Efficacy of Cognitive–Behavioral Interventions Targeting Personality
Risk Factors for Youth Alcohol Misuse
Patricia J. Conrod
Department of Psychological Medicine and Psychiatry, Section of Addiction, King’s College London,
University of London
Sherry H. Stewart
Departments of Psychiatry, Psychology, and Community Health and Epidemiology, Dalhousie University
Department of Psychology, Dalhousie University
A. Michael Maclean
Peter Lougheed Centre, Calgary Health Region
Sensation seeking, anxiety sensitivity, and hopelessness are personality risk factors
vene at the level of personality risk and associated maladaptive coping strategies, in-
cluding alcohol misuse. Manuals contained psychoeducational information on the
target personality risk factor and how it is associated with maladaptive coping, as
sonality type. We tested the efficacy of these novel interventions on reducing drinking
age 16, mean grade 11) to personality-targeted interventions (group format; 2 ses-
effects of the intervention and Intervention × Personality interactions on drinking
rates, drinking quantity, binge drinking, and problem drinking symptoms at 4-month
pattern of maladaptive drinking from the clinical syn-
dromes of alcohol abuse or alcohol dependence. Clini-
cal demand for preventative interventions to address
adolescent alcohol misuse has outpaced empirical re-
search to investigate their actual efficacy. Of those pro-
grams that have been evaluated, few have been shown
to be truly preventative (Wagner, Brown, Monti, My-
ers, & Waldron, 1999). A recent review of universal
prevention strategies for alcohol misuse in young peo-
ple (i.e., programs provided to all adolescents; Fox-
croft, Ireland, Lister-Sharp, Lowe, & Breen, 2002)
concluded that there is little support for the efficacy of
drug education programs. Universal programs that did
show promise were multifaceted school-based pro-
grams, involving skills training for teachers, parents,
and young (often elementary school age) children, as
well as ongoing professional and peer support. Pro-
grams that were shown to be effective, such as the Life
Skills Training Program (Botvin, Baker, & Dusenbury,
1995) or the Strengthening Families Program (Spoth,
Redmon, & Shin, 1998), involved multiple years of in-
Journal of Clinical Child and Adolescent Psychology
2006, Vol. 35, No. 4, 550–563
Copyright © 2006 by
Lawrence Erlbaum Associates, Inc.
This research was supported by the Alcoholic Beverages Medi-
cal Research Foundation to Sherry H. Stewart and Patricia J. Conrod
and an Investigator Award from the Canadian Institutes of Health
Research to Sherry H. Stewart.
We thank Pamela Collins, Gayla Swihart, Jennifer Theakston,
and the many undergraduate and graduate students who contrib-
uted to this project. We would also like to thank the staff at the Van-
couver School Board, particularly Isabel Grant, and the counselors
and students at Churchill, Kitsilano, David Thompson, Lord Byng,
and Vancouver Technical High Schools. Also, we would like to
thank the staff, counselors, and students of the Annapolis Valley
High School, and those who participated from North Kings Edu-
cation Centre, Central Kings, and Horton High Schools. In addi-
tion, we would like to thank the therapists and the director from
the Choices Adolescent Treatment Program in Nova Scotia who
assisted in delivering the interventions at the Nova Scotia site, as
well as Tom Payette for facilitating this arrangement with Choices.
We would like to thank artist Vincent Walsh for creative illustra-
tion and manual design. Finally, we extend appreciation to Alexa
Thompson for her assistance on early stages of program manual
Correspondence should be addressed to Patricia Conrod, Insti-
tute of Psychiatry, King’s College London, Department of Psycho-
United Kingdom. E-mail: firstname.lastname@example.org
on drinking behavior in adolescence.
There is a recognized need in the field of substance
use prevention for intervention strategies targeting
populations at significantly increased risk (i.e., selec-
tive interventions), or interventions that are more ther-
apeutic in nature (i.e., indicated interventions), to sup-
plement existing universal intervention strategies
cated prevention programs for youth alcohol problems
(e.g., Far & Miller, 2003; Monti, Barnett, O’Leary, &
Colby, 2001) have been shown to be effective in help-
ing young, heavy, or problematic drinkers reduce their
drinking. However, such programs are somewhat lim-
ited in that they only target and are effective for indi-
viduals who show heavy or problematic alcohol use
(O’Leary Tevyaw & Monti, 2004). They may not eas-
ily extend to those individuals at risk for developing
heavier drinking patterns but who have yet to demon-
strate significant drinking problems. Selective pro-
grams are rarer, but meta-analyses of school-based
substance abuse prevention programs have concluded
that selective programs generally yield higher effect
sizes than universal programs (Gottfredson & Wilson,
2003). Nonetheless, effects are still modest for even
the most effective and well-evaluated prevention pro-
grams (Ennett et al., 2003; Tobler et al., 2000).
a program targeting young people who demonstrated
1997) and personality risk for alcohol abuse (Caspi,
Moffitt, Newman, & Silva, 1998; Rutledge & Sher,
2001; Smith & Anderson, 2001). In this article, we
randomized controlled trial of this new approach to the
prevention of adolescent alcohol misuse.
Personality is a construct that is important for un-
derstanding alcohol use among adults (Caspi et al.,
Frone, Russell, & Mudar, 1995) and adolescents
Using a variety of measures of personality, research
has repeatedly shown that those personality dimen-
sions marking a broad impulsive sensation-seeking or
behavioral disinhibition trait are robust predictors of
Bartholow, & Wood, 2000). But in addition to traits re-
flecting behavioral undercontrol, neurotic personality
adolescent drinking to alcohol problems in young
adulthood (e.g., Jackson & Sher, 2003). There is also
some indication that these two sets of traits are associ-
ated with different aspects of drinking behavior. Neu-
rotic personality traits and symptoms have been shown
ciation with negative affect coping motives even after
disinhibited personality traits have been shown to be
associated with positive affect related drinking, which
was indirectly related to drinking problems by way of
its association with heavier drinking (Cooper, 1994;
Cooper et al., 1995).
There is also emerging research suggesting that
or that they map onto specific motivational processes
underlying alcohol use or misuse (Conrod, Pihl, et al.,
2000; Cooper et al., 1995). Anxiety sensitivity (AS),
hopelessness (H), and sensation seeking (SS) are per-
sonality risk factors that have been linked to alcohol
misuse (Comeau et al., 2001), and each is associated
with specific substance misuse patterns, maladaptive
motives for use, and vulnerability to specific forms of
comorbid psychopathology in both adolescents and
sensations due to beliefs that such sensations will lead
to catastrophic outcomes (Reiss, Peterson, Gursky, &
McNally, 1986). AS has been shown to be associated
with increased drinking levels (Stewart, Peterson, &
Pihl, 1995), a higher incidence of problem drinking
symptoms (Conrod, Pihl, & Vassileva, 1998), and neg-
ative reinforcement drinking motives (Comeau et al.,
2001) in nonclinical samples of young adults and ado-
ality traits have been shown to predict adult depression
and alcohol dependence (Caspi et al., 1998), and H,
a personality risk factor for depression, appears to
be especially associated with substance dependence
comorbid with recurrent depression (Conrod, Pihl, et
al., 2000). Studies examining motives for drinking in
high H young people indicated depression-specific
motives for alcohol misuse (Blackwell, Conrod, &
Hansen, 2002; Conrod et al., 2002). SS, or the desire
for intense and novel experiences (Zuckerman, 1994),
is associated with risk-taking and reckless behavior
among youth (Arnett, 1994) and with heavier drinking
Kemeny, & Maltzman, 1992). SS, particularly the in-
tensity-seeking component, has been shown to be as-
sociated with elevated enhancement-motivated drink-
ing (e.g., drinking to get high) among both young
adults (e.g., Stewart & Devine, 2000) and adolescents
(Comeau et al., 2001; Cooper et al., 1995).
Conrod, Stewart, et al. (2000) developed a novel set
of personality-matched interventions designed to tar-
ing substance-related behaviors in 197 adult female
substance abusers. Manualized interventions provided
personalized feedback and personality-specific cogni-
tive–behavioral exercises designed to facilitate more
adaptive coping. The personality-matched interven-
tions were shown to be associated with significantly
greater reduction in substance-dependence symptoms,
longer abstinence from alcohol and prescription drugs,
less concern about substance use, and fewer primary
care visits over the 6-month follow-up period, relative
cognitive–behavioral interventions that were adminis-
tered in a manner that did not match clients’personal-
Considering that these same personality factors are
implicated in adolescent alcohol misuse (e.g., Comeau
the extent to which the personality-based approach
could be effective in preventing the early onset of alco-
hol misuse by targeting known prospective risk factors
for early onset alcohol misuse in adolescents. To de-
velop interventions that would be more meaningful to
youth at high personality risk, interventions were de-
veloped, in part, based on data gathered through quali-
tative interviews with high personality risk teens
(Stewart et al., 2005). Stories drawn from these stu-
dents’ own experiences were incorporated within the
intervention manuals through the use of illustrative
scenarios and stylized images that would appeal to
youth. The interventions were administered in a group
format over two sessions, with a between-session
homework exercise. As recommend by Tobler et al.
(2000), the in-session exercises encouraged group in-
teraction so that the teens could learn from one an-
The goal of this study was to conduct a randomized
controlled trial of the effect of interventions targeting
one of three personality profiles: AS, H, and SS. We
tested the efficacy of these novel interventions in high
tia. Students were randomly assigned to the appropri-
ate personality intervention or to a no-treatment con-
trol group at each site and then reassessed 4 months
later. Our primary hypothesis was that high-risk youth
who received these personality-targeted interventions
would show reductions in overall drinking levels,
binge drinking, and drinking problems over the fol-
trol group. By excluding a nonmatched intervention
control group, this design did not provide a test of
the need to match to personality factors in treat-
group, this study served as a first step in establishing
empirical support for the overall effect of the personal-
ity-targeted approach. We also examined Personality ×
Intervention interactions to explore whether the differ-
ent personality interventions would result in different
outcomes (i.e., changes on those drinking measures to
which each personality group is most susceptible).
Considering that several cognitive–behavioral preven-
tion programs focusing on global coping skills have
not been very successful at preventing onset of alcohol
problems (see review by Foxcroft et al., 2002), the
demonstration that personality-targeted interventions
are efficacious relative to no treatment is a neces-
sary first step in establishing clinical validity of the
We recruited nine high schools (four from Nova
this study, in which students from Grades 9 to 12 (ages
14 to 17) were surveyed during class time, either in a
large-assembly format or in individual classrooms. Of
those surveyed, 58% reported drinking within the past
cruited and selected and the gender ratio at each stage
of participant recruitment and selection.
ers who also scored at least 1 standard deviation above
the sample mean on the Arnett Inventory of Sensation
Seeking–Intensity subscale (AISS–I; Arnett, 1994),
the Childhood Anxiety Sensitivity Index (CASI; Sil-
verman, Fleisig, Rabian, & Peterson, 1991), or the
Hopelessness subscale of the Substance Use Risk Pro-
file Scale (SURPS; Conrod et al., 2002) in schoolwide
screenings. These cutoffs were determined based on a
statistical rationale, because these scales were not de-
veloped for the purpose of clinical diagnosis. Using a
cutoff of 1 SD above the mean, we automatically se-
lected the top 16% of the samples for each dimension.
When participants demonstrated statistically deviant
scores on more than one scale (<25%), they were as-
signed to a personality intervention based on the score
fore, although multiple personality-risk elevations
were a common occurrence and related to more severe
alcohol abuse symptoms (as reported elsewhere by
Stewart, Comeau, Conrod, & Maclean, 2004), we did
not target more than one personality risk at a time.
As participation in the intervention portion of the
study was voluntary, we approached only those stu-
dents who had indicated interest in participating in the
students who met study eligibility indicated interest in
participating in the intervention and provided parental
compared all eligible students (drinkers with personal-
ity elevations) who volunteered to those who did not
volunteer on various demographic, personality, and
drinking behavior measures. These analyses revealed
significant differences in gender, χ2(1) = 4.14, p < .05;
SS, t(1,052) = –1.93, p = .05; H, t(1,031) = 2.135, p <
CONROD, STEWART, COMEAU, MACLEAN
.05; typical drinking quantity, t(986) = –2.36, p < .05;
and binge drinking status, χ2(1) = 6.85, p < .01. Those
who volunteered were more likely to be female, had
higher SS and lower H scores, drank more heavily, and
were more likely to be binge drinkers than those who
did not volunteer.
111 AS teens, 146 SS teens, and 40 H teens, of whom
166 were randomly assigned to participate in the rele-
vant personality-targeted intervention and 131 to par-
ticipate in the no-intervention control groups (Figure
1). The reason that the H group was smaller than the
other two groups is that only the British Columbia site
tested the efficacy of the H intervention. Of those ran-
intervention sessions; data from all randomized partic-
ipants were included in the outcome analyses.
wide screenings through letters sent home from schools
asking them to contact the experimenters by phone or
e-mail if they did not wish their child to participate in
Parents were informed of the school-
Figure 1.Recruitment and selection protocol.
the screening (i.e., negative consent). On the day of
screening, students were given a full description of the
screening protocol and rationale and were also pro-
vided with clear information on ethical issues such as
confidentiality and the voluntary nature of their par-
ticipation. Those who were willing to participate re-
mained in the group context and completed screening
measures whereas those few who did not assent were
invited to work on school-related activities during the
same time. For those eligible students indicating inter-
est in participating in the interventions, a letter was
sent home to parents with information about this phase
of the study. Parents were told that the interventions
were coping skills training sessions designed to reduce
ticipants’ confidentiality, parents were not explicitly
informed about any of the selection variables for the
study. Parents provided active informed consent for
their child to participate in the intervention proportion
of the study, and students themselves provided signed
tery, and only those randomly assigned to the experi-
mental or control intervention completed the 4-month
intervention occurred. Follow-up surveys were com-
pleted by initially contacting intervention and control
group participants by telephone and having them con-
sent to be called out of class the following day to com-
plete the survey. The follow-up survey contained the
same alcohol measures as the initial screening survey.
The CASI (Silverman et al., 1991) is a self-
report questionnaire designed to assess children’s and
constructed the CASI as a developmentally sensitive
version of the adult Anxiety Sensitivity Index (Reiss et
al., 1986) for younger test-takers. On this scale, re-
spondents are asked to rate their degree of agreement
with each of 18 items (e.g., “It scares me when my
heart beats fast”) on a 3-point Likert scale ranging
from 1 (none) to 3 (a lot). The CASI has good inter-
nal consistency (α = .84 in this sample), acceptable
2-week test–retest reliability, and good criterion-re-
lated validity in clinical and nonclinical samples of
children and teens (e.g., Walsh, Stewart, McLaughlin,
& Comeau, 2004; Weems, Hammond-Laurence, Sil-
verman, & Ginsburg, 1998).
The AISS–I (Arnett, 1994) is a 10-item sub-
scale of the AISS and assesses levels of intensity seek-
ing in adolescents (e.g., “I like the feeling of standing
next to the edge on a high place and looking down”).
The AISS–I has been shown to have good predic-
tive validity with measures of alcohol and drug use in
respondents as young as 12 years of age (Comeau,
Stewart, & Loba, 2001). In this sample, the internal
consistency of the AISS–I was low (α = .60) but equiv-
alent to the results of previous psychometric evalua-
tions of this scale (Andrew & Cronin, 1997; Zarevski,
Marusic, Zolotic, Bunjevac, Vukosav, 1998).
The SURPS (Conrod et al., 2002) assesses
levels of several personality risk factors for substance
abuse and dependence, including H. The SURPS sub-
scales are designed to have nonoverlapping items
between the risk factors to assist in discriminating per-
sonality dimensions that are normally highly cor-
scale assesses H independent of AS). The SURPS
subscales are also designed to tap personality variables
independent of substance-use behavior. A sample item
on the Hopelessness subscale is “I feel that I am a fail-
ure.” Each brief subscale appears to have sufficient
Cronbach coefficient alphas (α = .80 in the case of the
to have good convergent and discriminant validity
(Conrod et al., 2002). The SURPS has been used in
both substance-abusing clinical populations and non-
ulations (Blackwell et al., 2002) and has good test–re-
test reliability (Conrod et al., 2002).
Demographics and drinking behavior.
report questionnaire sought basic demographic infor-
asked to provide their age, gender, current grade level
in school, and estimated income range of their family
of origin according to a forced-choice answering pro-
cedure. Participants were requested to indicate wheth-
er they had consumed any alcohol within the past
4 months. Only those who responded affirmatively
to this item were invited to complete the remaining al-
cohol-related measures. Given that the personality-
matched interventions could have had differential ef-
fects on different aspects of drinking behavior, we de-
cided to utilize the standard method of assessing alco-
hol use with separate quantity and frequency of use
measures. We followed many of the recommendations
imize the accuracy of participants’self-reports. Quan-
tity of alcohol consumption was assessed by asking
students to indicate the average number of standard al-
coholic beverages they typically consumed on a single
drinking occasion over the past 4 months according to
a 5-point scale. The questionnaire included illustra-
CONROD, STEWART, COMEAU, MACLEAN
tions of standard units of alcohol drinks to assist stu-
as a continuous measure of typical drinking quantity
and to determine if participants were binge drinkers
(reporting consuming five or more standard units of al-
cohol [more than three to four drinks for girls] on one
occasion in the past 4 months). With regard to drinking
frequency, students reported how often they usually
drank alcohol over the same 4-month period.
lems Index (RAPI; White & Labouvie, 1989) is a
23-item self-report measure that assesses behavioral
symptoms of adolescent problem drinking (e.g., missed
school because of drinking). The RAPI asks respon-
purposes of this intervention outcome study, the
timeframe for participants’responses was shortened to
“during the past 4 months” as opposed to the longer
6 times) to more be more realistic for our shorter
has been well validated for use with both clinical and
the RAPI was excellent in this sample (α = .95).
The Rutgers Alcohol Prob-
All interventions were delivered by master’s-level
therapists, and a cofacilitator (a bachelor’s-level re-
search assistant or undergraduate psychology student).
across 2 weeks, and the number of students per group
ranged from 2 to 7.
Each intervention incorporated principles from the
motivational (Monti et al., 2001) and cognitive–behav-
ioral literatures (e.g., see review in Kendall & Choud-
hury, 2003). The three main components of the in-
terventions were (a) psychoeducation, (b) behavioral
coping skills training, and (c) cognitive coping skills
training. The interventions began with a psychoedu-
cational component: Girls and boys were educated
lematic coping behaviors associated with that person-
ality style. Students were then encouraged to discuss
the short-term reinforcing properties of a variety of
problematic coping strategies (including alcohol use),
as an attempt to help them understand their specific
motivations for engaging in problematic and risky be-
haviors. This was followed by a motivational interven-
tion (weighing the short- and long-term positive and
the use of problematic behavioral strategies for coping
with that particular personality dimension.
Next, cognitive coping skills training involved
learning how to identify and challenge personality-
veloped cognitive restructuring interventions for indi-
viduals fearful of anxiety (Barlow & Craske, 1988;
Conrod, Stewart, et al., 2000), for hyperactive and SS
individuals (Conrod, Stewart, et al., 2000; Kendall &
Braswell, 1985), and for depressed individuals (Bar-
low, 1985; Conrod, Stewart, et al., 2000), in the case of
the AS, SS, and H interventions, respectively. The in-
terventions also involved the use of exercises in which
students engaged in activities designed to recognize
and identify automatic thoughts (e.g., thought record
of an anxiety-provoking situation for the AS group).
Adolescents were simultaneously instructed by the
therapist and cofacilitator to utilize cognitive restruc-
turing techniques to counter such thoughts (Barlow,
1985; Kendall & Braswell, 1985). In the coping skills
section, participants completed exercises and engaged
from adolescents’real lives) that were informed by the
thematic analyses of qualitative data (Comeau, 2004;
Stewart et al., 2005) in which the context and conse-
quences of risky or maladaptive behavior (including
viously tested group of high personality risk adoles-
cents. Participants were also encouraged to generate
personal examples of similar scenarios and then com-
pleted exercises around these personal scenarios to fa-
cilitate learning of new skills.
Participants were provided with the manual and a
tervention. The intervention manuals provided space
riences relating to concepts presented in the interven-
tions. The content of the manuals was reviewed by a
panel of eight experts prior to the outset of the study.
The student manuals each comprised 28 single-sided
pages of text and exercises (Comeau, Stewart, Conrod,
& Javin Creative Inc., 2004a, 2004b, 2004c).
author) supervised group training sessions involv-
ing all the study therapists and cofacilitators using a
common training protocol. Training also involved su-
pervised practice in which therapists were observed
running group sessions and provided with feedback.
Therapists were instructed to stick very closely to the
material covered in the manuals (e.g., reading scenar-
group). Interventions were only considered to be com-
plete if each section of the manual was covered and
every exercise completed by the group. The principal
investigators were available for clinical supervision
throughout the implementation of the interventions.
Table 1 summarizes the demographic characteris-
tics of the sample, broken down by personality group
and experimental condition. There were no significant
differences between the personality groups or experi-
mental conditions on any of the demographic variables
and no interactions between personality group and ex-
Table 2 similarly presents data on baseline drinking
behavior of the sample. SS adolescents were over-
represented in the heavier drinking categories with the
SS group reporting more frequent drinking, χ2(8) =
17.95, p < .05, and a trend toward drinking larger
amounts of alcohol per occasion, χ2(8) = 14.28, p <
.08. The SS group evidenced higher rates (59%) of
binge drinking relative to the other two groups, χ2(2) =
7.09, p < .05. One-way analyses of variance indicated
that there were no significant differences in number or
severity of problem drinking symptoms across the per-
no significant intervention or intervention by personal-
ity effects on any of the drinking-related variables save
interaction on the drinking frequency variable, χ2(12)
= 20.69, p = .06. But analyses of simple main effects
did not reveal any significant differences between the
intervention and control groups for any of the three
personality groups, thus emphasizing the marginal na-
ture of the interaction.
4-Month Follow-Up Measures
A total of 265 (89%) participants completed fol-
low-up assessments 4 months after their random as-
signment to control or experimental groups. There
were no significant differences in attrition rates across
the intervention or personality groups.
the intervention on drinking behavior using the most
conservative data analysis procedure—namely, in-
tent-to-treat analyses. Students who did not complete
status and binge drinking status at follow-up and on all
continuous variables; they were assigned outcome
scores based on their baseline scores. Most of the out-
come variables in this study were noncontinuous vari-
ple). Therefore, main effects of intervention and
interactions were assessed using chi-square analyses.
based statistic that is calculated by dividing the square
root of the chi-square statistic by the sample size. For
We examined the effect of
CONROD, STEWART, COMEAU, MACLEAN
Table 1. Demographic Characteristics of Sample in Percentages by Personality Profile
and Intervention Group
14 and under
18 and older
Note: AS = anxiety sensitive; SS = sensation seeking; H = hopeless.
an = 111.bn = 146.cn = 40.dn = 131.en = 166.
greater than .30 representing a moderate effect, a value
lower than .10 representing a trivial effect. Cohen’s d
of variance and is a number that represents how many
value of .80 representing a large effect, a value of .50
vent one additional bad outcome (Laupacis, Sackett, &
ciprocal of the difference in rates of occurrence of the
problem in control and experimental groups.
indicated having consumed alcohol in the 4 months
prior to their participation in the study, a substantial
stinent from alcohol during the 4-month follow-up pe-
riod. Chi-square analyses revealed a trend for an inter-
vention effect, χ2(1) = 3.1, p < 0.08, φ = .10, NNT =
stinence rates at follow-up (22%), relative to the con-
trol group (14%) and a significant Intervention × Per-
sonality Group interaction, χ2(3) = 11.05, p = 0.01.
Subsequent analyses at each level of personality re-
vealed a significant intervention effect on abstinence
rates for the AS group, χ2(1) = 4.50, p < .05, φ = 0.21,
NNT = 5.6, a trend toward a significant effect for the H
group, χ2(1) = 2.68, p < 0.1, φ = 0.25, NNT = 4.9, and
no effect of intervention on abstinence rates in the SS
group (see Figure 2). The NNT analyses indicated that
for every 6 AS individuals treated, 1 case of abstinence
Despite the fact that all participants
was achieved at follow-up, and for every 5 H individu-
als treated, 1 case of abstinence was achieved.
ing rates indicated a significant effect of intervention,
χ2(1) = 9.5, p < .01, φ = .18, NNT = 5.5, with 60% of
drinking at follow-up (see Figure 2). A significant in-
teraction effect, χ2(3) = 12.8, p < .01, was also found.
Binge drinking was significantly more prevalent in the
SS control group (68%) at follow-up relative to the SS
intervention group (48%) at follow-up, χ2(1) = 5.65, p
< 0.05, φ = 0.20, NNT = 5.1. Binge drinking was also
more prevalent in the AS and H control groups (51%
and 46%, respectively) at follow-up relative to the AS
and H intervention groups (37%, NNT = 7.0 and 32%,
NNT = 6.2, respectively), but analyses did not reveal
significant intervention effects for these latter two per-
sonality groups (see Figure 2).
Similar analyses on binge drink-
Drinking quantity and frequency.
ed two-way (intervention by personality group) analy-
ses of covariance on drinking quantity and frequency,
with the baseline drinking variable as a covariate. This
analysis is somewhat more conservative than a re-
peated-measures analysis as it does not capitalize on
the increase in power resulting from a repeated mea-
sure, but it allowed us to control for personality group
differences on baseline drinking variables. For drink-
effect, F(1, 288) = 4.33, p < 0.05, d = 0.26, with the in-
consumption at follow-up relative to the control group.
The intervention group scored 2.0 (unadjusted mean)
Table 2. Drinking Behavior of the Sample in Percentages by Personality Profile and Intervention Group
Drinks per occasion
1 or 2
3 or 4
5 or 6
7 to 9
10 or more
1 per month
2–3 times per month
Daily or almost
Note: AS = anxiety sensitive; SS = sensation seeking; H = hopeless.
an = 111.bn = 146.cn = 40.dn = 131.en = 166.
on the alcohol consumption scale (SD = 1.7), indicat-
ing an average of three to four drinks per drinking oc-
casion, whereas the control group scored an average of
2.6 on the drinking quantity measure (SD = 1.7), indi-
cating an average of close to five to six drinks per
drinking occasion. The interaction was not significant,
and no significant effects were revealed in the analysis
of covariance on drinking frequency.
Problem drinking symptoms.
lems variable was severely skewed in this sample and
could not be corrected using square-root or log trans-
formations. Given the shorter time frame that partici-
pants were asked about, the usual clinical cutoffs for
this scale were not applicable and a variable represent-
ing presence versus absence of problem drinking symp-
toms seemed more appropriate and appeared to best
characterize the data in categorical terms. This method
1998). Using this method for dichotomizing RAPI
scores, 20% of participants at baseline reported ab-
sence of drinking-related problems (RAPI score = 0),
and there were no personality or intervention group
differences evident at baseline. At follow-up, 31% of
participants reported absence of drinking problems,
but intervention and Intervention × Personality Group
interaction effects were revealed by chi-square analy-
ses, χ2(1) = 8.0, p < .01, φ = 0.16 and χ2(3) = 10.9, p <
.05, respectively. Thirty seven percent of the interven-
tion group reported absence of drinking-related prob-
lems at follow-up, whereas only 22% of the control
group reported absence of such problems at follow-up
(NNT = 6.5). Analyses of simple main effects of inter-
intervention effects for the AS and the H groups, χ2(1)
.05, φ = 0.31, NNT = 3.5, respectively (see Figure 3).
tervention effects were limited to behavioral correlates
of personality risk or if the interventions also reduced
deviance on each of the three personality measures.
Three three-way (Personality × Intervention × Time)
the personality measures. Results indicated significant
Time × Personality Group effects for CASI, AISS,
= 19.80, p < .01, F(2, 148) = 10.27, p < .01, re-
spectively. All three analyses indicated that students
showed significant reductions over time on the person-
ality dimension on which they were most deviant (re-
gression to the mean). There was no evidence of Inter-
vention × Personality interactions.
We examined whether in-
The main objective of this study was to explore the
clinical utility of brief interventions targeting dimen-
sions of personality risk for alcohol abuse. In general,
these brief interventions were shown to significantly
improve outcome by facilitating abstinence and reduc-
problems in selected groups of high-risk youth relative
ations of effective substance-use prevention programs
CONROD, STEWART, COMEAU, MACLEAN
less; SS = sensation seeking.
lished universal prevention programs in that only one
produce an effect on drinking behavior. We found that
generally only five personality-targeted interventions
need to be provided to high-risk youth to prevent one
case of alcohol misuse, and our two-session interven-
tion strategy is briefer than most established programs.
efficiency of this new approach include targeting pro-
and incorporating intervention techniques that specifi-
abuse prevention programs (e.g., Darkes & Goldman,
1993) in that the intervention discusses issues that are
ality dimension suggests that these interventions are
helping youth better manage their personality vulnera-
bility rather than actually change their personality. The
larger implication of these findings is that alcohol use
for the treatment of nonaddictive mental disorders.
current models of alcohol misuse in young people by
highlighting the role of vulnerability to psychopathol-
et al., 1998).
Although the personality-based approach appears
to be a promising method for reducing drinking behav-
the intervention strategy appeared somewhat depend-
ent on the outcome variables investigated. The inter-
ventions were not shown to be effective in reducing
intervention were revealed for the quantity of alcohol
consumed and binge-drinking variables. One possibil-
ity for the differences in intervention efficacy across
ventions actually only influenced aspects of drinking
behavior that were linked to risk for substance misuse,
particularly personality risk for substance misuse. Pri-
or research has shown the personality-mediated anxio-
lytic and psychostimulant properties of alcohol to be
dose dependent (MacDonald, Baker, Stewart, & Skin-
ner, 2000; Stewart, Finn, & Pihl, 1992). By learning
more effective cognitive and behavioral coping strate-
gies for managing aspects of their personality, the ado-
lescent participants may have been less inclined to
drink heavily to obtain these effects. Indeed, analysis
come data indicated that only those in the control
group, and not those in the active intervention groups,
were drinking at a level likely to produce those risky,
highly reinforcing alcohol effects at follow-up. Fre-
quency with which youth engaged in drinking may be
more influenced by external factors than internal, per-
sonality, or motivational factors. Stewart, Angelopou-
search suggesting that drinking quantity is a more
important indicator of problem drinking than drinking
frequency in terms of its negative health implications.
Thus, if our intervention was to impact on only one
of these two drinking parameters, it would be most
groups. AS = anxiety sensitive; H = hopeless; SS = sensation seeking.
Percentage of students indicating absence of drinking problems at baseline and follow-up for intervention and personality
important for it to reduce these adolescents’ typical
drinking quantities. An important finding was that the
intervention was also associated with a significant re-
duction in alcohol problems on the RAPI, because al-
current difficulties, as well as pose increased risk for
(Windle, Shope, & Bukstein, 1996).
Beyond just affecting the most “risky” aspects of
early-onset alcohol use, each intervention also ap-
peared to have effects on aspects of drinking behav-
ior that are particular to each of the personality types.
According to baseline data, the SS group was more
prone to binge drinking than the other two personality
pact on this drinking variable for the SS group than the
other two personality risk groups. By contrast, the AS
and H groups demonstrated similar drinking-related
problems relative to the SS group, despite drinking
lower quantities of alcohol than the SS group. Further-
more, the AS and H intervention appeared to exert its
effects by increasing abstinence and decreasing prob-
and the control conditions. This unique relation be-
tween negative affect related drinking and drinking
problems has been documented by Cooper and col-
leagues (Cooper, 1994; Cooper et al., 1995; Cooper,
Russell, Skinner, & Windle, 1992). Therefore, our re-
sults can be interpreted as indicating that these person-
ality-specific interventions are effective in reducing
the very drinking behaviors that are most problematic
for each personality type, thus providing further sup-
port for the necessity of targeting personality in early
interventions for alcohol misuse.
Despite the very promising findings reported here,
there are some limitations to the investigation that
should be acknowledged. First, the design did not al-
low us to test hypotheses about matching treatment to
personality. Furthermore, this study did not allow for
the assessment of the efficacy of the personality-based
approach relative to other evidence-based alcohol pre-
vention programs or an attention-only control inter-
vention. Rather, this first study only provided an initial
test of the efficacy of individual cognitive–behavioral
therapy interventions targeting specific personality
risk factors relative to a no-treatment control. We are
currently not able to conclude whether such interven-
tions must necessarily be provided in a “matched”
fashion for treatment effects to be observed or whether
the reported effects are due to the therapeutic attention
received by the treatment group or even the more inter-
active nature of the treatment itself. However, it is
doubtful that just attention alone or just the interactive
nature of the group sessions could have produced the
effects that we saw considering the numerous failed
adolescent alcohol prevention attempts that have in-
cluded, among a number of components, therapeutic
attention and group interaction (Tobler et al., 2000).
compare the personality-based approach to an atten-
tion-only control administered either individually or in
interactive group sessions. Another logical extension
of this research would be to examine the relative effi-
cacy of this program compared to established effective
Sussman et al., 2005). Finally, only in a study that in-
cludes a nonmatched control group in which youth are
provided interventions that target a personality dimen-
sion that is irrelevant to their own personality profile
can we address the matching hypothesis.
A second limitation of this study was that even for
AS, H, and S youth in the experimental group, the ob-
The quantity and frequency index for measurement of
alcohol use may have limited the type, number, and
complexity of variables that could be examined as out-
comes of the treatment. Future research might include
(cf. Sobell, Maisto, Sobell, & Cooper, 1979), thus al-
lowing for greater range of outcome variables. Future
ment impact such as changes in drinking motives and
sonality and drinking behavior tests would be useful in
our original substance-abuse intervention that was not
incorporated into the early intervention program, be-
Fromme, 2000; Winters, 2001) have advised that brief
motivational interventions use self-report assessment
decisional balancing exercise (Winters, 2001). There
low internal consistency (Andrew & Cronin, 1997;
Zarevski, Marusic, Zolotic, Bunjevac, & Vukosav,
the content validity of their items and not their internal
structure. The use of more internally valid scales, such
mogeneous group of SS individuals who respond more
ture, relative to the large body of literature on empiri-
cally supported interventions for anxiety and depres-
sion. Unless SS co-occurs with substance misuse, it
tends not to present in clinical settings as a target of in-
tervention, which may explain why there is less known
CONROD, STEWART, COMEAU, MACLEAN
was based on empirically supported interventions for
childhood hyperactivity (Kendall & Braswell, 1985)
and data collected through qualitative interviews with
SS youth (Comeau, 2004; Stewart et al., 2005). Al-
behavioral and biological aspects of SS, there is rela-
tively little research characterizing SS at a cognitive
level, and further developments in this area may im-
prove our understanding of the cognitive–behavioral
processes that mediate SS drinking.
We also did not address the fact that some high-risk
youth had multiple personality elevations and could
have benefited from an intervention that targets more
than one personality risk factor. Future studies should
dition, the relative degree of prediction of the person-
ality constructs might be strengthened by inclusion
of other theoretically relevant personality variables in
future research (e.g., impulsivity; see Castellanos &
Conrod, in press; Conrod, Stewart, et al., 2000). More-
over, there are other nonpersonality factors operating
that place adolescents at particular risk for alcohol
& Leukefeld, 1998) and childhood victimization
(Miller & Downs, 1995).
Another possible limitation is the failure to test
for longer-term outcomes beyond 4-months postinter-
programs (Drug Abuse and Resistance Education and
Risk Skills Training Program), D’Amico and Fromme
(2002) found that although Resistance Education and
Risk Skills Training Program participants decreased
participation in several risk behaviors at posttest, re-
ductions were not maintained at 6-month follow-up.
Although our findings show that the personality-based
interventions were effective up to 4-months postin-
tend the follow-up period to determine durability of
these gains. It is also possible that more robust differ-
ential intervention effects might be observed at even
pants in the control group might continue to develop
more problematic drinking patterns in the longer term
their current levels or continue to improve.
A final possible limitation of this study is that par-
who volunteered to participate in the interventions.
such as high levels of motivation to change among
those who volunteered to participate. Although we did
not assess degree of motivation to change in this study,
there were indeed differences between eligible teens
who did and did not volunteer to participate on certain
demographic, personality, and drinking behavior vari-
ables that indicated that heavy drinking, SS girls were
gram. Future research should try to determine how to
make the interventions more attractive for engaging
(e.g., hopeless youth) and should assess the efficacy of
the interventions in samples of high personality risk
drinkers recruited through different means (e.g., man-
Despite these practical limitations, there are several
exciting future directions for this research, including
examining the efficacy of the brief interventions for
prevention of comorbid addictive and mental health
disorders. Considering the elevated and problematic
orders in adolescents (Myers, Brown, Tate, Abrantes,
ity traits in nonaddictive psychopathology, this inter-
vention strategy presents clinical benefits over other
prevention strategies because this new approach has
the possible advantage of improving coping skills re-
lated to both alcohol abuse and comorbid disorders to
which an adolescent is most vulnerable (Conrod &
Stewart, 2005). For example, AS is a known risk factor
not only for alcohol abuse problems but also for anxi-
ety disorders, including panic disorder, that are com-
(Birch, Stewart, Watt, & Bernier, 2003). In fact, a very
recent trial investigating the effect of the personal-
toms in adolescence revealed that personality-based
interventions were effective in reducing emotional and
behavioral symptoms relevant to each personality type
(e.g., depressive symptoms in H adolescents, panic
symptoms and avoidance behaviors in AS students,
and antisocial risk taking in impulsive adolescents;
Castellanos & Conrod, in press).
ready reporting drinking alcohol, which leaves room
for further potential “preventative” effects if the inter-
vention is provided to younger, nondrinking youth. It
will be important to determine whether personality
management prior to onset of drinking behavior can
prevent youth from even initiating underage drinking
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Received December 21, 2004
Accepted May 18, 2006