VOICES: An efficacious trauma-informed, gender-responsive cannabis use intervention for justice and school-referred girls with lifetime substance use history
Open accessAbstract
Background Girls have unique developmental pathways to substance use and justice system involvement, warranting gender-responsive intervention. We tested the efficacy of VOICES (a 12-session, weekly trauma-informed, gender-responsive substance use intervention) in reducing substance use and HIV/STI risk behaviors among justice- and school-referred girls.Methods Participants were 113 girls (M age = 15.7 years, SD = 1.4; 12 % White, 19 % Black, 15 % multi-racial; 42 % Latinx) with a history of substance use referred from juvenile justice (29 %) and school systems (71 %). Study assessments were completed at baseline, 3-, 6- and 9-months follow-up. Primary outcomes included substance use and HIV/STI risk behaviors; secondary outcomes included psychiatric symptoms (including posttraumatic stress) and delinquent acts. We hypothesized that girls randomized to the VOICES (n = 51) versus GirlHealth (attention control; n = 62) condition would report reduced alcohol, cannabis and other substance use, HIV/STI risk behaviors, psychiatric symptoms, and delinquent acts.Results Girls randomized to VOICES reported significantly less cannabis use over 9-month follow-up relative to the control condition (time by intervention, p < .01), but there were no between group differences over time in HIV/STI risk behavior. Girls in both conditions reported fewer psychiatric symptoms and delinquent acts over time.Conclusions Data support the use of a trauma-informed, gender-responsive intervention to reduce cannabis use among girls with a substance use history and legal involvement; reducing cannabis use in this population has implications for preventing future justice involvement and improving public health outcomes for girls and young women, who are at disproportionate health and legal risk relative to their male counterparts.
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Compared with a general health promotion control, the Voices intervention significantly improved alcohol use at 6-month follow-up.
“significant improvements (compared to general health promotion control group), in cannabis and alcohol use at 6-month follow-up”
From Interventions for prevention and treatment of substance use in youth with traumatic childhood experiences: a systematic review and synthesis of the literature (2024) · cites this paper as [63]
The Methods identify GirlHealth as a general health-promotion control, and the Discussion says alcohol-use reductions followed a pattern similar to cannabis-use reductions through six months after the intervention. But the Data analyses section says alcohol use was too infrequent to analyze separately over time. The significant result in Primary outcomes was for a combined alcohol-or-drug-use measure, not alcohol use alone. (LLM, conf=0.86)
Experimental — accuracy not yet measuredSeveral group interventions have found significant reductions in pre-post substance use and mental health symptoms, but only two randomized controlled trials have evaluated group intervention effectiveness.
“Several group interventions have found significant reductions in pre-post SU and mental health symptoms, however only two RCTs have been conducted to evaluate group intervention effectiveness [49, 52, 59, 61, 63].”
From Interventions for prevention and treatment of substance use in youth with traumatic childhood experiences: a systematic review and synthesis of the literature (2024) · cites this paper as [63]
The Introduction (Current study; page unavailable) identifies VOICES as a randomized controlled trial of a group intervention. The Results (Primary and Secondary outcomes; pages unavailable) report reduced cannabis use in the VOICES group and significant decreases in psychiatric symptoms in both groups. The paper does not establish that several group interventions had these results or that only two RCTs had evaluated their effectiveness. (LLM, conf=0.84)
Experimental — accuracy not yet measuredCompared with a general health promotion control, the Voices intervention significantly improved cannabis use at 6-month follow-up, from 57% to 39%, with an intervention-by-time effect F(3,281)=2.92, p=0.03.
“significant improvements (compared to general health promotion control group), in cannabis and alcohol use at 6-month follow-up (for cannabis, 57% at baseline to 39% at follow-up, with significant intervention x time effect (F(3, 281)= 2.92, p=0.03).”
In the Voices trial, both intervention and control groups showed significant improvement over time in substance use consequences.
“Both groups had significant improvements over time in SU consequences, PTSD symptoms, general psychiatric symptoms, and delinquent behaviors, with no significant between-group differences.”
In the Voices trial, both intervention and control groups showed significant improvement over time in delinquent behaviors.
“Both groups had significant improvements over time in SU consequences, PTSD symptoms, general psychiatric symptoms, and delinquent behaviors, with no significant between-group differences.”
In the Voices trial, there were no significant between-group differences in substance use consequences, PTSD symptoms, general psychiatric symptoms, or delinquent behaviors.
“Both groups had significant improvements over time in SU consequences, PTSD symptoms, general psychiatric symptoms, and delinquent behaviors, with no significant between-group differences.”
In the Voices trial, both intervention and control groups showed significant improvement over time in PTSD symptoms.
“Both groups had significant improvements over time in SU consequences, PTSD symptoms, general psychiatric symptoms, and delinquent behaviors, with no significant between-group differences.”
In the Voices trial, both intervention and control groups showed significant improvement over time in general psychiatric symptoms.
“Both groups had significant improvements over time in SU consequences, PTSD symptoms, general psychiatric symptoms, and delinquent behaviors, with no significant between-group differences.”
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References 50 · Cited by 18
Research works printed but not linked: 1
- Messina N, Grella CE, Cartier J, Torres S, 2010b. A randomized experimental study of gender-responsive substance abuse treatment for women in prison. J. Subst. Abuse Treat 38 (2), 97– 107. 10.1016/j.jsat.2009.09.004. 20015605 PMC2815183 · DOI · Paper page
- Authors
- Tolou-Shams, M., Dauria, E. F., Folk, J., Shumway, M., Marshall, B. D. L., Rizzo, C. J., Messina, N., Covington, S., Haack, L. M., Chaffee, T., & Brown, L. K.
- Affiliations
- University of California, San Francisco (US)
- Brown University (US)
- Northeastern University (US)
- University of California, Los Angeles (US)
- ORCID
- Venue
- Drug and Alcohol Dependence
- Publisher
- Elsevier BV
- Published
- 2021-11
- Volume
- 228
- Pages
- 108934
- ISSN
- 0376-8716 (ISSN-L)
- PMC
- PMC8717799
- OpenAlex
- W3186799005
- Cited by
- 18
- References
- 50
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 1 · 2023: 4 · 2022: 6 · 2021: 1
- FWCI
- 2.16
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- Drug and Alcohol Dependence (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- National Institutes of Health
- National Institute on Drug Abuse (K24DA046569, R01DA035231, R25DA037190)
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Sociology and Political Science › Crime Patterns and Interventions
- Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
- Keywords
- cannabis use, trauma-informed interventions, gender-responsive interventions, girls, juvenile justice involvement, substance use history, psychiatric symptoms, post-traumatic stress, alcohol consumption
- MeSH terms
- Adolescent, Cannabis, Female, Humans, Male, Schools, Sexually Transmitted Diseases, HIV Infections, Substance-Related Disorders
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