Newswise — Skilled facilitators of an alcohol intervention based on motivational interviewing are key to promoting safer drinking behaviors among young adults experiencing homelessness, a new study suggests. The study is the first to examine the effects of the group process on emerging adults’ drinking outcomes using several different measures of group dynamics. Some young adults experiencing homelessness can access services at drop-in centers, but interventions must be brief and feasible in resource-stretched environments. Previous studies of AWARE, an intervention based on motivational interviewing in a four-session group format, found reductions in drinking in this vulnerable population. It is not well understood, however, which aspects of the group experience—process, structure, and clinician behavior—contribute to these outcomes. Research points to the importance of change talk (e.g., “I’m quitting for the summer”), cohesion (group bonding), climate (group engagement and mutual support), and facilitator empathy (how well the clinician understands clients’ perspectives). For the study in Alcohol: Clinical & Experimental Research, investigators explored the AWARE intervention process, measuring multiple facets of the group experience and their associations with drinking outcomes among young adults experiencing homelessness.

The investigators worked with 132 adults aged 18–25 who were experiencing homelessness and seeking services at one of three drop-in centers in Los Angeles County. The participants were predominantly male and non-White. They filled out baseline surveys on their frequency and amount of alcohol use in the past month and rated the importance of cutting down on drinking or remaining abstinent. The researchers digitally recorded and coded 63 group sessions—with an average of 6 participants in each—flagging talk of positive change around drinking, the extent to which participants supported each other and exhibited solidarity, and facilitators’ efforts to grasp clients’ perspectives. Ratings from each session were assigned to every participant who attended that session and averaged. Participants completed additional surveys at 3, 6, and 12 months after the intervention. The researchers used statistical analysis to examine associations between group processes and drinking outcomes. Site 1 differed substantively from the others for reasons including higher alcohol use at baseline; consequently, the researchers examined each site separately.

Overall, the study found reductions in drinking for AWARE participants at all three sites, with improvements apparent a year after the intervention. The findings on group processes provide more granular evidence of how sessions influenced behavior change. At 6 months, a higher percentage of change talk was linked to fewer drinks per drinking day at sites 2 and 3; at site 1, the reverse was found. There was no effect of change talk at one year. Greater group cohesion was linked to fewer drinking days at 6 months. Higher facilitator empathy was associated with fewer maximum drinks in one day at both 6- and 12-months, among other positive outcomes. Group climate was not associated with drinking outcomes.

The study highlights the importance of measuring multiple factors in the group process to enable a more textured understanding of group dynamics and behavior change outcomes. It highlights the value of change talk—including its benefit to observers as well as those who express it—in addition to group cohesion and facilitator empathy. The study adds to growing evidence of the importance of facilitators’ skills, which may also contribute to indirect effects, for example, via nurturing change talk and cohesion.

Understanding effects of the group process on drinking outcomes for emerging adults experiencing homelessness. E. D’Amico, J. Houck, E. Pedersen, D. J. Klein, A. Rodriguez, J. Tucker. (pp xxx)


Journal Link: Alcohol: Clinical and Experimental Research