Effectiveness of a peer-led telephone counseling intervention integrated with instant messaging chat support using motivational interviewing techniques for reducing drug misuse in youth : a randomized controlled trial

Abstract

Background: Youth drug misuse is a pervasive issue with detrimental consequences. However, youth drug misusers have low motivation to seek help due to stigma, confidentiality, or parental involvement. Motivational interviewing (MI) shows promise in facilitating behavior change. Peer-led telephone counseling using MI has been explored, but its long-term effectiveness varies. Integrating instant messaging (IM) chat support with MI-based telephone counseling may offer accessible and continuous support, potentially enhancing long-term outcomes. Aim: To test the effectiveness of integrating IM chat support versus general health messages into peer-led MI-based telephone counseling in reducing youth drug use. Methods: In this two-arm, pragmatic, randomized controlled trial (RCT), participants under the age of 25 and used drugs in the past 30 days were recruited via an addiction hotline. Structured training was developed for university students to deliver addiction counseling in the addiction hotline. Participants were randomized to either receive MI-based IM chat support or general health messages twice a week for 6 months. Both groups received peer-led MI-based telephone counseling at baseline. A pilot RCT was conducted to test the feasibility and effects of the intervention. The primary outcome was self-reported 30-day drug consumption at 6- and 12-month follow-ups. The secondary outcomes were self-reported/biochemical validated 30-day drug abstinence, drug misuse-related knowledge, attitudes towards the drug misuse, readiness to change drug consumption, relapse risk, and health-related quality of life (HRQoL). The primary analysis was intention-to-treat using generalized estimation equation model. The trial is registered as NCT04672746 on ClinicalTrials.gov. Results: Between November 2020 and February 2023, 62 participants (80.5% male, 95.2% cannabis user, 54.9% not ready to change in 30 days) were randomly assigned to the intervention (n=31) or control (n=31) groups. Both groups had significant reduction in self-reported 30-day drug consumption at 6-month. No significant difference was observed in the change of self-reported drug consumption at both 6- and 12-month follow-ups (with participant attrition rates of 9.7% and 24.2%, respectively) between the intervention and control groups, compared to baseline (6-month: -5.59 vs -7.05, p=0.615; 12-month: -6.64 vs -4.13, p= 0.445). Among the secondary outcomes, only the increase in readiness to change at 12-month compared to baseline was significantly higher in the intervention group than in the control group (4.39 vs 2.90, p=0.039). No significant differences were observed between the intervention and control groups in self-reported/biochemically validated 30-day drug abstinence (61.3% versus 41.9%, p=0.130), drug misuse-related knowledge (1.04 versus 0.32, p=0.675), attitudes towards drug misuse (2.04 versus 1.42, p=0.60), relapse risk (3.80 versus 4.44, p=0.676), and HRQoL (0.03 versus 0.13, p=0.179) at the 12-month follow-up compared with baseline. Conclusion: Integrating IM chat support into peer-led MI-based telephone counseling was effective in enhancing the readiness to change but not effective in reducing youth drug consumption. The findings are limited by incomplete recruitment and follow-up due to COVID-19 pandemic. Future research should aim to convert increased readiness to change into actual reductions in youth drug consumption.