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Adapting the personality‐targeted Preventure program to prevent substance use and associated harms among high‐risk Australian adolescents
Abstract
Substance use among adolescents is of significant concern and the need for preventive interventions is clear. Although universal prevention programs have shown to reduce substance use among Australian adolescents, no effective selective program has been developed for high-risk youth in Australia. Preventure is a personality-targeted intervention that has shown to be effective in the UK and Canada and is yet to be trialled in Australia. Before doing so, it is necessary to ensure the content is relevant for the Australian setting. This study reports data collected to update and adapt the UK-based Preventure program for use in Australia.
Eight focus groups were conducted with 69 students from three secondary schools in Sydney, Australia. Students who screened high risk for early-onset substance misuse were invited to participate in focus groups specific to their personality profile and provide feedback. Written feedback was also obtained from 12 teachers and health professionals.
Students, teachers and experts recommended specific changes to the content, language, scenarios and graphics of the Preventure manuals. The majority of teachers and experts believed that the educational content of the program was appropriate for students and that it would be effective in reducing substance use in this population.
The information obtained in the current study was used to update the Preventure program for use with Australian adolescents. It is expected that this modified Preventure program will demonstrate similar effects in reducing alcohol and drug use among high-risk youth in Australia, as it did in the UK and Canada.
... Brief alcohol intervention (Giles et al., 2016; Personalized feedback about the individual student's drinking behavior and attitude, behavior change counselling, advice about the health and social consequences of continued risky alcohol consumption Preventure (Barrett et al., 2015;Conrod, 2016) Psycho-education (personality profile), behavioral and cognitive coping skills (e.g., goal setting, cognitive restructuring), motivational interviewing MobileCoach ...
... For example, sensation seeking, is closely related to PVS domain of the RDoC, and is targeted using psychoeducation, motivational enhancement therapy, and cognitive behavioral therapy techniques specifically focused on reward sensitivity. The impulsivity component of the intervention is relevant to CS and focuses on building motivation and cognitive behavioral skills to help young people manage an impulsive personality style and has been shown to reduce substance misuse as well as risk for conduct disorder symptoms (O'Leary- Barrett et al., 2013). The hopelessness and anxiety sensitivity components are relevant to the NVS domain of the RDoC (although hopelessness might be etiologically related to low PVS and lack of inhibition on NVS). ...
... The hopelessness and anxiety sensitivity components are relevant to the NVS domain of the RDoC (although hopelessness might be etiologically related to low PVS and lack of inhibition on NVS). Experimental designs have shown that cognitivebehavioral strategies that differentially target these risk factors show some specificity in reducing risk for substance misuse and clinically significant levels of anxiety disorders and major depression (O'Leary- Barrett et al., 2013). The other example of a multi-dimensional program is life skill programs (LSPs) which target intra-and interpersonal skills (e.g., communication skills, empathy, assertiveness, problem solving and decision-making skills, coping with emotions and stress), as well as training substance-related skills (e.g., resistance skills), changing attitude, and improving substance-related knowledge (e.g., norms) (Wenzel et al., 2009). ...
... Ready4life (Haug et al., 2021) Substance-related knowledge and attitudes, normative expectations, and skills for resisting media and peer influences to use, personal selfmanagement (decision-making and problem-solving ability, skills for identifying, analyzing, interpreting, and resisting media influences, skills for coping with negative emotions (e.g., anxiety, anger, and frustration), basic principles of personal behavior change and self-improvement (e.g., goalsetting, self-monitoring, and selfreinforcement) and social skills (communication, initiating social interactions, conversation, complimenting, skills related to malefemale relationships, and verbal and nonverbal assertive skills) eCHECKUP TO GO (Doumas et al., 2020) Personalized normative feedback on peer drinking, positive alcohol beliefs, and positive alcohol expectancies, as perceptions of peer drinking and cognitions about alcohol, protective behavioral strategies (e.g., social activities instead of partying) ALERT, Alerta Alcohol program ( Martinez-Montilla et al.,2020) Change students' beliefs about drug norms and the social, emotional, and physical consequences of using drugs; help them identify and resist pro-drug pressures from parents, peers, the media, and others; build resistance selfefficacy, the belief that one can successfully resist pro-drug influences Kripalu Yoga in the Schools (KYIS) curriculum (Butzer et al.,2017) Stress management, emotion regulation, self-appreciation, confidence, and strong peer relationships The GOOD life (Stock et al.,2016;Vallentin-Holbech et al., 2018) Social Norms Intervention (social norm and attitude) Brief alcohol intervention (Giles et al., 2016; Personalized feedback about the individual student's drinking behavior and attitude, behavior change counselling, advice about the health and social consequences of continued risky alcohol consumption Preventure (Barrett et al., 2015;Conrod, 2016) Psycho-education (personality profile), behavioral and cognitive coping skills (e.g., goal setting, cognitive restructuring), motivational interviewing MobileCoach Alcohol (Haug et al., 2014) Social norm interventions, outcome expectations, self-efficacy, planning processes Saluda program (Hernández-Serrano et al., 2013) Information on alcohol and illicit drugs, and their effects; information on causal factors (motivations) for drinking and taking pills among adolescents; advertising analysis; social skills and assertiveness skills; information on healthy leisure offers existing in the city; abilities in problem solving and decision making; public commitment to non-abuse of alcohol and synthetic drugs Motivational interviewing-oriented brief alcohol interventions (Gmel et al., 2012) Knowledge, attitude, motivation ...
... For example, sensation seeking, is closely related to PVS domain of the RDoC, and is targeted using psychoeducation, motivational enhancement therapy, and cognitive behavioral therapy techniques specifically focused on reward sensitivity. The impulsivity component of the intervention is relevant to CS and focuses on building motivation and cognitive behavioral skills to help young people manage an impulsive personality style and has been shown to reduce substance misuse as well as risk for conduct disorder symptoms (O'Leary- Barrett et al., 2013). The hopelessness and anxiety sensitivity components are relevant to the NVS domain of the RDoC (although hopelessness might be etiologically related to low PVS and lack of inhibition on NVS). ...
... Coping skills for negative emotions (e.g., skills for coping with anxiety), Positive Valence Systems (PVS) includes Motivation to change behavior (e.g., self-reinforcement), Drug-free activities (e.g., information on healthy leisure offers existing in the city), Knowledge about drug reward (e.g., immediate rewards against personal values), Social Processes (SP) includes Social skills (e.g., communication skills), Social attitudes and selfperception for drugs (e.g., modifying attitude towards using drug), Social norms (e.g., personalized normative feedback), Social pressure resisting skills (e.g., refusal skills), Changing self/other perspective (perception of self and other), Self-related awareness and self-efficacy skills (e.g., belief in one's ability to overcome drug temptation), Self-monitoring (e.g., personal self-management), Drug effects on body and brain (e.g., accurate insight towards harmful effects of substances), Cognitive System (CS) includes Cognitive-management skills (e.g., problem solving), Cognitive empowerment skills (e.g., goal-setting), Cognitive-control skills (e.g., self-control skills), Arousal and Regulatory Systems (ARS) includes Stress management (e.g., coping skills for stress) References (In alphabetical order of the interventions): Alerta Alcohol program (Martinez-Montilla et al., 2020), Alcohol Misuse Prevention Study (AMPS) (Shope et al., 2001), Brief alcohol intervention (Giles et al., 2016;, WISEteens (Brief intervention for poly-drug use) (Arnaud et al., 2012), Climate Schools (now known as OurFutures) (Vogl et al., 2009;Slade et al., 2021), CognitionMotivation-Emotional Intelligence-Resistance Skills (CMER) (Guo et al., 2010), Drug education program (Midford et al., 2012), eCHECKUP TO GO (Doumas et al., 2020), IPSY (Spaeth et al., 2010), keepin' it REAL (Kulis et al., 2007), Kripalu Yoga in the Schools (KYIS) curriculum (Butzer et al., 2017), Life skills training (LST) (Seal, 2006;Botvin et al., 1990), Motivational interviewing-oriented brief alcohol interventions (MIBAI) (Gmel et al., 2012), MobileCoach Alcohol (Haug et al., 2014), Preventure (Barrett et al., 2015;Conrad, 2016), Project Toward No Drug Abuse (TND) (Sussman et al., 2011) Ready4life (Haug et al., 2021), Reconnecting Youth (Hallfors et al., 2006), RealTeen (Schwinn et al., 2010), these risk factors show some specificity in reducing risk for substance misuse and clinically significant levels of anxiety disorders and major depression (O'Leary- Barrett et al., 2013). The other example of a multi-dimensional program is life skill programs (LSPs) which target intra-and interpersonal skills (e.g., communication skills, empathy, assertiveness, problem solving and decision-making skills, coping with emotions and stress), as well as training substance-related skills (e.g., resistance skills), changing attitude, and improving substance-related knowledge (e.g., norms) (Wenzel et al., 2009). ...
... In their cultural adaptation of a mental health literacy intervention to the First Nations context, Crooks and colleagues describe modifications to foster community resilience by building upon specific healing resources of First Nations cultures [37] In an adaptation of an evidence-informed nursing intervention to improve medication adherence among people with HIV/AIDS in China, Williams and colleagues included family members in intervention activities to acknowledge the social importance of the family in China [32] Types of adaptation: modifications made to the outward design When transferring the intervention to prevent substance use and associated harms from UK to Australian adolescents, Barrett and colleagues changed the places (e.g., train station) and activities (e.g., athletics) on student leaflets to present more culturally appropriate situations [42] Types of adaptation: modifications to how interventions are delivered In their adaptation of HIV care and treatment in rural Mozambique, Audet and colleagues selected traditional healers as support workers to deliver the intervention When culturally adapting an intervention to reduce sexual risk behaviours among patients attending a STI clinic in St. Petersburg, Russia, Grau and colleagues used gradual and indirect introduction of role plays, as these exercises were not very common in the Russian context [36] Process of adaptation: involving stakeholders to inform key decisions on modifications ...
... Studies also referred to the modifications made to the language and wording of the intervention [25,28,33,34,36,[40][41][42][43]47] and its outward design, such as when interventions involved the use of specific materials [24,25,27,28,33,34,37,[40][41][42][43][44]. Modifications to how interventions are delivered constitute another frequently discussed type of adaptation, including changes to the format of delivery and deliverers [25-27, 31, 36, 41, 43, 44, 49, 50] (see Table 4). ...
... Studies also referred to the modifications made to the language and wording of the intervention [25,28,33,34,36,[40][41][42][43]47] and its outward design, such as when interventions involved the use of specific materials [24,25,27,28,33,34,37,[40][41][42][43][44]. Modifications to how interventions are delivered constitute another frequently discussed type of adaptation, including changes to the format of delivery and deliverers [25-27, 31, 36, 41, 43, 44, 49, 50] (see Table 4). ...
Background
Implementing evidence-informed population health interventions in new contexts often requires adaptations. While the need to adapt interventions to better fit new contexts is recognised, uncertainties remain regarding why and when to adapt (or not), and how to assess the benefits (or not) of adaptation. The ADAPT Study aims to develop comprehensive guidance on adaptation. This scoping review informs guidance development by mapping and exploring how adaptation has been undertaken in practice, in public health and health services research.
Methods
We searched seven databases from January 2000 and October 2018 to identify eligible studies for this scoping review and a related systematic review of adaptation guidance. We mapped the studies of adaptation by coding data from all eligible studies describing the methods, contexts, and interventions considered for adaptation. From this map, we selected a sample of studies for in-depth examination. Two reviewers extracted data independently into seven categories: description, key concepts, types, rationale, processes, evaluation methods, evaluation justification, and accounts of failures and successes.
Results
We retrieved 6694 unique records. From 429 records screened at full text, we identified 298 eligible studies for mapping and selected 28 studies for in-depth examination. The majority of studies in our map focused on micro- (i.e., individual-) level interventions (84%), related to transferring an intervention to a new population group within the same country (62%) and did not report using guidance (73%). Studies covered a range of topic areas, including health behaviour (24%), mental health (19%), sexual health (16%), and parenting and family-centred interventions (15%). Our in-depth analysis showed that adaptation is seen to save costs and time relative to developing a new intervention, and to enhance contextual relevance and cultural compatibility. It commonly follows a structured process and involves stakeholders to help with decisions on what to adapt, when, and how.
Conclusions
Adaptation has been undertaken on a range of health topics and largely in line with existing guidance. Significant gaps relate to adaptation of macro- (e.g., national-) level interventions, consideration of programme theories, mechanisms and contexts (i.e., a functional view of interventions), nuances around stakeholder involvement, and evaluation of the adapted interventions.
Registration Open Science Framework, 2019, osf.io/udzma.
... Identifying BPD in vulnerable populations gains relevance because early interventions have demonstrated the efficacy of BPD treatment. 5 Considering the above, it is expected that SUD-BPD patients have more comorbidity with other psychiatric disorders. The main aim is to compare addiction-related variables and psychiatric comorbidity between SUD-BPD and SUD without this comorbid condition. ...
... 6 Therefore, in women and younger consumers, identification programs and treatment are critical in order to prevent more severe cases of BPD. 5 Another interesting finding is that cocaine and benzodiazepines were the substances most closely associated to BPD. A similar study found that the primary substance in SUD-BPD patients was more likely to be illicit drugs and less likely to be alcohol. ...
The comorbidity between substance-use disorders and borderline personality disorder (SUD-BPD) with other psychiatric disorders has been little studied. A total of 937 drug-dependent patients were evaluated using semistructured interviews and 13.7% were SUD-BPD patients. After multivariate analysis, gender, Affective Disorder (OR 2.59), Anxiety Disorder (OR 1.90), Eating Disorders (OR 4.29), Cocaine (OR 2.16), benzodiazepine dependence (OR 1.90), early age of onset of drug consumption (OR 0.94), and dependent (OR 4.04), paranoid (OR 3.70) and antisocial personality disorders (OR 3.46) were associated with SUD-BPD. Several psychiatric comorbidities are the norm in SUD-BPD patients; therefore these patients are a challenge for clinicians.
... 1 22 Before conducting a full-scale RCT, determining the feasibility and acceptability of an intervention is an important step before evaluating its effectiveness in a new context to ensure that it is relevant, suitable and easy to implement with the target audience. [23][24][25] It was expected that teachers and students in the UK who deliver and complete the Climate Schools programme would rate it as (1) easy to implement and understand; ...
... Prior to evaluating an intervention in a new context, it is important to ensure that it is relevant, suitable and easy to implement with the target audience. [23][24][25] The Climate Schools programme is a 12-lesson universal school-based intervention to prevent alcohol and cannabis use and related harms. The programme has previously been found to be effective in reducing the use of alcohol and cannabis among adolescents in Australia; however, it is yet to be trialled internationally. ...
Objectives
The online universal Climate Schools intervention has been found to be effective in reducing the use of alcohol and cannabis among Australian adolescents. The aim of the current study was to examine the feasibility of implementing this prevention programme in the UK.
Design
A pilot study examining the feasibility of the Climate Schools programme in the UK was conducted with teachers and students from Year 9 classes at two secondary schools in southeast London. Teachers were asked to implement the evidence-based Climate Schools programme over the school year with their students. The intervention consisted of two modules (each with six lessons) delivered approximately 6 months apart. Following completion of the intervention, students and teachers were asked to evaluate the programme.
Results
11 teachers and 222 students from two secondary schools evaluated the programme. Overall, the evaluations were extremely positive. Specifically, 85% of students said the information on alcohol and cannabis and how to stay safe was easy to understand, 84% said it was easy to learn and 80% said the online cartoon-based format was an enjoyable way to learn health theory topics. All teachers said the students were able to recall the information taught, 82% said the computer component was easy to implement and all teachers said the teacher's manual was easy to use to prepare class activities. Importantly, 82% of teachers said it was likely that they would use the programme in the future and recommend it to others.
Conclusions
The Internet-based universal Climate Schools prevention programme to be both feasible and acceptable to students and teachers in the UK. A full evaluation trial of the intervention is now required to examine its effectiveness in reducing alcohol and cannabis use among adolescents in the UK before implementation in the UK school system.
... Far fewer interventions for personality traits have been attempted. The largest number of studies have looked at personality traits as a side effect of interventions that target other constructs such as cognitive ability 147,180,183 , psychopathology [184][185][186][187][188] or delinquent behaviour [189][190][191] . Even though these interventions attempt to directly influence the four change mechanisms, the evidence for personality trait change as a result of these interventions is mixed at best. ...
Although personality is relatively stable across the lifespan, there is also ample evidence that it is malleable. This potential for change is important because many individuals want to change aspects of their personality and because personality influences important life outcomes. In this Review, we examine the mechanisms responsible for intentional and naturally occurring changes in personality. We discuss four mechanisms — preconditions, triggers, reinforcers and integrators — that are theorized to produce effective change, as well as the forces that promote stability, thereby thwarting enduring changes. Although these mechanisms are common across theories of personality development, the empirical evidence is mixed and inconclusive. Personality change is most likely to occur gradually over long timescales but abrupt, transformative changes are possible when change is deliberately attempted or as a result of biologically mediated mechanisms. When change does occur, it is often modest in scale. Ultimately, it is difficult to cultivate a completely different personality, but small changes are possible.
... Second, knowledge that impulsivity personality exerts its effects in increasing injury risk in part through increasing peak drinking levels suggests a mechanism that can be targeted among impulsive emerging adults-namely heavy drinking-in injury risk reduction efforts. More specifically, interventions known to reduce heavy drinking by impulsive young people, like the PreVenture substance misuse prevention/ early intervention program (Barrett et al. 2015;Conrod et al. 2013) may be helpful in reducing impulsive emerging adults' risk for physical injury. Our results showed that impulsivity and peak drinking quantity significantly predicted higher odds of physical injury, and that the pathway from impulsivity to physical injury in emerging adults was partially mediated by peak drinking quantity. ...
Background
Alcohol-induced injury is one of the leading causes of preventable morbidity and mortality. We investigated the relationship between impulsive personality and physical injury (e.g. falls, sports), and whether peak drinking quantity specifically, and/or risky behaviour more generally, mediates the relationship between impulsivity and injury in undergraduates.
Method
We used data from the winter 2021 UniVenture survey with 1316 first- and second-year undergraduate students aged 18–25 years (79.5% female) from five Canadian Universities. Students completed an online survey regarding their demographics, personality, alcohol use, risky behaviours, and injury experiences. Impulsivity was measured with the substance use risk profile scale, past 30-day peak alcohol use with the quantity-frequency-peak Alcohol Use Index, general risky behaviour with the risky behaviour questionnaire, and past 6-month injury experience with the World Health Organization’s (2017) injury measurement questionnaire.
Results
Of 1316 total participants, 12.9% ( n = 170) reported having sustained a physical injury in the past 6 months. Mean impulsivity, peak drinking quantity, and risky behaviour scores were significantly higher among those who reported vs. did not report injury. Impulsivity and peak drinking quantity, but not general risky behaviour, predicted injury in a multi-level generalized mixed model. Mediation analyses supported impulsivity as both a direct predictor of physical injury and an indirect predictor through increased peak drinking (both p < .05), but not through general risky behaviour.
Conclusion
Results imply emerging adults with impulsive tendencies should be identified for selective injury prevention programs and suggest targeting their heavy drinking to decrease their risk for physical injury.
... The semi-structured interview guide was designed to gather information to support the eventual development of scenarios and material for a future personality targeted intervention with OAT clients. This was similar to the strategy used for developing other adaptations of the personality-targeted intervention [e.g., (27,28)]. Briefly, we collected information regarding treatment goals, barriers, needs, and personality-specific information regarding the cognitive, affective, and behavioral lived experience of the personality trait that was elevated in the individual participant. ...
Background
The Four Factor Personality Vulnerability model identifies four specific personality traits (e.g., sensation seeking [SS], impulsivity [IMP], anxiety sensitivity [AS], and hopelessness [HOP]) as implicated in substance use behaviors, motives for substance use, and co-occurring psychiatric conditions. Although the relationship between these traits and polysubstance use in opioid agonist therapy (OAT) clients has been investigated quantitatively, no study has examined the qualitative expression of each trait using clients’ voice.
Method
Nineteen Methadone Maintenance Therapy (MMT) clients (68.4% male, 84.2% white, mean age[SD] = 42.71 [10.18]) scoring high on one of the four personality traits measured by the Substance Use Risk Profile Scale [SURPS] completed a semi-structured qualitative interview designed to explore their lived experience of their respective trait. Thematic analysis was used to derive themes, which were further quantified using content analysis.
Results
Themes emerging from interviews reflected (1) internalizing and externalizing symptoms, (2) adversity experiences, and (3) polysubstance use. Internalizing symptoms subthemes included symptoms of anxiety, fear, stress, depression, and avoidance coping. Externalizing subthemes included anger, disinhibited cognitions, and anti-social and risk-taking behaviors. Adverse experiences subthemes included poor health, poverty, homelessness, unemployment, trauma, and conflict. Finally, polysubstance use subthemes include substance types, methods of use, and motives. Differences emerged between personality profiles in the relative endorsement of various subthemes, including those pertaining to polysubstance use, that were largely as theoretically expected.
Conclusion
Personality is associated with unique cognitive, affective, and behavioral lived experiences, suggesting that personality may be a novel intervention target in adjunctive psychosocial treatment for those undergoing OAT.
... Although the feedback regarding the accuracy of the personality profile was somewhat mixed, this is often the case in personality assessment (Layne & Ally, 1980). Our approach is similar to the concept of personality-targeted interventions for prevention of substance abuse (Barrett et al., 2015), but less pathology-oriented. Note that the personality specific recommendations are in need of further refinement. ...
The early stages of the COVID-19 pandemic posed a twofold global health threat: Besides the evident danger to human life, the corona crisis is also a psychological crisis. Psychologists worldwide have contributed to cushion the distress that is laid on many societies and enforce adaptive coping strategies. However, psychological support in the past has often been broadly applied, has not been particularly parsimonious and has often been focused on severe psychological stressors. In this brief report we describe the development and application of a low-threshold tool that generates personality-specific recommendations on how to functionally cope with the psychological challenges of the corona crisis. The tool gained widespread attention in Germany and many other countries and was well received by users. It demonstrates how psychological knowledge from personality and health psychology can be combined to be of very concrete use for many people in a threatening situation. We also show that personality is related to health behavior in a crisis in a meaningful way, providing further evidence that personality-specific advice can be a useful approach for supporting persons to cope with the crisis.
... The effectiveness of the Preventure program when delivered by external psychologists has been demonstrated in Canada and the United Kingdom (Conrod et al., , 2008Castellanos and Conrod, 2006). A recent Australian cluster RCT replicated these results, indicating successful adaptation of the Preventure program for students in Australia when led by psychologists; results showed that Preventure successfully reduced the uptake of alcohol, binge drinking and alcoholrelated harms up to 36-months following the intervention (Teesson et al., 2017;Newton et al., , 2019Barrett et al., 2015), with effect sizes (in Cohen's d) of 0.47, 0.65 and 0.54 respectively (Conrod, 2016), equating to a moderate effect. In addition, the Australian adaptation showed secondary effects for mental health outcomes, including anxiety and depressive symptoms, conduct problems and hyperactivity symptoms (Newton et al., 2019). ...
Mental disorders and problematic alcohol use are common, co-occurring and cause significant harm to individuals and society. It is critical to intervene early to prevent chronic and debilitating trajectories. Existing prevention programs among adolescents are limited in effectiveness and implementation. This Australian-first study will examine the effectiveness and feasibility of a personality-targeted program called Preventure, in preventing the onset or escalation of alcohol use, internalising problems and externalising problems among young Australians, when delivered by school staff.
A cluster randomised controlled trial (RCT) of effectiveness will be conducted from 2020 to 2022 with 12 schools in Sydney, Australia, with students aged 13 years at baseline. Schools will be randomly allocated to the Preventure intervention or a control condition who will receive their usual Health Education curriculum. Schools allocated to the intervention will deliver Preventure to students scoring one standard deviation above the population mean on one of four personality traits. Preventure consists of two 90-minute group sessions that incorporate cognitive-behavioural therapy and motivational interviewing to promote coping skills. Students will be invited to complete surveys at baseline, 6- and 12-months following the intervention. Primary outcomes include student alcohol use, internalising problems, and externalising problems. Implementation fidelity, feasibility and acceptability will also be examined through surveys with school staff and students. Ethical approval has been obtained from the University of Sydney Human Research Ethics Committee, and the State Education Research Applications Process for research in public schools in NSW. This trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12620000790943).
... Personality-targeted selective prevention. Preventure is a personality-targeted, selective prevention programme, which has been modified for Australian youth (Barrett et al., 2015). The Preventure programme comprised two 90-minute group sessions delivered one week apart. ...
Objective
This study examined the secondary mental health outcomes of two contrasting alcohol prevention approaches, whereby one intervention targets common underlying personality risk for alcohol use and mental health problems ( Preventure) and the other targets alcohol- and drug-related behaviours and cognitions ( Climate Schools).
Methods
A 2 × 2 cluster randomised controlled factorial design trial was conducted in 26 Australian schools randomised to the following 4 conditions: Climate Schools ( n = 6), Preventure ( n = 7), combined Climate Schools and Preventure (CAP; n = 6) or treatment as usual (TAU; n = 7). Participants completed questionnaires at baseline, 6, 12, 24 and 36 months post-baseline including the Brief Symptom Inventory anxiety and depression scales and hyperactivity and conduct scales of the Strengths and Difficulties Questionnaire. Analyses focused on students who were at high-risk based on personality traits ( n = 947; M age = 13.3). The effectiveness of each approach in reducing symptoms of internalising and externalising problems was assessed using multi-level mixed effects analysis.
Results
Main effects for each intervention relative to not receiving that intervention revealed significant main effects of Preventure in reducing anxiety symptoms ( d = −0.27, 95% confidence interval [CI] = [−0.53, −0.01], p < 0.05) and a marginal effect in reducing depressive symptoms ( d = −0.24, 95% CI = [−0.49, 0.01], p = 0.06) over 3 years. Interaction effects revealed that when delivered alone, Preventure significantly reduced conduct problems ( d = −0.45, 95% CI = [−0.78, −0.11], p < 0.05) and hyperactivity symptoms ( d = −0.38, 95% CI = [−0.70,−0.07], p < 0.05) compared to TAU.
Conclusion
This study is the first to report the effectiveness of personality-targeted alcohol prevention in reducing internalising and externalising symptoms relative to an active control, providing evidence in favour of its specificity in preventing concurrent substance use and mental health problems among high-risk youth.
... This study extends previous research on personality associations with bullying by examining four specific personality dimensions found to be high-risk for other problems among adolescents: impulsivity, hopelessness, anxiety sensitivity and sensation seeking. Previous research has found these personality dimensions to be predictive of substance misuse, psychopathology and behavioural problems (Barrett et al., 2015;Castellanos-Ryan et al., 2013;Conrod and Woicik, 2002;Newton et al., 2016). Furthermore, a personality-focused group intervention incorporating psychoeducation about the participants' dominant personality style, motivational interviewing and cognitive behavioural components has been found to be effective in reducing a number of psychosocial problems among adolescents, such as substance use, depressive symptoms, panic attacks, shoplifting and truancy (Conrod et al., 2013). ...
Objective:
This study aimed to examine whether high-risk personality dimensions increased susceptibility to bullying victimisation and perpetration among Australian adolescents.
Method:
Longitudinal cohort study of 527 secondary school students in Australia (baseline average age = 13 years, 67% female and 93% Australian-born). Bullying was measured using an amended version of the Revised Olweus Bully/Victim Scale. Personality was measured using the Substance Use Risk Profile Scale. The data were analysed using mixed models, examining the association between baseline personality scores and frequency of victimisation/perpetration 12 months later.
Results:
Baseline hopelessness and baseline impulsivity were positively associated with frequency of victimisation 12 months later. Baseline anxiety sensitivity was negatively associated with victimisation 12 months later for males. There was a positive association between baseline impulsivity and frequency of bullying perpetration 12 months later.
Conclusion:
High-risk personality dimensions predicted later bullying victimisation and bullying perpetration among Australian adolescents. This indicates that adding a personality-focused intervention for high-risk adolescents to existing universal bullying prevention approaches may be effective in improving the prevention of bullying among adolescents, as well as reducing other associated emotional and behavioural problems.
... Additional validation procedures can include qualitative interviews with high-risk youth identified using the SURPS, such as described by Barrett et al. [70], and procedures that include even more community engagement, such as described by Mushquash et al. [71,72]. In both adaptations, a mixedmethod approach was used in which quantitative surveys such as the Drinking Motives Questionnaire are used to confirm different motivational profiles in high-risk youth and qualitative surveys and interviews with high-risk youth are used to collect detailed information on where drinking and drug use situations occur in young people's lives and other local interests and pastime activities for youth. ...
Purpose of ReviewPersonality factors have been implicated in risk for substance use disorders through longitudinal and neurobiologic studies for over four decades. Only recently, however, have targeted interventions been developed to assist individuals with personality risk factors for substance use disorders manage their risk. This article reviews current practices in personality-targeted interventions and the eight randomised trials examining the efficacy of such approaches with respect to reducing and preventing substance use and misuse. Recent FindingsResults indicate a moderate mean effect size for personality-targeted approaches across several different substance use outcomes and intervention settings and formats. Conclusions
Personality-targeted interventions offer several advantages over traditional substance use interventions, particularly when attempting to prevent development of problems in high-risk individuals or when addressing concurrent mental health problems in brief interventions.
... Preventure is a personality-targeted, selective intervention which was modified for Australian youth in (Barrett, Newton, Teesson, Slade, & Conrod, 2015. Only high-risk students as determined by the SURPS were invited to participate in the interventions. ...
Background:
This study investigated the long-term effectiveness of Preventure, a selective personality-targeted prevention program, in reducing the uptake of alcohol, harmful use of alcohol, and alcohol-related harms over a 3-year period.
Methods:
A cluster randomized controlled trial was conducted to assess the effectiveness of Preventure. Schools were block randomized to one of two groups: the Preventure group (n = 7 schools) and the Control group (n = 7 schools). Only students screening as high-risk on one of four personality profiles (anxiety sensitivity, negative thinking, impulsivity, and sensation seeking) were included in the analysis. All students were assessed at five time points over a 3-year period: baseline; immediately after the intervention; and 12, 24, and 36 months after baseline. Students were assessed on frequency of drinking, binge drinking, and alcohol-related harms. Two-part latent growth models were used to analyze intervention effects, which included all students with data available at each time point. This trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12612000026820; www.anzctr.org.au).
Results:
A total of 438 high-risk adolescents (mean age, 13.4 years; SD = 0.47) from 14 Australian schools were recruited to the study and completed baseline assessments. Relative to high-risk Control students, high-risk Preventure students displayed significantly reduced growth in their likelihood to consume alcohol [b = -0.225 (0.061); p < .001], to binge drink [b = -0.305 (.096); p = 0.001], and to experience alcohol-related harms [b = -0.255 (0.096); p = .008] over 36 months.
Conclusions:
Findings from this study support the use of selective personality-targeted preventive interventions in reducing the uptake of alcohol, alcohol misuse, and related harms over the long term. This trial is the first to demonstrate the effects of a selective alcohol prevention program over a 3-year period and the first to demonstrate the effects of a selective preventive intervention in Australia.
... Current research recommends a values-centered approach to prevention education (Gosin, Marsiglia, et al., 2003), the process of infusing dominant cultural values into prevention curricula, particularly when those values serve as deterrents to substance use behavior (Harthun, Dustman, Reeves, Marsiglia, & Hecht, 2009).There were three readily-observed cultural value categories relating to substance use behavior: collectivism versus individualism, family connectedness and norms concerning substance use, all of which are represented in the column labeled ''Values'' inTable 1. Substituted basketball for soccer, as an activity depicted in the curricula Adaptation of kiR for multicultural students Gosin, Marsiglia, et al. (2003) Reproduced the videos in order to represent local settings so that the students were able to identify the places and consider them relevant Adaptation of SF for Italian students Ortega et al. (2012) Changed the role plays and activities because parents complained that the household chores being depicted were done by the mothers or grandmothers, not adolescents as was suggested in the stories Adaptation of kiR for three groups: Mexican American, African American, and European American students Holleran-Steiker (2008), Holleran-Steiker, Powell, Goldbach, and Hopson (2011) and Marsiglia Kulis, Rodriguez, Becerra, and Castillo (2009) Observed that drug offers were conducted in different contexts for three groups and adapted the role-plays, lessons, and videos accordingly Adaptation of kiR for Mexican students Marsiglia et al. (2009) Observed that alcohol was more accessible to minors due to lighter legal restrictions and such realities should be incorporated in program materials Adaptation of Preventure for Australian students Barrett et al. (2013) Scenarios depicting use of fireworks was changed to use of a cigarette lighter because fireworks are illegal in Australia Introducing cultural variables 7 Collectivism is a cultural value that emphasizes the good of the whole group (e.g. family, community, etc.), and is contrasted with individualism which emphasizes an individual's personal desires, achievements and talents (Unger et al., 2004). ...
Adolescent substance abuse is a global problem which educators have sought to address through school-based preventive education. Prior research suggests that cultural sensitivity may mediate program success; however the ideal program composition remains unclear. Thus, the purpose of this review is to identify the cultural variables used in the adaptation of substance abuse prevention programs and to evaluate whether the inclusion of such variables enhance program outcomes. We reviewed 58 articles describing study design, results and the cultural variables involved. Cultural variables were categorized as surface-level variables (e.g. language, character names) and deep-level variables (e.g. normative beliefs, motivational factors). Empirical studies implied that variations in language, communication preferences, level of individualism, family orientation, religiosity, norms regarding substance use, gender, ethnic identity and environmental accessibility were possibly related to overall program success. Recommendations for future research and program modifications are discussed.
Taking a multi-disciplinary perspective (including public health, sociology, criminology, and political science amongst others) and using examples from across the globe, this book provides a detailed understanding of the complex and highly contested nature of drug policy, drug policy making, and the theoretical perspectives that inform the study of drug policy. It draws on four different theoretical perspectives: evidence-informed policy, policy process theories, democratic theory, and post-structural policy analysis.
The use of and trade in illegal drugs are a global phenomenon. It is viewed by governments as a significant social, legal, and health problem that shows no signs of abating. The key questions explored throughout this book are what governments and other bodies of social regulation should do about illicit drugs, including drug policies aimed at improving health and reducing harm, drug laws and regulation, and the role of research and values in policy development. Seeing policy formation as dynamic iterative interactions between actors, ideas, institutions, and networks of policy advocates, the book explores how policy problems are constructed and policy solutions selected, and how these processes intersect with research evidence and values. This then animates the call to democratise drug policy and bring about inclusive meaningful participation in policy development in order to provide the opportunity for better, more effective, and value-aligned drug policies. This book will be of great interest to students and scholars of drug policy from a number of disciplines, including public health, sociology, criminology, and political science.
This is the first study to investigate the effectiveness of Preventure, a selective personality-targeted prevention program, in reducing the uptake of tobacco smoking over a three-year period in adolescence. A cluster randomised controlled trial was conducted to assess the effectiveness of Preventure. Schools were block randomised to either the Preventure group (n = 7 schools) or the Control group (n = 7 schools) and students were assessed at five time points (baseline, 6-, 12-, 24- and 36-months post-baseline) on measures of tobacco use, intentions to use and self-efficacy to resist peer pressure to smoke tobacco. Intervention effects were estimated using mixed models to account for the hierarchical data structure. Exploratory analyses assessed intervention effects among internalising and externalising personality traits. This trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12612000026820; www.anzctr.org.au). A total of 1005 adolescents (mean age: 13.4 years, SD = 0.47) attending 14 Australian schools in February 2012 were recruited to the study. Relative to students in Control schools, students in Preventure schools were less likely to report recent tobacco use (OR = 0.66 95% CI = 0.50, 0.87) and intentions to use tobacco in the future (OR = 0.77 95% CI = 0.60, 0.97) over the three-year follow-up. Students in Preventure schools with internalising personality traits had a greater increase in their likelihood to report high self-efficacy to resist peer pressure to smoke sustained three-years post program delivery (OR = 1.85 95% CI = 1.0, 3.4). Findings from this study support the use of selective personality-targeted preventive interventions in reducing tobacco smoking during adolescence.
Objective:
To examine the secondary effects of a personality-targeted intervention on bullying and harms among adolescent victims and bullies.
Method:
Outcomes were examined for victims and bullies in the Climate and Preventure study, Australia. Participants completed self-report measures at baseline and four follow-up assessments (6, 12, 24, and 36 months). Thirteen intervention schools (n = 1,087) received Preventure, a brief personality-targeted cognitive-behavioral therapy intervention for adolescents with high-risk personality types (hopelessness, anxiety sensitivity, impulsivity, sensation seeking). Thirteen control schools (n = 1,103) received health education as usual. Bullying was examined for high-risk victims (n = 143 in Preventure schools versus n = 153 in control schools) and bullies (n = 63 in Preventure schools versus n = 67 in control schools) in the total sample. Harms were examined for high-risk victims (n = 110 in Preventure schools versus n = 87 in control schools) and bullies (n = 50 in Preventure schools versus n = 30 in control schools) in independent schools.
Results:
There was no significant intervention effect for bullying victimization or perpetration in the total sample. In the subsample, mixed models showed greater reductions in victimization (b = -0.208, 95% CI -0.4104 to -0.002, p < .05), suicidal ideation (b = -0.130, 95% CI -0.225 to -0.034, p < .01), and emotional symptoms (b = -0.263, 95% CI -0.466 to -0.061, p < .05) among high-risk victims in Preventure versus control schools. Conduct problems (b = -0.292, 95% CI -0.554 to -0.030, p < .05) showed greater reductions among high-risk bullies in Preventure versus control schools, and suicidal ideation showed greater reductions among high-risk female bullies in Preventure versus control schools (b = -0.820, 95% CI -1.198 to -0.442, p < .001).
Conclusion:
The findings support targeting personality in bullying prevention.
Clinical trial registration information:
The CAP Study: Evaluating a Comprehensive Universal and Targeted Intervention Designed to Prevent Substance Use and Related Harms in Australian Adolescents; http://www.anzctr.org.au/; ACTRN12612000026820.
Citation: Maierová, E., Charvát, M., Miovský, M., Šťastná, L. (2015). Preventure: Adaptation and Pilot Implementation of a Targeted Brief Intervention in the Czech Setting-Process Evaluation Study [Evaluace procesu èeské adaptace programu cílené krátké intervence PreVenture a jeho pilotní implementace pro žáky základních škol]. Adiktologie, 15(1), 12-32.
BACKGROUND: Despite the high prevalence of drug use
and other forms of risk behaviour among children and adolescents,
only a few indicated prevention programmes are
delivered in Czech schools. Therefore, we decided to implement
Preventure in the Czech setting. It is an evidence-
based indicated prevention programme which was
developed in Canada in 2001. The programme was tested
for its effectiveness and shows very promising results. It is
intended for children aged 12-15. AIMS: The manuscript
describes the process of adapting and implementing this
indicated prevention tool in the Czech setting, as well as
presenting the results of the evaluation of the process.
RESULTS: The method was implemented following the
steps proposed by the EMCDDA. Specifically, it involved
the translation and standardisation of the Substance Use
Risk Profile Scale (SURPS). The methodological guidelines
VÝCHODISKA: Z dùvodù vysoké prevalence užívání
drog a rizikového chování u dìtí a dospívajících a nedostatku
programù indikované prevence, které se realizují ve
školách v Èeské republice, implementujeme do Èeského
prostøedí efektivní program indikované prevence. Program
Preventure vznikl v Kanadì v roce 2001, prošel testováním
efektivity a vykazuje velmi slibné parametry a byl implementován
v dalších zemích (napø. Velká Británie, Nizozemí,
Austrálie atd.). Tento program se skládá ze dvou èástí,
diagnostického screeningového dotazníku a intervenèních
setkání face-to-face. Urèen je pro cílovou skupinu dìtí ve
vìku 12–15 let. CÍLE: Èlánek popisuje proces pøevodu a implementace
indikované prevence do èeského prostøedí.
Zároveò popisuje výsledky hodnocení tohoto procesu.
VÝSLEDKY: Metoda byla implementována dle krokù
EMCDDA, konkrétnì se jednalo o pøeklad a standardizaci
Purpose
There is a lack of evidence for effective school-based prevention programmes to reduce alcohol misuse in adolescents. The purpose of this paper is to explore teacher’s views about alcohol education in secondary schools in order to inform the subsequent development of new educational and intervention measures.
Design/methodology/approach
Semi-structured interviews were conducted with nine female teachers from a range of schools who had responsibility for designing and delivering personal social, health, and economic education (PSHE).
Findings
Three main themes were identified in a thematic analysis of the interview transcripts. The themes demonstrated the importance of PSHE to these teachers, who faced challenges in delivering a comprehensive enough curriculum. Alcohol unit knowledge and responsible drinking were priorities for the teachers. However, given the many pressures faced by young people, alcohol could be viewed as just one challenge amongst many.
Research limitations/implications
Interventions may be seen as too compartmentalised by teachers if they fail to address the wider concerns of adolescents. Intervention developers should consider gaining input from teachers on the content of their programmes prior to running a trial to enhance feasibility and acceptability.
Originality/value
There are few studies that have explored what teachers think about alcohol education in general or about the content of specific interventions prior to their implementation. This study adds their voice to the literature and highlights the importance of considering the views and first hand experiences when developing new alcohol interventions aimed at adolescents.
Purpose
– Social marketing benchmark criteria were used to understand the extent to which single-substance alcohol education programmes targeting adolescents in middle and high school settings sought to change behaviour, utilised theory, included audience research and applied the market segmentation process. The paper aims to discuss these issues.
Design/methodology/approach
– A systematic literature review retrieved a total of 1,495 identified articles; 565 duplicates were removed. The remaining 930 articles were then screened. Articles detailing formative research or programmes targeting multiple substances, parents, families and/or communities, as well as elementary schools and universities were excluded. A total of 31 articles, encompassing 16 qualifying programmes, were selected for detailed evaluation.
Findings
– The majority of alcohol education programmes were developed on the basis of theory and achieved short- and medium-term behavioural effects. Importantly, most programmes were universal and did not apply the full market segmentation process. Limited audience research in the form of student involvement in programme design was identified.
Research limitations/implications
– This systematic literature review focused on single-substance alcohol education programmes targeted at middle and high school student populations, retrieving studies back to the year 2000.
Originality/value
– The results of this systematic literature review indicate that application of the social marketing benchmark criteria of market segmentation and audience research may represent an avenue for further extending alcohol education programme effectiveness in middle and high school settings.
This study explored the validity of classifying a community-recruited sample of substance-abusing women (N = 293) according to 4 personality risk factors for substance abuse (anxiety sensitivity, introversion–hopelessness, sensation seeking, and impulsivity). Cluster analyses reliably identified 5 subtypes of women who demonstrated differential lifetime risk for various addictive and nonaddictive disorders. An anxiety-sensitive subtype demonstrated greater lifetime risk for anxiolytic dependence, somatization disorder, and simple phobia, whereas an introverted–hopeless subtype evidenced a greater lifetime risk for opioid dependence, social phobia, and panic and depressive disorders. Sensation seeking was associated with exclusive alcohol dependence, and impulsivity was associated with higher rates of antisocial personality disorder and cocaine and alcohol dependence. Finally, a low personality risk subtype demonstrated lower lifetime rates of substance dependence and psychopathology.
Although effective school-based alcohol pre-vention programs do exist, the overall efficacy of these programs has been compromised by implementation failure. The CLIMATE Schools: Alcohol Module was developed to overcome some of the obstacles to high fidelity program implementation. This paper details this devel-opment of the CLIMATE Schools: Alcohol Mod-ule. The development involved two stages, both of which were considered essential. The first stage, involved reviewing the literature to en-sure the program was based on the most effect-tive pedagogy and health promotion practice and the second stage involved collaborating with teachers, students and specialists in the area of alcohol and other drugs, to ensure these goals were realised. The final CLIMATE Schools: Alcohol Module consists of computer-driven harm minimisation program which is based on a social influence approach. The program con-sists of six lessons, each with two components. The first component involves students com-pleting an interactive computer-based program, with the second consisting of a variety of indi-vidual, small group and class-based activities. This program was developed to provide an in-novative new platform for the delivery of drug education and has proven to be both feasible and effective in the school environment. The success of this program is considered to be testament to this collaborative development ap-proach.
Context:
Selective school-based alcohol prevention programs targeting youth with personality risk factors for addiction and mental health problems have been found to reduce substance use and misuse in those with elevated personality profiles.
Objectives:
To report 24-month outcomes of the Teacher-Delivered Personality-Targeted Interventions for Substance Misuse Trial (Adventure trial) in which school staff were trained to provide interventions to students with 1 of 4 high-risk (HR) profiles: anxiety sensitivity, hopelessness, impulsivity, and sensation seeking and to examine the indirect herd effects of this program on the broader low-risk (LR) population of students who were not selected for intervention.
Design:
Cluster randomized controlled trial.
Setting:
Secondary schools in London, United Kingdom.
Participants:
A total of 1210 HR and 1433 LR students in the ninth grade (mean [SD] age, 13.7 [0.33] years).
Intervention:
Schools were randomized to provide brief personality-targeted interventions to HR youth or treatment as usual (statutory drug education in class).
Main outcome measures:
Participants were assessed for drinking, binge drinking, and problem drinking before randomization and at 6-monthly intervals for 2 years.
Results:
Two-part latent growth models indicated long-term effects of the intervention on drinking rates (β = -0.320, SE = 0.145, P = .03) and binge drinking rates (β = -0.400, SE = 0.179, P = .03) and growth in binge drinking (β = -0.716, SE = 0.274, P = .009) and problem drinking (β = -0.452, SE = 0.193, P = .02) for HR youth. The HR youth were also found to benefit from the interventions during the 24-month follow-up on drinking quantity (β = -0.098, SE = 0.047, P = .04), growth in drinking quantity (β = -0.176, SE = 0.073, P = .02), and growth in binge drinking frequency (β = -0.183, SE = 0.092, P = .047). Some herd effects in LR youth were observed, specifically on drinking rates (β = -0.259, SE = 0.132, P = .049) and growth of binge drinking (β = -0.244, SE = 0.073, P = .001), during the 24-month follow-up.
Conclusions:
Findings further support the personality-targeted approach to alcohol prevention and its effectiveness when provided by trained school staff. Particularly novel are the findings of some mild herd effects that result from this selective prevention program.
Trial registration:
clinicaltrials.gov Identifier: NCT00776685.
Background: Personality-targeted cognitive-behavioural interventions have been proven to be effective in reducing alcohol-related behaviours in adolescents. Aims: As these interventions target personality traits linked to risk for non-addictive psychopathology, the aim of this study is to examine the extent to which this approach can also prevent the onset or reduce relevant psychological problems in youth. Method: Participants aged 13 – 16 years (n = 423) were randomly assigned to either a personality matched cognitive-behavioural intervention or a no-intervention control. The personality matched interventions targeted four personality risk factors: negative thinking (NT), anxiety sensitivity (AS), impulsivity (IMP), and sensation seeking (SS). Results: Baseline and follow-up data were obtained on depression scores, panic attacks, and reckless behaviour. Results showed a moderate effect of the NT intervention on depression scores, and a similar effect of the AS intervention on panic attack and truancy (i.e., school avoidance). A small but significant intervention effect was found for shoplifting for the entire sample, as well as a moderate intervention effect on this outcome for the IMP intervention group. Conclusions: These intervention effects indicate that personality-targeted interventions designed to prevent alcohol misuse, can concurrently reduce other relevant psychological problems in youth.
Background
Alcohol misuse amongst young people is a serious concern. The need for effective prevention is clear, yet there appear to be few evidenced-based programs that prevent alcohol misuse and none that target both high and low-risk youth. The CAP study addresses this gap by evaluating the efficacy of an integrated approach to alcohol misuse prevention, which combines the effective universal internet-based Climate Schools program with the effective selective personality-targeted Preventure program. This article describes the development and protocol of the CAP study which aims to prevent alcohol misuse and related harms in Australian adolescents.
Methods/Design
A cluster randomized controlled trial (RCT) is being conducted with Year 8 students aged 13 to 14-years-old from 27 secondary schools in New South Wales and Victoria, Australia. Blocked randomisation was used to assign schools to one of four groups; Climate Schools only, Preventure only, CAP (Climate Schools and Preventure), or Control (alcohol, drug and health education as usual). The primary outcomes of the trial will be the uptake and harmful use of alcohol and alcohol related harms. Secondary outcomes will include alcohol and cannabis related knowledge, cannabis related harms, intentions to use, and mental health symptomatology. All participants will complete assessments on five occasions; baseline; immediately post intervention, and at 12, 24 and 36 months post baseline.
Discussion
This study protocol presents the design and current implementation of a cluster RCT to evaluate the efficacy of the CAP study; an integrated universal and selective approach to prevent alcohol use and related harms among adolescents. Compared to students who receive the stand-alone universal Climate Schools program or alcohol and drug education as usual (Controls), we expect the students who receive the CAP intervention to have significantly less uptake of alcohol use, a reduction in average alcohol consumption, a reduction in frequency of binge drinking, and a reduction in alcohol related harms.
Trial registration
This trial is registered with the Australian and New Zealand Clinical Trials registry, ACTRN12612000026820.
his paper details how researchers and community partners have combined results from quantitative and qualitative investigations to develop a program for preventing alcohol abuse in First Nation at-risk teens that are meaningful to the lives of these youth. This article focuses on the levels of theory and evidence which support the development of youth interventions. While this novel, innovative program attempts to nurture health and healing practices, work needs to be done at a level not often considered by academics: the "root" level or where you meet the client to be served before the level of crisis, considering youth development as an opportunity to support a healthy growth pathway. A metaphor can help convey the associated underlying meaning. Imagine a young person, with an inclination toward alcohol abuse, standing at the edge of a cliff. Interveners tend to grab the individual at the edge, if possible. In contrast, work at the "root" level considers youth who may be a mile away from that edge of the cliff. The "root" level is a grounding level that encourages activities which speak to the creative Spirit. For example, arts, crafts, and puppetry can provide a re-vitalization of self-esteem important to achieving a sense of belonging and making a difference in one's life. Some First Nation youth may lack a sense of identification or belonging. Root re-vitalization ultimately cultivates in First Nation young people a sense of pride in their own history, their own language and in themselves. The underlying assumption behind this research is that inclination toward alcohol abuse among First Nation youth can ultimately be reduced. The purpose of this project is to learn more about the drinking behaviour of First Nation youth at high personality risk of alcohol abuse. Central features of this article include project aims and background of what this research is trying to achieve. Focus group activities, whereby a small number of youth provide their feedback and opinions about the issues and helpful processes, direct program facilitators and co-facilitators within the broad process of collaboration. The overall approach of this research is to work together with First Nation community partners to help prevent alcohol abuse by First Nation adolescents. In affiliation with the
For a decade in Australia, drug education in schools has been shaped by the approach of harm minimization adopted by state and national governments alike. Harm minimization has been accepted broadly by drug educators, and has encouraged schools to deepen their commitment to drug education, allowed them to communicate honestly with students, and to respond to instances of drug use in a less confrontational and more caring manner. Despite those advances, the notion of ‘zero tolerance’ within schools has been promoted recently by protagonists in the formulation of drug policy and it is mentioned in the recently published national school drug education policy. This article suggests that the adoption of a zero tolerance policy will end the consensus among drug educators, reduce the efficacy of drug education, lead to more punitive treatment of youthful drug experimenters, while doing nothing to reduce drug use. It concludes the existing policy of harm minimization offers schools more scope to address drug issues in a constructive manner than does zero tolerance, which in practice may inflate the harmful effects on young people of drug use.
A new conception of sensation seeking is presented, along with a new scale [the Arnett Inventory of Sensation Seeking (AISS)]. The new conception emphasizes novelty and intensity as the two components of sensation seeking. Two studies were conducted to validate the new scale. In the first study, the AISS was found to be more strongly related to risk behavior than Zuckerman's Sensation Seeking Scale (SSS) among 116 adolescents aged 16–18 years, although the new scale contains no items related to risk behavior (in contrast to the SSS). In the second study, involving 139 adolescents, similar relations were found between the AISS and risk behavior, and the new scale was also found to be significantly correlated with the Aggression subscale of the California Psychological Inventory (CPI). In addition, adults (N = 38) were found to be lower in sensation seeking than adolescents. In both studies, males were higher in sensation seeking than females.
Background
Alcohol misuse in young people is cause of concern for health services, policy makers, prevention workers, criminal justice system, youth workers, teachers, parents. This is one of three reviews examining the effectiveness of (1) school‐based, (2) family‐based, and (3) multi‐component prevention programs.
Objectives
To review evidence on the effectiveness of universal school‐based prevention programs in preventing alcohol misuse in school‐aged children up to 18 years of age.
Search methods
Relevant evidence (up to 2002) was selected from the previous Cochrane review. Later studies, to July 2010, were identified from MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, Project CORK, and PsycINFO.
Selection criteria
Randomized trials evaluating universal school‐based prevention programs and reporting outcomes for alcohol use in students 18 years of age or younger were included. Two reviewers screened titles/abstracts and full text of identified records.
Data collection and analysis
Two reviewers extracted relevant data independently using an a priori defined extraction form. Risk of bias was assessed.
Main results
53 trials were included, most of which were cluster‐randomised. The reporting quality of trials was poor, only 3.8% of them reporting adequate method of randomisation and program allocation concealment. Incomplete data was adequately addressed in 23% of the trials. Due to extensive heterogeneity across interventions, populations, and outcomes, the results were summarized only qualitatively.
Six of the 11 trials evaluating alcohol‐specific interventions showed some evidence of effectiveness compared to a standard curriculum. In 14 of the 39 trials evaluating generic interventions, the program interventions demonstrated significantly greater reductions in alcohol use either through a main or subgroup effect. Gender, baseline alcohol use, and ethnicity modified the effects of interventions. Results from the remaining 3 trials with interventions targeting cannabis, alcohol, and/or tobacco were inconsistent.
Authors' conclusions
This review identified studies that showed no effects of preventive interventions, as well as studies that demonstrated statistically significant effects. There was no easily discernible pattern in characteristics that would distinguish trials with positive results from those with no effects. Most commonly observed positive effects across programs were for drunkenness and binge drinking. Current evidence suggests that certain generic psychosocial and developmental prevention programs can be effective and could be considered as policy and practice options. These include the Life Skills Training Program, the Unplugged program, and the Good Behaviour Game. A stronger focus of future research on intervention program content and delivery context is warranted.
Plain Language Summary
Psychosocial and Developmental Alcohol Misuse Prevention in Schools can be effective
We conducted a Cochrane systematic review of 53 well‐designed experimental studies that examined the effectiveness of school‐based universal programs for the prevention of alcohol misuse in young people. The studies were divided into two major groups based on the nature of the prevention program: 1) programs targeting specifically prevention or reduction of alcohol misuse and 2) generic programs with wider focus for prevention (e.g., other drug use/abuse, antisocial behavior). In the review we found studies that showed no effects of the preventive program, as well as studies that demonstrated statistically significant effects. There was no easily discernible pattern in program characteristics that would distinguish studies with positive results from those with no effects. Most commonly observed positive effects across programs were for drunkenness and binge drinking. In conclusion, current evidence suggests that certain generic psychosocial and developmental prevention programs can be effective and could be considered as policy and practice options. These include the Life Skills Training Program, the Unplugged program, and the Good Behaviour Game.
To examine the long-term effects of a personality-targeted intervention on drinking quantity and frequency (QF), problem drinking, and personality-specific motivations for alcohol use in early adolescence.
A randomized control trial was carried out with 364 adolescents (median age 14) recruited from 13 secondary schools with elevated scores in Hopelessness, Anxiety-Sensitivity (AS), Impulsivity, and Sensation-Seeking. Participants were randomly assigned to a control no-intervention condition or a 2-session group coping skills intervention targeting 1 of 4 personality risk factors. The effects of the intervention on quantity/frequency (QF) of alcohol use, frequency of binge drinking, problem drinking, and motives were examined at 6, 12, 18, and 24 months postintervention.
Intent-to-treat repeated measures analyses revealed a significant overall intervention effect in reducing problem drinking symptoms, and a Time × Intervention effect on drinking QF and binge drinking frequency. Relative to the control group, the intervention group showed significantly reduced drinking and binge drinking levels at 6 months postintervention and reduced problem drinking symptoms for the full 24-month follow-up period (Cohen's d = 0.33). A significant Time × Intervention × Personality interaction was demonstrated for coping and enhancement drinking motives. In addition to an overall effect of intervention on coping motives, the AS group who received that intervention reported fewer coping motives compared with the AS control group at 12 and 24 months postintervention.
This study provides further evidence showing that personality-targeted interventions reduce drinking behavior in adolescents in the short term. Novel findings were that the interventions were shown to produced long-term effects on drinking problems and personality-specific effects on drinking motives.
In comparison to other Europe countries, Dutch adolescents are at the top in drinking frequency and binge drinking. A total of 75% of the Dutch 12 to 16 year olds who drink alcohol also engage in binge drinking. A prevention programme called Preventure was developed in Canada to prevent adolescents from binge drinking. This article describes a study that aims to assess the effects of this selective school-based prevention programme in The Netherlands.
A randomized controlled trial is being conducted among 13 to 15-year-old adolescents in secondary schools. Schools were randomly assigned to the intervention and control conditions. The intervention condition consisted of two 90 minute group sessions, carried out at the participants' schools and provided by a qualified counsellor and a co-facilitator. The intervention targeted young adolescents who demonstrated personality risk for alcohol abuse. The group sessions were adapted to four personality profiles. The control condition received no further intervention above the standard substance use education sessions provided in the Dutch national curriculum. The primary outcomes will be the percentage reduction in binge drinking, weekly drinking and drinking-related problems after three specified time periods. A screening survey collected data by means of an Internet questionnaire. Students have completed, or will complete, a post-treatment survey after 2, 6, and 12 months, also by means of an online questionnaire.
This study protocol presents the design and current implementation of a randomized controlled trial to evaluate the effectiveness of a selective alcohol prevention programme. We expect that a significantly lower number of adolescents will binge drink, drink weekly, and have drinking-related problems in the intervention condition compared to the control condition, as a result of this intervention.
This trial is registered in the Dutch Trial Register (Cochrane Collaboration) as NTR1920.
The present study proposed and tested a motivational model of alcohol use in which people are hypothesized to use alcohol to regulate both positive and negative emotions. Two central premises underpin this model: (a) that enhancement and coping motives for alcohol use are proximal determinants of alcohol use and abuse through which the influence of expectancies, emotions, and other individual differences are mediated and (b) that enhancement and coping motives represent phenomenologically distinct behaviors having both unique antecedents and consequences. This model was tested in 2 random samples (1 of adults, 1 of adolescents) using a combination of moderated regression and path analysis corrected for measurement error. Results revealed strong support for the hypothesized model in both samples and indicate the importance of distinguishing psychological motives for alcohol use.
This study explored the validity of classifying a community-recruited sample of substance-abusing women (N = 293) according to 4 personality risk factors for substance abuse (anxiety sensitivity, introversion-hopelessness, sensation seeking, and impulsivity). Cluster analyses reliably identified 5 subtypes of women who demonstrated differential lifetime risk for various addictive and nonaddictive disorders. An anxiety-sensitive subtype demonstrated greater lifetime risk for anxiolytic dependence, somatization disorder, and simple phobia, whereas an introverted-hopeless subtype evidenced a greater lifetime risk for opioid dependence, social phobia, and panic and depressive disorders. Sensation seeking was associated with exclusive alcohol dependence, and impulsivity was associated with higher rates of antisocial personality disorder and cocaine and alcohol dependence. Finally, a low personality risk subtype demonstrated lower lifetime rates of substance dependence and psychopathology.
A hierarchical biometric model is presented of the origins of comorbidity among substance dependence, antisocial behavior, and a disinhibited personality style. The model posits a spectrum of personality and psychopathology, united by an externalizing factor linked to each phenotype within the spectrum, as well as specific factors that account for distinctions among phenotypes within the spectrum. This model fit self-report and mother-report data from 1,048 male and female 17-year-old twins. The variance of the externalizing factor was mostly genetic, but both genetic and environmental factors accounted for distinctions among phenotypes within the spectrum. These results reconcile evidence for general and specific causal factors within the externalizing spectrum and offer the externalizing factor as a novel target for future research.
This study identifies the conceptual underpinnings of effective school-based drug education practice in light of contemporary research evidence and the practical experience of a broad range of drug education stakeholders. The research involved a review of the literature, a national survey of 210 Australian teachers and others involved in drug education, and structured interviews with 22 key Australian drug education policy stakeholders. The findings from this research have been distilled and presented as a list of 16 principles that underpin effective drug education. In broad terms, drug education should be evidence-based, developmentally appropriate, sequential, and contextual. Programs should be initiated before drug use commences. Strategies should be linked to goals and should incorporate harm minimization. Teaching should be interactive and use peer leaders. The role of the classroom teacher is central. Certain program content is important, as is social and resistance skills training. Community values, the social context of use, and the nature of drug harm have to be addressed. Coverage needs to be adequate and supported by follow-up. It is envisaged that these principles will provide all those involved in the drug education field with a set of up-to-date, research-based guidelines against which to reference decisions on program design, selection, implementation, and evaluation.
Progress in identifying effective programs and policies for preventing tobacco, alcohol, and illicit drug use has stimulated a growing sense of optimism about the potential of prevention science and practice. This paper summarizes some of the key challenges and critical issues that still need to be addressed for the advances of the past two decades of prevention research to have an impact on the nature of prevention practice and eventually translate into reductions in mortality and morbidity. In addition to identifying effective strategies for disseminating the use of evidence-based prevention programs and policies, issues related to implementation fidelity and adaptation need to be better understood as well as factors associated with institutionalization of effective prevention programs. Further advances in prevention science and practice will require a new emphasis on blended research models that involve conducting prevention research in practice settings with the active collaboration of researchers and practitioners.
Sensation seeking, anxiety sensitivity, and hopelessness are personality risk factors for alcohol use disorders, each associated with specific risky drinking motives in adolescents. We developed a set of interventions and manuals that were designed to intervene at the level of personality risk and associated maladaptive coping strategies, including alcohol misuse. Manuals contained psychoeducational information on the target personality risk factor and how it is associated with maladaptive coping, as well as exercises targeting maladaptive cognitions and behaviors specific to each personality type. We tested the efficacy of these novel interventions on reducing drinking behavior by randomly assigning 297 Canadian high school students (56% girls, mean age 16, mean grade 11) to personality-targeted interventions (group format; 2 sessions) or to a no-treatment control group. Intent-to-treat analyses indicated beneficial effects of the intervention and Intervention x Personality interactions on drinking rates, drinking quantity, binge drinking, and problem drinking symptoms at 4-month follow-up.
Early onset substance use has consistently been associated with increased risk for a range of adverse outcomes in late adolescence and early adulthood. However, the mechanisms that underlie this relationship are not fully understood. Recent advances in developmental neuro-science, together with emerging literature on early onset substance use, suggest that the adolescent brain may be more vulnerable to the effects of addictive substances because of the extensive neuromaturational processes that are occurring during this period. Such findings are suggestive of disrupted developmental trajectories in early onset users, although there is growing evidence that high-risk youths have premorbid neurobiological vulnerabilities. Prospective studies investigating neurobiological correlates and sequelae of early adolescent drug use are urgently required to inform appropriate public health responses.
This chapter provides an overview of the epidemiology of cannabis use, cannabis use disorder and its treatment. Cannabis is the most commonly used illicit drug internationally, although global consumption patterns and trends are unevenly distributed. Early initiation and regular adolescent use have been identified as particular risk factors for later problematic cannabis (and other drug) use, impaired mental health, delinquency, lower educational achievement, risky sexual behaviour and criminal offending in a range of studies. It is estimated that approximately one in ten people who have ever used cannabis will become dependent with risk increasing markedly with frequency of use. While relatively few users who may potentially experience such problems seek professional assistance, there have been increases in demand for cannabis treatment services. There are as yet no evidence-based pharmacotherapies available for the management of cannabis withdrawal and craving. Relatively brief cognitive behavioural therapy and contingency management have the strongest evidence of success, and structured, familybased interventions, provide potent treatment options for adolescents. Innovative models of intervention delivery, such as mail, telephone and web-based interventions, may be promising ways of reducing the barriers to cannabis treatment provision, With criminally involved young people and those with severe, persistent mental illness, longer and more intensive therapies provided by interdisciplinary teams may be required.
The Substance Use Risk Profile Scale (SURPS) is based on a model of personality risk for substance abuse in
which four personality dimensions (hopelessness, anxiety sensitivity, impulsivity, and sensation seeking) are
hypothesized to differentially relate to specific patterns of substance use. The current series of studies is a
preliminary exploration of the psychometric properties of the SURPS in two populations (undergraduate and
high school students). In study 1, an analysis of the internal structure of two versions of the SURPS shows
that the abbreviated version best reflects the 4-factor structure. Concurrent, discriminant, and incremental
validity of the SURPS is supported by convergent/divergent relationships between the SURPS subscales and
other theoretically relevant personality and drug use criterion measures. In Study 2, the factorial structure of
the SURPS is confirmed and evidence is provided for its test–retest reliability and validity with respect to
measuring personality vulnerability to reinforcement-specific substance use patterns. In Study 3, the SURPS
was administered in a more youthful population to test its sensitivity in identifying younger problematic
drinkers. The results from the current series of studies demonstrate support for the reliability and construct
validity of the SURPS, and suggest that four personality dimensions may be linked to substance-related
behavior through different reinforcement processes. This brief assessment tool may have important
implications for clinicians and future research.
Drug abuse continues to be an important public health problem throughout the world. Although considerable progress has been made in identifying effective prevention approaches, there is a large gap between what research has shown to be effective and the methods generally used in most schools. The most promising prevention approaches target individuals during the beginning of adolescence and teach drug resistance skills and norm setting either alone or in combination with general personal and social skills. Evaluation studies testing these approaches show that they can significantly reduce adolescent tobacco, alcohol, and marijuana use. While some studies show that these effects may decrease over time, booster interventions have been found to maintain and in some instances even enhance prevention effects. The results of one large-scale evaluation study shows that it is possible to produce reductions in drug use that last until the end of high school. Available evidence suggests that these approaches may be effective when taught by different kinds of teachers and with different populations. The current paper provides a brief review of school-based prevention approaches targeting individual-level etiologic factors, evidence supporting their effectiveness, and a discussion of potential mediating mechanisms.
This study assessed the validity, sensitivity, and specificity of the Substance Use Risk Profile Scale (SURPS), a measure of personality risk factors for substance use and other behavioral problems in adolescence.
The concurrent and predictive validity of the SURPS was tested in a sample of 1,162 adolescents (mean age: 13.7 years) using linear and logistic regressions, while its sensitivity and specificity were examined using the receiver operating characteristics curve analyses.
Concurrent and predictive validity tests showed that all 4 brief scales—hopelessness (H), anxiety sensitivity (AS), impulsivity (IMP), and sensation seeking (SS)—were related, in theoretically expected ways, to measures of substance use and other behavioral and emotional problems. Results also showed that when using the 4 SURPS subscales to identify adolescents “at risk,” one can identify a high number of those who developed problems (high sensitivity scores ranging from 72 to 91%). And, as predicted, because each scale is related to specific substance and mental health problems, good specificity was obtained when using the individual personality subscales (e.g., most adolescents identified at high risk by the IMP scale developed conduct or drug use problems within the next 18 months [a high specificity score of 70 to 80%]).
The SURPS is a valuable tool for identifying adolescents at high risk for substance misuse and other emotional and behavioral problems. Implications of findings for the use of this measure in future research and prevention interventions are discussed.
Comorbidity between substance use disorders and other psychological disorders has emerged as a major clinical, public health and research issue over the past few decades thanks in large part to population surveys of mental disorders that have highlighted that comorbidity is common. The reasons for comorbidity are complex but longitudinal research has begun to provide insights into the underlying mechanisms. This chapter will give a brief overview of epidemiological research into comorbidity and examines the most recent longitudinal data on patterns and causal pathways of comorbidity. The chapter highlights the increasingly consistent evidence of shared risk factors for both mental disorders and substance use disorders as well as suggesting that causal relationships may operate in both directions, that is from substance use to mental disorders and vice versa. In particular, there is a causal pathway from depression to substance use in males, and from daily cannabis use to depression and anxiety in females. There is also evidence that cannabis use precipitates psychosis in persons who are vulnerable because of a personal or family history of psychosis. Externalizing behavior problems in children, particularly conduct disorder and aggressive behavior emerging prior to age 12, have been shown to predict a greater likelihood of progressing to adolescent poly-drug use and or alcohol use problems in adulthood. The effect of childhood internalizing problems such as anxiety and depression on the subsequent development of substance use problems is less clear. Finally, the chapter addresses the implications of this information for prevention. While we should intervene to prevent or delay the onset of substance use and mental disorders during adolescence, such interventions should not focus solely on substance use or mental disorders alone. They should target a range of potentially health-threatening behaviors including substance use, sexual risk-taking and problems of personal adjustment since many of these behaviors co-occur because of shared risk factors.
The present study investigated relations of anxiety sensitivity and other theoretically relevant personality factors to Copper's [Psychological Assessment 6 (1994) 117.] four categories of substance use motivations as applied to teens' use of alcohol, cigarettes, and marijuana. A sample of 508 adolescents (238 females, 270 males; mean age=15.1 years) completed the Trait subscale of the State-Trait Anxiety Inventory for Children, the Childhood Anxiety Sensitivity Index (CASI), and the Intensity and Novelty subscales of the Arnett Inventory of Sensation Seeking. Users of each substance also completed the Drinking Motives Questionnaire-Revised (DMQ-R) and/or author-compiled measures for assessing motives for cigarette smoking and marijuana use, respectively. Multiple regression analyses revealed that, in the case of each drug, the block of personality variables predicted “risky” substance use motives (i.e., coping, enhancement, and/or conformity motives) over-and-above demographics. High intensity seeking and low anxiety sensitivity predicted enhancement motives for alcohol use, high anxiety sensitivity predicted conformity motives for alcohol and marijuana use, and high trait anxiety predicted coping motives for alcohol and cigarette use. Moreover, anxiety sensitivity moderated the relation between trait anxiety and coping motives for alcohol and cigarette use: the trait anxiety–coping motives relation was stronger for high, than for low, anxiety sensitive individuals. Implications of the findings for improving substance abuse prevention efforts for youth will be discussed.
Issues. To reduce the occurrence and costs related to substance use and associated harms it is important to intervene early. Although a number of international school-based prevention programs exist, the majority show minimal effects in reducing drug use and related harms. Given the emphasis on early intervention and prevention in Australia, it is timely to review the programs currently trialled in Australian schools. This paper reports the type and efficacy of Australian school-based prevention programs for alcohol and other drugs.
Approach. Cochrane, PsychInfo and PubMed databases were searched. Additional materials were obtained from authors, websites and reference lists. Studies were selected if they described programs developed and trialled in Australia that address prevention of alcohol and other drug use in schools.
Key Findings. Eight trials of seven intervention programs were identified. The programs targeted alcohol, cannabis and tobacco and most were based on social learning principles. All were universal. Five of the seven intervention programs achieved reductions in alcohol, cannabis and tobacco use at follow up.
Conclusion. Existing school-based prevention programs have shown to be efficacious in the Australian context. However, there are only a few programs available, and these require further evaluative research. This is critical, given that substance use is such a significant public health problem. The findings challenge the commonly held view that school-based prevention programs are not effective.[Teesson M, Newton NC, Barrett EL. Australian school-based prevention programs for alcohol and other drugs: A systematic review. Drug Alcohol Rev 2012;31:731–736]
The Climate Schools: Alcohol and Cannabis Module is a universal harm-minimization school-based prevention program for adolescents aged 13-15 years. The core content of the program is delivered over the Internet using cartoon storylines to engage students, and teacher-driven activities reinforce the core information. The program is embedded within the school health curriculum and is easy to implement with minimal teacher training required. The program was developed in 2007 through extensive collaboration with teachers, students, and health professionals (N = 24) in Sydney, Australia and has since been evaluated (N = 764). This article describes the formative research and process of planning that formed the development of the program and the evidence base underpinning the approach. The study's limitations are noted.
For a decade in Australia, drug education in schools has been shaped by the approach of harm minimization adopted by state and national governments alike. Harm minimization has been accepted broadly by drug educators, and has encouraged schools to deepen their commitment to drug education, allowed them to communicate honestly with students, and to respond to instances of drug use in a less confrontational and more caring manner. Despite those advances, the notion of 'zero tolerance' within schools has been promoted recently by protagonists in the formulation of drug policy and it is mentioned in the recently published national school drug education policy. This article suggests that the adoption of a zero tolerance policy will end the consensus among drug educators, reduce the efficacy of drug education, lead to more punitive treatment of youthful drug experimenters, while doing nothing to reduce drug use. It concludes the existing policy of harm minimization offers schools more scope to address drug issues in a constructive manner than does zero tolerance, which in practice may inflate the harmful effects on young people of drug use.
Background:
Disinhibited traits, assessed both at the self-report and at the cognitive/behavioral levels, have been frequently implicated in externalizing behaviors, such as conduct disorder (CD), binge drinking, and drug use. However, self-report measures of disinhibition, such as impulsivity (IMP) and sensation seeking (SS), and cognitive measures of disinhibition are not often studied together in the same participants. Thus, it is still unclear how cognitive measures such as response inhibition and reward response bias relate to self-report measures of IMP and SS, and whether they can explain some of the association found between these self-report measures and specific facets of externalizing problems.
Methods:
The aim of this study was to assess whether cognitive measures of disinhibition relate to self-report measures of disinhibition and can mediate the specific relationships between self-report measures of disinhibition and CD symptoms, binge drinking and drug use in adolescence. Seventy-six adolescents were assessed on personality, substance use, and conduct problems every 6 months from 14 to 16 years of age and completed a test battery that included a Stop task, rewarded go/no-go task, digit span, and intelligence quotient tests at 16 years of age.
Results:
Multiple regression analyses showed that self-report IMP at 14 and deficits in response inhibition were associated with a 2-year average CD symptoms score and that deficits in response inhibition partially mediated the association between self-report IMP and CD symptoms (ab = 0.018 CI: 0.00002 to 0.04827). In contrast, SS and reward response bias were significantly associated with the unique variance in binge drinking, and that part of the overlap between SS and binge drinking was mediated by reward response bias (ab = 0.019, CI: 0.00131 to 0.04662).
Conclusions:
Findings show a dissociation between inhibitory measures associated with CD symptoms and those associated with binge drinking, with "cool" inhibitory and executive functions being associated with CD but "hot," reward-related disinhibition measures being specific mediators between SS and binge drinking. The findings support the theoretical conceptualization for dual cognitive/motivational pathways of disinhibition, in this case IMP and SS, and their unique association with externalizing behavior in adolescence.
A brief personality risk profile (23 items), the Substance Use Risk Profile Scale was tested for concurrent and predictive validity for substance use in 1139 adolescents (grades 8-10) from a mid-sized city in western Canada. The SURPS was administered in two waves of a longitudinal study separated by 12 months (2003-04). As expected, four subscales were supported by confirmatory factor and metric invariance analysis. In regression analysis, three subscales, hopelessness, impulsivity, and sensation seeking, were positively related to current and future use; while one, anxiety sensitivity, was negatively related. Findings suggest clinical utility for screening adolescents at risk for substance use.
This trial examined the efficacy of teacher-delivered personality-targeted interventions for alcohol-misuse over a 6-month period.
This randomized controlled trial randomly allocated participating schools to intervention (n = 11) or control (n = 7) conditions. A total of 2,506 (mean age, 13.7 years) were assessed for elevated levels of personality risk factors for substance misuse: sensation-seeking, impulsivity, anxiety sensitivity, and hopelessness. Six hundred ninety-six adolescents were invited to participate in teacher-delivered personality-targeted interventions, and 463 were assigned to the nontreatment condition. Primary outcomes were drinking, binge-drinking status, quantity by frequency of alcohol use, and drinking-related problems.
School delivery of the personality-targeted intervention program was associated with significantly lower drinking rates in high-risk students at 6-month follow-up (odds ratio, 0.6), indicating a 40% decreased risk of alcohol consumption in the intervention group. Receiving an intervention also predicted significantly lower binge-drinking rates in students who reported alcohol use at baseline (odds ratio, 0.45), indicating a 55% decreased risk of binge-drinking in this group compared with controls. In addition, high-risk intervention-school students reported lower quantity by frequency of alcohol use (beta = -.18) and drinking-related problems (beta = -.15) compared with the nontreatment group at follow-up.
This trial replicates previous studies reporting the efficacy of personality-targeted interventions and demonstrates that targeted interventions can be successfully delivered by teachers, suggesting potential for this approach as a sustainable school-based prevention model. Clinical trial registration information-Personality-Targeted Interventions for Adolescent Alcohol Misuse, URL: http://www.clinicaltrials.gov, unique identifier: NCT00344474.
To establish the long-term efficacy of a universal internet-based alcohol and cannabis prevention programme in schools.
A cluster-randomized controlled trial was conducted to assess the effectiveness of the Climate Schools: Alcohol and Cannabis Course. The evidence-based course, aimed at reducing alcohol and cannabis use, is facilitated by the internet and consists of 12 novel and curriculum consistent lessons delivered over 6 months.
A total of 764 year 8 students (13 years) from 10 Australian secondary schools were allocated randomly to the internet-based prevention programme (n = 397, five schools), or to their usual health classes (n = 367, five schools).
Participants were assessed at baseline, immediately post, and 6 and 12 months following completion of the intervention, on measures of alcohol and cannabis knowledge, attitudes, use and related harms.
This paper reports the final results of the intervention trial, 12 months following the completion of the Climate Schools: Alcohol and Cannabis Course. The effectiveness of the course 6 months following the intervention has been reported previously. At the 12-month follow-up, compared to the control group, students in the intervention group showed significant improvements in alcohol and cannabis knowledge, a reduction in average weekly alcohol consumption and a reduction in frequency of drinking to excess. No differences between groups were found on alcohol expectancies, cannabis attitudes or alcohol- and cannabis-related harms. The course was found to be acceptable by teachers and students as a means of delivering drug education in schools.
Internet-based prevention programs for school-age children can improve student's knowledge about alcohol and cannabis, and may also reduce alcohol use twelve months after completion.
Selective interventions targeting personality risk are showing promise in the prevention of problematic drinking behavior, but their effect on illicit drug use has yet to be evaluated.
To investigate the efficacy of targeted coping skills interventions on illicit drug use in adolescents with personality risk factors for substance misuse.
Randomized controlled trial.
Secondary schools in London, United Kingdom.
A total of 5302 students were screened to identify 2028 students aged 13 to 16 years with elevated scores on self-report measures of hopelessness, anxiety sensitivity, impulsivity, and sensation seeking. Seven hundred thirty-two students provided parental consent to participate in this trial.
Participants were randomly assigned to a control no-intervention condition or a 2-session group coping skills intervention targeting 1 of 4 personality profiles.
The trial was designed and powered to primarily evaluate the effect of the intervention on the onset, prevalence, and frequency of illicit drug use over a 2-year period.
Intent-to-treat repeated-measures analyses on continuous measures of drug use revealed time x intervention effects on the number of drugs used (P < .01) and drug use frequency (P < .05), whereby the control group showed significant growth in the number of drugs used as well as more frequent drug use over the 2-year period relative to the intervention group. Survival analysis using logistic regression revealed that the intervention was associated with reduced odds of taking up the use of marijuana (beta = -0.3; robust SE = 0.2; P = .09; odds ratio = 0.7; 95% confidence interval, 0.5-1.0), cocaine (beta = -1.4; robust SE = 0.4; P < .001; odds ratio = 0.2; 95% confidence interval, 0.1-0.5), and other drugs (beta = -0.7; robust SE = 0.3; P = .03; odds ratio = 0.5; 95% confidence interval, 0.3-0.9) over the 24-month period.
This study extends the evidence that brief, personality-targeted interventions can prevent the onset and escalation of substance misuse in high-risk adolescents.
clinicaltrials.gov Identifier: NCT00344474.
This paper provides an overview of the epidemiology of cannabis use, cannabis use disorders and its treatment. Cannabis is the most commonly used illicit drug internationally. While use is decreasing in the developed world, it appears to be stable or increasing in developing countries and some indigenous communities. Early initiation and regular adolescent use have been identified as particular risk factors for later problematic cannabis (and other drug) use, impaired mental health, delinquency, lower educational achievement, risky sexual behaviour and criminal offending in a range of studies. It is estimated that approximately one in ten people who had ever used cannabis will become dependent with risk increasing markedly with frequency of use. There has been an increase in the proportion of treatment provided for cannabis use. There are as yet no evidence-based pharmacotherapies available for the management of cannabis withdrawal and craving. Relatively brief cognitive behavioural therapy and contingency management have the strongest evidence of success, and structured, family-based interventions, provide potent treatment options for adolescents. With criminally involved young people and those with severe, persistent mental illness, longer and more intensive therapies provided by interdisciplinary teams may be required.
The aim of the present study was to conduct a cross-validation trial of the efficacy of a computerized school-based intervention for alcohol misuse in adolescents.
A cluster randomized control trial was carried out. Intervention and control groups were assessed at baseline, immediately after and 6 months after the intervention. A total of 764 Year 8 students from 10 independent secondary schools in Sydney, Australia participated in the study. Half of the schools were randomly allocated to the computerized prevention programme (n=397), and half to their usual classes (n=367). The six-lesson computerized intervention was evidence and curriculum based while having a focus on harm-minimization. Knowledge, expectancies, alcohol consumption (frequency, quantity and binging), patterns of use, and harms associated with one's own use of alcohol were assessed.
There were significant improvements in knowledge regarding alcohol use at immediate and 6 month follow up. Average weekly alcohol consumption was reduced immediately after the intervention. No differences between groups were found on alcohol expectancies, frequency of drinking to excess and harms related to alcohol use over time.
The present results support the Climate Management and Treatment Education (CLIMATE) Schools: alcohol module as an effective intervention in increasing alcohol knowledge and reducing alcohol use in the short term.
A review of school-based drug abuse prevention programs was conducted for 1989-1994. In addition to a comprehensive literature review, interviews were conducted with a panel of 15 leading experts in prevention research. Key elements of promising prevention curricula were identified. Effective prevention programs were found to be based on a sound theoretical or research foundation. They included developmentally appropriate information about drugs, social resistance skills training, and normative education. Broader based personal and social skills training appeared to enhance program effects. Effective programs used interactive teaching techniques and teacher training, and provided adequate coverage and sufficient follow-up. Cultural sensitivity to the target population was found to be critical to program success. Additional program components were expected to enhance curriculum effectiveness. Finally, experts agreed that adequate evaluation of prevention curricula was critical. Unfortunately, despite information about the types of curricula that are effective, the most promising prevention curricula are not widely disseminated. Reasons for under-utilization are explored, and recommendations made for correcting the situation.
Through comparative socio-historical analysis of American school-based drug education, this review critically examines past perspectives and practices and how they shaped current programs. Among the key findings emerging from this analysis: Contrary to the popular belief that drug education began in the 1960s, its roots actually go back at least 115 years to the advent of compulsory temperance instruction. Although the particular substances targeted by such approaches have changed, the underlying approaches and dominant "no-substance-use" injunction has not. Despite the existence of "informed choice" approaches, throughout much of this period, evaluation efforts continue to be constrained by the limited dictates of "no-use" perspectives. A pragmatic alternative to contemporary "Just Say No" education is offered that strives to minimize potential harm resulting from the uninformed misuse of licit and illicit substances. A unique evaluative strategy designed to assess the effectiveness of this form of "informed choice" or "harm reduction" drug education is discussed.
Drug abuse continues to be an important public health problem throughout the world. Although considerable progress has been made in identifying effective prevention approaches, there is a large gap between what research has shown to be effective and the methods generally used in most schools. The most promising prevention approaches target individuals during the beginning of adolescence and teach drug resistance skills and norm setting either alone or in combination with general personal and social skills. Evaluation studies testing these approaches show that they can significantly reduce adolescent tobacco, alcohol, and marijuana use. While some studies show that these effects may decrease over time, booster interventions have been found to maintain and in some instances even enhance prevention effects. The results of one large-scale evaluation study shows that it is possible to produce reductions in drug use that last until the end of high school. Available evidence suggests that these approaches may be effective when taught by different kinds of teachers and with different populations. The current paper provides a brief review of school-based prevention approaches targeting individual-level etiologic factors, evidence supporting their effectiveness, and a discussion of potential mediating mechanisms.
The series of seminal meta-analytic studies of school-based substance use prevention program studies conducted by the late Nancy S. Tobler and colleagues concluded that programs with content focused on social influences' knowledge, drug refusal skills, and generic competency skills and that use participatory or interactive teaching strategies were more effective than programs focused on knowledge and attitudes and favoring traditional didactic instruction. The present study compared current school practice against evidence-based standards for "effective content" and "effective delivery," derived from the Tobler findings. Respondents were the lead staff who taught substance use prevention in the 1998-1999 school year in a national sample of public and private schools that included middle school grades (N = 1,795). Results indicate that most providers (62.25%) taught effective content, but few used effective delivery (17.44%), and fewer still used both effective content and delivery (14.23%). Those who taught an evidence-based program (e.g., Life Skills Training, Project ALERT), however, were more likely to implement both effective content and delivery, as were those teachers who were recently trained in substance use prevention and were comfortable using interactive teaching methods. The findings indicate that the transfer to practice of research knowledge about school-based substance use prevention programming has been limited.
The purpose of this study was to compare the effects of a single drug, i.e., alcohol, against a multiple drug preventive intervention.
A controlled trial was conducted with 448 8th grade students (mean age = 13 years old) from an inner-city middle school (n = 216) and a rural junior high school (n = 232) in 2000-2001. Students were randomized within school, and 3-month post-intervention follow-up data were collected.
Two risk/protective factors were found to differ significantly in favor of youth receiving the single drug alcohol intervention (p's = 0.03), while the frequency of alcohol use and two additional risk/protective factors approached significance (p's < 0.10).
These findings support the potential efficacy of a brief, single drug preventive intervention over a brief, multi-drug intervention in producing short-term alcohol outcomes for adolescents, and indicate differential effects of interventions for subgroups of substance using youth.
Emerging evidence suggests that anxiety sensitivity (AS) predicts subsequent development of anxiety symptoms and panic attacks. However, evidence regarding whether AS serves as a premorbid risk factor for the development of clinical syndromes is lacking. The primary aim of the present study was to determine whether AS acts as a vulnerability factor in the pathogenesis of psychiatric diagnoses. A large nonclinical sample of young adults (N=404) was prospectively followed over two years. The Anxiety Sensitivity Index (ASI: Reiss S, Peterson RA, Gursky DM, McNally RJ. Anxiety sensitivity, anxiety frequency, and the prediction of fearfulness. Behaviour Research and Therapy 1986; 24: 1-8.) and trait anxiety served as predictors. Consistent with prior reports, AS predicted the development of spontaneous panic attacks in those with no history of panic. Importantly, AS was found to predict the incidence of anxiety disorder diagnoses and overall Axis I diagnoses in those with no history of Axis I diagnoses at study entry. These are the first data to provide strong prospective evidence for AS as a risk factor in the development of anxiety disorders.
Emerging evidence suggests that elevated anxiety sensitivity (AS) is associated with substance use disorders. However, prospective evidence regarding this association is currently lacking. The primary aim of the present study was to determine whether AS is involved in the pathogenesis of substance-related psychopathology. A large, nonclinical sample of young adults (N = 404) was prospectively followed for approximately 2 years. AS (i.e., 16-item Anxiety Sensitivity Index total scores) at study entry and gender served as the primary predictor variables. Findings indicated that AS was uniquely associated with the later development of alcohol use disorder diagnoses. Data indicated that gender and AS did not act synergistically to predict alcohol use disorders. These data provide novel evidence for the unique effects of AS as a prospective risk factor in the development of alcohol-related disorders.
The School Health and Alcohol Harm Reduction Project (SHAHRP study) aimed to reduce alcohol-related harm in secondary school students.
The study used a quasi-experimental research design in which randomly selected and allocated intervention and comparison groups were assessed at eight, 20 and 32 months after baseline.
Metropolitan, government secondary schools in Perth, Western Australia.
The sample involved over 2300 students. The retention rate was 75.9% over 32 months.
The evidence-based intervention, a curriculum programme with an explicit harm minimization goal, was conducted in two phases over a 2-year period.
Knowledge, attitude, total alcohol consumption, risky consumption, context of use, harm associated with own use and harm associated with other people's use of alcohol.
There were significant knowledge, attitude and behavioural effects early in the study, some of which were maintained for the duration of the study. The intervention group had significantly greater knowledge during the programme phases, and significantly safer alcohol-related attitudes to final follow-up, but both scores were converging by 32 months. Intervention students were significantly more likely to be non-drinkers or supervised drinkers than were comparison students. During the first and second programme phases, intervention students consumed 31.4% and 31.7% less alcohol. Differences were converging 17 months after programme delivery. Intervention students were 25.7%, 33.8% and 4.2% less likely to drink to risky levels from first follow-up onwards. The intervention reduced the harm that young people reported associated with their own use of alcohol, with intervention students experiencing 32.7%, 16.7% and 22.9% less harm from first follow-up onwards. There was no impact on the harm that students reported from other people's use of alcohol.
The results of this study support the use of harm reduction goals and classroom approaches in school drug education.
Personality factors are implicated in the vulnerability to adolescent alcohol misuse. This study examined whether providing personality-targeted interventions in early adolescence can delay drinking and binge drinking in high-risk youth.
A randomised control trial was carried out with 368 adolescents recruited from years 9 and 10 (median age 14) with personality risk factors for substance misuse. Participants received either a personality-targeted intervention or no intervention. Outcome data were collected on alcohol use through self-reports at 6 and 12-month post intervention and analyses were conducted on the full intent to treat sample.
Multi-group analysis of a latent growth curve model showed a group difference in the growth of alcohol use between baseline and 6-months follow-up, with the control group showing a greater increase in drinking than the intervention group for this period. Interventions were particularly effective in preventing the growth of binge drinking in those students with a sensation seeking (SS) personality. SS drinkers in the intervention group were 45% and 50% less likely to binge drink at 6 (OR = .45) and 12 months (OR = .50) respectively, than SS drinkers in the control group, p = .001, phi = .49, Number Needed to Treat = 2.0.
Considering the robust, inverse relationship between age of onset of alcohol use and later alcohol dependence, this intervention strategy may prove effective in preventing the onset of adult alcohol use disorders, by helping high-risk youth delay the growth of their drinking to a later developmental stage.