (EAs) showing the highest rates of heavy use among all age groups. Persistent heavy drinking in this population is linked to a range of negative outcomes, including poor mental health, reduced life satisfaction, cognitive impairments, academic difficulties, increased risk for motor vehicle accidents, and the development of substance use disorders.

Brief interventions (BIs) for substance use typically involve one or two individual sessions that provide personalized feedback. These interventions aim to challenge inaccurate normative beliefs and emphasize personal consequences of substance use. While BIs have demonstrated success in reducing alcohol consumption and related problems in numerous clinical trials, their impact is often limited. Common challenges include small effect sizes that diminish over time and reduced effectiveness among individuals with interpersonal trauma-specifically, trauma involving human-perpetrated violence and associated emotional distress.

One explanation for these limited outcomes is that BIs are not tailored to high-risk groups such as trauma survivors. Improving BIs may require addressing two key gaps: (1) targeting coping motives-strong predictors of heavy and persistent drinking among trauma-exposed individuals that are typically not addressed in standard BIs, and (2) incorporating peer coaches to support continued gains after the intervention.

There are compelling reasons to integrate trauma content, coping strategies, and peer support into BIs for substance-using EAs. Emerging adulthood is the developmental stage with the highest risk of experiencing interpersonal trauma, which is linked to poor mental health, low social support, and elevated alcohol use. Research indicates that coping with negative emotions is a common motive for substance use in this age group-especially among trauma-exposed individuals-yet these connections are not typically addressed in standard BIs. Additionally, traditional BIs often fail to provide adaptive strategies for managing trauma-related emotional distress, despite the availability of evidence-based coping techniques.

Peer influence also plays a critical role in both initiating and maintaining substance use during emerging adulthood. Including affiliated peers in in-person BIs has improved treatment outcomes in past studies. However, few interventions have extended peer involvement to the post-intervention period, despite the demonstrated success of peer coaches in other health domains.

Further, in-person, counselor-delivered BIs have been criticized as costly and difficult to implement broadly, limiting their scalability. Since few EAs actively seek substance use prevention or treatment services, there is a pressing need for low-cost, accessible delivery methods. Given the widespread use of mobile phones, mobile-delivered BIs represent a promising approach. Early evidence suggests they can be effective with EAs, though engagement tends to be low. Incorporating peer coaches into follow-up may help address this issue and boost engagement.

The primary aim of the proposed study is to evaluate the feasibility and efficacy of a mobile-delivered, trauma-informed, and peer-supported brief intervention (TIPS-BI) for emerging adults with a history of interpersonal trauma. This study will advance the BI literature by:

1. including content that links trauma to substance use and teaches emotion regulation strategies, and
2. integrating trained peer coaches into the text-message follow-up phase.

A total of 190 emerging adults (ages 18-29, with 60% expected to be female) who have a history of interpersonal trauma and report recent heavy alcohol use will be enrolled in a two-arm randomized controlled trial. Participants will be assigned to one of two conditions:

Group 1: Mobile-delivered TIPS-BI with peer coach follow-up (N=95)

Group 2: Mobile-delivered standard substance use BI (N=95)

Aim 1: Assess the feasibility and acceptability of the TIPS-BI. The investigators hypothesize that the TIPS-BI will result in low dropout rates (<10%) at follow-up, comparable to the standard BI. They also expect participants to rate the TIPS-BI as satisfactory, relevant, helpful, and minimally burdensome.

Aims 2 & 3: Evaluate the efficacy of the TIPS-BI. It is hypothesized that participants in the TIPS-BI group will show greater reductions in alcohol use and coping motives at 3- and 6-month follow-ups compared to those receiving the standard BI. Additionally, the TIPS-BI is expected to lead to greater improvements in coping self-efficacy at both follow-up time points.