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REVIEW
published: 22 January 2019
doi: 10.3389/fpsyt.2018.00770
Frontiers in Psychiatry | www.frontiersin.org 1January 2019 | Volume 9 | Article 770
Edited by:
Marie-Josée Fleury,
McGill University, Canada
Reviewed by:
Sebastian Sattler,
Universität zu Köln, Germany
Leandro Da Costa Lane Valiengo,
University of São Paulo, Brazil
*Correspondence:
Patricia J. Conrod
patricia.conrod@umontreal.ca
Specialty section:
This article was submitted to
Public Mental Health,
a section of the journal
Frontiers in Psychiatry
Received: 09 September 2018
Accepted: 21 December 2018
Published: 22 January 2019
Citation:
Edalati H and Conrod PJ (2019) A
Review of Personality-Targeted
Interventions for Prevention of
Substance Misuse and Related Harm
in Community Samples of
Adolescents. Front. Psychiatry 9:770.
doi: 10.3389/fpsyt.2018.00770
A Review of Personality-Targeted
Interventions for Prevention of
Substance Misuse and Related Harm
in Community Samples of
Adolescents
Hanie Edalati and Patricia J. Conrod*
Department of Psychiatry, CHU Sainte-Justine Research Center, University of Montreal, Montreal, QC, Canada
Several school-based prevention programmes have been developed and used to
prevent, delay, or reduce substance misuse, and related problems among community
samples of adolescents. However, findings indicate that many of these interventions
are associated with null, small, or mixed effects in reducing adolescent substance
misuse, in particular for those mostly at risk of transitioning to substance use disorders.
These findings highlight the need to shift the focus of substance use prevention
efforts toward intervention strategies which directly target high-risk adolescents. The
Preventure programme was designed to target four personality risk factors for substance
misuse: hopelessness, anxiety sensitivity, impulsivity, and sensation seeking. This article
reviews findings from the previous trials of personality-targeted interventions (i.e.,
Preventure programme) with adolescents and discuss the promises and benefits of these
interventions for targeting community samples of high-risk adolescents at school level for
reducing substance misuse and related mental health problems. Findings indicated that
this programme has been successful in reducing the rates of alcohol and illicit drug use
and substance-related harms by ∼50% in high-risk adolescents with the effects last for
up to 3 years. These interventions were also associated with a 25% reduction in likelihood
of transitioning to mental health problems, such as anxiety, depression, suicidal ideation,
and conduct problems. The programme is particularly beneficial for youth with more
significant risk profiles, such as youth reporting clinically significant levels of externalizing
problems, and victimized adolescents. A key strength of the Preventure programme is
that it is embedded in the community and provides substance use intervention at school
level to the general samples of high-risk adolescents who might not otherwise have
access to those programmes.
Keywords: school-based substance use prevention programme, community-based targeted prevention, cluster
randomized trial, substance use outcomes, mental health, high-risk adolescents
Edalati and Conrod Preventure Programme for Adolescent Substance Use
INTRODUCTION
Several school-based prevention programmes have been
developed and used to prevent, delay, or reduce substance misuse
and related problems among community samples of adolescents
[e.g., (1–3)]. However, the majority of these interventions have
not been evaluated using controlled randomized trials and do
not meet the scientific standards against which many other
medical interventions are compared (4,5). A recent review
of 46 systematic reviews on the effectiveness of interventions
to prevent substance abuse among adolescents indicated that
school-based prevention programmes were the most highly
evaluated interventions for targeting adolescent substance abuse
compared to other platforms including family/community-
based interventions, digital platforms, policy interventions,
multicomponent interventions, and incentives (6). Results from
these reviews have indicated that many of these interventions
are associated with null, small, or mixed effects with respect to
reducing substance misuse among adolescents [e.g., (1–3,7–9)].
There is also very limited evidence on medium or long-term
impact of these interventions (7,10), however, a small number
of well-evaluated programmes do indeed indicated long-term
benefits [e.g., (11)].
Among effective school-based prevention programmes,
prevention programmes targeting never-smokers, and combined
social competence and social influences curricula reduced
smoking initiation (8). Smoke-Free Class Competition (SFC)
decreased current smoking (12). School-based brief alcohol
interventions (BAIs) were associated with reduced alcohol
consumption (13). Combined social competence and social
influence interventions were effective in preventing drugs and
cannabis use (14,15). Finally, programmes combining antidrug
information with refusal skills, self-management skills, and
social-skills training were linked to reduction in marijuana and
alcohol use (16) [see (6)]. The majority of these intervention
programmes are based on universal approaches which target
all students, regardless of their level of risk for substance use
and are based on delivering generic intervention components
that are appropriate for general populations of adolescents
[e.g., (17,18)]. Therefore, adolescents who are most at risk
of transitioning to substance use disorders, and those who
have already started using substances may not benefit from
these approaches (19). Some programmes were only successful
when delivered individually and had no significant effect when
delivered in groups (13) which requires many resources. Many
programmes were effective when they incorporated components
of multiple prevention models (8,15,16), included several
intervention sessions (e.g., ≥15 sessions), or were facilitated by
individuals other than teachers (15) which put a heavy burden on
school systems. While programmes such as brief school-based
interventions have been shown to reduce alcohol problem
symptoms in young drinkers, they are limited in the extent
to which they can address the full spectrum of drug-related
behaviors and prevention aims (7). In addition, implementation
fidelity is a significant challenge, with programs rarely being
implemented in the way that they were originally designed and
tested—due to limited resources and lack of mechanisms for
promoting sustainability of prevention efforts [see Ennett et al.
(20)]. One of the most widely studied school-based program
was even shown to produce harmful effects when implemented
through a program delivery system for which it was not initially
intended (21). Despite these effects, substance use and misuse
remain a highly prevalent problem and an escalating problem in
certain high-risk communities and populations (22,23).
The combination of limited efficacy or effectiveness of
programmes and limited resources in the school settings to invest
in prevention universally have stimulated research focusing on
risk for early onset or more problematic substance use for
the purpose of directing resources at those most in need of
intervention, and to better understand and target risk trajectories
to produce more impactful interventions (24).These findings
suggest that shifting the focus of substance use prevention efforts
toward more selective and targeted intervention strategies to
target youth most at risk of transitioning to substance misuse
and disorders might result in more impactful interventions, both
from a cost-benefit perspective and potentially from an efficacy
perspective. The distinction between selective and targeted
programmes is of importance, where the former would simply
direct existing interventions toward those most in need, and the
latter would involve intervening upon the specific risk factor in
a particular high-risk group [e.g., (25,26)]. A combination of
the selective and targeted approach is not always possible due
to inability to target some known risk factors (e.g., gender), but
when selective programs have been developed to directly target
factors that render youth at greater risk for problematic use,
such programmes have been shown to be highly beneficial for
adolescents with higher risk profiles, both at individual (e.g.,
high-risk personality profiles) and contextual/environmental
(e.g., poverty, trauma) levels (25–29).
One selective and targeted programme that has been
widely tested in recent years is the “Preventure” programme,
which targets personality risk factors through brief, selective
interventions for groups of youth reporting higher levels of
traits indicating risk. This personality-targeted approach to
substance use prevention offers many advantages over more
traditional universal prevention approaches by allowing schools
and communities to direct their limited resources to those most
in need, and by providing an integrated framework for addressing
multiple prevention targets (e.g., substance use, mental health,
victimization). A previous review article of personality-targeted
interventions (27) included results from both adolescents and
community and clinical adult samples and reported on delivery
of the programme in any format, including full Preventure
programme and personality-specific interventions (e.g., anxiety-
sensitivity intervention for adults with high levels of anxiety
sensitivity) and platform (e.g., delivered at school, delivered by
telephone or email) (27). This article was focused on primary
findings of each trial related to the substance use outcomes and
does not include the secondary data analyses of these trials and
outcomes related to mental health problems and other relevant
outcomes (e.g., victimization). The present article reviews the
findings from the five previous trials of personality-targeted
interventions with community samples of at-risk adolescents
delivered using school platform and discusses the promises of
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Edalati and Conrod Preventure Programme for Adolescent Substance Use
this approach for targeting early substance use and other mental
health problems.
PREVENTURE PROGRAMME: A
PERSONALITY-TARGETED APPROACH TO
SUBSTANCE USE PREVENTION
The Preventure programme was designed to target four
personality risk factors for substance misuse: hopelessness,
anxiety sensitivity, impulsivity, and sensation seeking (27).
Longitudinal cohorts have identified these personality factors
as strong and reliable predictors of future risk for substance
use and related problems (30–32). These traits appear to be
related to distinct substance use trajectories, differentiated on
the basis of substance use and co-morbidity patterns, age
of onset, and motivations for use [for a review, see (24)].
Sensation seeking trait is associated with biological and subjective
sensitivity to the incentive rewarding and enhancing effects of
substances and directly linked to early onset experimentation
with substances and binge drinking, whereas, impulsivity,
reflected as poor inhibition and a tendency to behave without
proper consideration of the consequences, seems indirectly
related to substance use through conduct problems, and therefore
is associated with a slightly later onset of use, but more severe
and problematic substance use profile (24,33). By contrast,
internalizing traits like hopelessness (i.e., a tendency to negative
and depressive thinking) and anxiety sensitivity (i.e., a fear
of anxiety-related physical sensations) are associated with the
tendency to report using substances to cope and regulate negative
affect and indirectly related to substance use through depressive
and anxiety symptoms (24,33). These traits are also able to
predict specific drug-use profiles suggesting different underlying
motivational drivers of the substance use, a hypothesis which
has been confirmed by studies on the relationship between these
traits and self-report motives for substance use in the general
population (34), and in high-risk communities (35,36).
Preventure is a “selective” substance use prevention
programme, that is, high-risk students are selected based
on their score on personality questionnaire, Substance Use Risk
Profile Scale [SURPS (37)]. Adolescents who score one standard
deviation above the population mean (e.g., school’s mean) on
one of the SURPS subscales (i.e., high-risk individuals; ∼45%
of the youth population) are invited to participate in brief
group-based intervention sessions which target their dominant
personality profile. Interventions are generally held during
school hours and involve only two 90-min sessions, with 1
week separating sessions. Interventions are conducted using
specific manuals for each personality profile that incorporate
psycho-educational, motivational enhancement therapy (MET)
and cognitive behavioral therapy (CBT) components and include
real life “scenarios” shared by local youth with similar personality
profiles [see (27)].
Personality-targeted interventions have been evaluated in
eight randomized trials, including samples of adolescents and
adults, in Canada, United Kingdom, Netherlands, and Australia,
with additional trials in progress [for a review of primary findings
of previous Preventure trials, see (27)]. Table 1 summarizes the
findings from five previous randomized trials of personality-
targeted interventions with community samples of high-risk
adolescents. Findings from five previous trials with adolescent
samples have indicated that the school-based Preventure
Programme is successful in reducing a range of substance use
outcomes by ∼50% in high-risk adolescents with the effects
lasting for up to 3 years [see (27)]. These interventions were
also associated with a 25% reduced likelihood of transitioning to
significant mental health problems, such as anxiety, depression,
suicidal ideation, and conduct problems (38).
FACILITATING ACCESS TO CARE AND
REDUCING THE BARRIERS OF DELIVERY
FOR HIGH-RISK YOUTH: A
COMMUNITY-BASED OUTREACH MODEL
TO SUBSTANCE USE PREVENTION
A key strength of the school-based Preventure programme is
that it is embedded in the community. It provides preventative
interventions to community samples of high-risk adolescents
who might not otherwise have access to mental health
programmes due to limited community resources, need to
involve third party payers for such services, and due to local
health care policies which often require that youth present with
clinical impairment in order to receive services, or through their
parents health insurance plan. To address these barriers, the
Preventure programme is largely delivered by school personnel,
including teachers and school counselors, but is designed to be
adapted to the context in which youth present: trials indicate
that Preventure is similarly efficacious when delivered by trained
clinicians or school teachers in terms of reducing problematic
mental health, alcohol and drug-related outcomes (39).
Results of the previous trials indicated that by targeting
personality risk factors instead of onset of mental health or
substance use problems, the programme also has the advantage
of involving youth who might be higher functioning or not yet
experiencing problems, allowing schools to promote it as a skill-
building workshop and making it much more attractive and less
intimidating to youth and their parents. Trials demonstrated
that when the programme is promoted in this way, 70–85% of
youth will voluntarily participate in the programme [see consort
flow diagrams of trials (39–41)]. Delivering personality-specific
skills in group format with adolescents with similar personality
profiles may also help increasing engagement and empathy
among adolescents and school personnel.
Finally, by training educational professionals to identify
and intervene early on psychological risk factors for mental
health and addiction, the programme equips professionals with
assessment tools, and cognitive-behavioral and motivational
interviewing skills that they can then use in future interventions
with student who might require more intensive or additional
services. In fact, a new trial in progress [i.e., Inter-Venture,
(see https://ichgcp.net/clinical-trials-registry/NCT03114007)]
delivers the 2-session Preventure programme in schools and
then follows youth annually to then proactively identify and have
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Edalati and Conrod Preventure Programme for Adolescent Substance Use
TABLE 1 | Summary of five randomized trials of personality-targeted interventions (Preventure Programme) for substance misuse and related problems in community
samples of high-risk adolescents.
Trial Sample Substance use outcomes Mental health
outcomes
Other related outcomes
1. Canadian preventure
trial (4 months) (45)
HR secondary
students (drinkers)
IG: n=166
CG: n=131
Reduction in:
Drinking rates (4 months)
Drinking quantity (4 months)
Binge drinking (4 months)
Drinking problems (4 months)
2. United Kingdom
preventure trial (2
years) (40, 46–48)
HR secondary
students
IG: n=190
CG: n=157
Reduction in:
Drinking rates (6 months)
Binge drinking (6 months)
Drinking problems (2 years)
Uptake of illicit substance misuse
(2 years)
Drugs use rates (2 years)
Drug use frequency (2 years)
Cannabis use (2 years)
Cocaine use (2 years)
Reduction in:
Panic attack (6 months)
Truancy (i.e., school
avoidance) (6 months)
Depression (6 months)
Shoplifting (6 months)
3. Dutch preventure
trial (12 months) (44,
64)
HR secondary
students (drinkers)
IG: n=343
CG: n=356
Reduction in:
Binge drinking (12 months)
Growth of binge drinking (12
months)
Reduction in alcohol use
outcomes in HR
adolescents in lower
education schools (e.g.,
vocational training)
4. United Kingdom
adventure trial (2 years)
(29, 39, 49, 51, 57, 59,
60, 64)
HR secondary
students
IG: n=558
CG: n=437
Reduction in:
Drinking rates (2 years)
Drinking quantity (2 years)
Drinking frequency (2 years)
Binge drinking (2 years)
Growth of binge drinking (2
years)
Drinking problems (2 years)
Cannabis use (2 years)
Reduction in:
Depressive symptoms
(2 years)
Anxiety symptoms (2
years)
Conduct symptoms (2
years)
Peer victimization (2
years)
Bullying perpetration (2
years)
Reduction in alcohol use
outcomes in HR adolescents
with pre-existing depression
and anxiety symptoms, and
those in different SES (2
years)
Additional reduction in those
with pre-existing ADHD
and conduct problems and
those victimized by peers (6
months & 2 years)
Reduction in drinking rates
and growth of binge
drinking in LR students (i.e.,
herd effect)
5. Australian CAP trial
(3 years) (41)
HR secondary
students
IG: n=202
CG: n=291
Reduction in:
Drinking rates (3 years)
Binge drinking (3 years)
Drinking problems (3 years)
Note. HR: High-risk; IG: intervention group; CG: control group; SES: Socioeconomic Status; LR: Low-risk; ADHD; attention-deficit/hyperactivity disorder; CAP: Climate and Preventure.
a dialogue with high-risk youth about their persistent emotional
and behavioral concerns or difficulties. These youth can then be
rapidly identified and assisted (either by revisiting Preventure
program in an individualized and extended version with the
trained school counselor), or by being assisted in finding services
or solutions to address their needs without having to wait for
symptoms to escalate into crisis. This trial will evaluate whether
integrating school-based prevention with community-based
youth services is an effective method of reaching youth with
mental health needs and preventing mental health problems at
the population level.
The Preventure programme and its intervention materials are
designed with consideration of cultural values, developmental
needs, and attitudes of the targeted youth to make it more
effective and relevant to adolescents receiving interventions in
each personality group. O’Leary-Barrett et al. (40) have shown
that youth-reported positive group experiences, learning, and
skill development were predictive of positive behavioral changes
in alcohol use and mental health symptoms after receiving
the Preventure programme (42). Youth perspectives on the
intervention independently accounted for up to 12–25% of the
variance in changes in alcohol consumption and mental health
symptoms over 12 months (42). These findings highlight the
positive youth experiences of the programme as a significant
indicator of its efficacy.
Adolescents may not be willing to share information regarding
their substance use for fear of negative consequences and schools
are often ambivalent about sharing drug-related information in
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Edalati and Conrod Preventure Programme for Adolescent Substance Use
the school context. Within the Preventure approach, substance
use is not directly assessed or discussed. Participants are primarily
selected based on their personality profiles. They learn about the
target personality profile and associated risky coping behaviors,
such as interpersonal dependence, aggression, avoidance, and
substance misuse, using psycho-educational strategies. Thus,
substance use is only discussed as one of the risky coping
behaviors within a personality-focused learning context. Finally,
the Preventure programme is very brief (only 2 sessions) and
cost effective to implement. Because it does not interfere with the
school curriculum, might prove to be easier to sustain compared
to many universal approaches for youth substance use prevention
[e.g., (43)].
EFFECTS ON SUBSTANCE USE
OUTCOMES
Preventure targets personality traits that have been shown to
associate with risk for early initiation of substance use and
development of substance use disorders (24,33). Thus, it
can be helpful in the context of both prevention and early
intervention for youth who have already started using substances.
Previous trials which included substance use onset as an
additional eligibility criterion have indicated that interventions
were effective in reducing substance use and related problems in
such groups of adolescents [e.g., (44,45)].
Findings from all five previous Preventure trials with
adolescents have reported a significant reduction with regard to
a number of alcohol outcomes including drinking rates, drinking
quantity, binge drinking, and problem drinking symptoms [up
to 4 months; Canadian Preventure Trial; (45)], drinking rates
and binge drinking (up to 6 months) and problem drinking
symptoms (up to 2 years; United Kingdom (UK) Preventure
Trial; (46–48), drinking rates, drinking quantity and frequency,
rates and growth of binge drinking, and problem drinking
symptoms [up to 2 years; Adventure Trial; (39,49)], binge
drinking and development of binge drinking [up to 12 months;
Dutch Preventurec Trial; (44)], and drinking rates, binge
drinking and alcohol-related harms [up to 3 years; Australian
Climate and Preventure (CAP) Study; (41)]. Results from the
U.K. Adventure and the Australian CAP trial also indicated
a positive indirect effect of this intervention on the drinking
rates and growth of binge drinking during the 24-month follow-
up in the broader low-risk population of students (55% of
age-matched school children) who were not selected for the
intervention but were simply in the schools in which the
Preventure programme was delivered to the high-risk students
(i.e., “herd immunity”) (49).
Results from the UK Preventure trial also indicated that
receiving interventions was associated with preventing uptake
of illicit substance misuse and decreasing number of drugs used
and drug use frequency in at-risk youth over a 2-year period
(48). Importantly, the intervention increased the likelihood that
high-risk adolescents survive as non-cannabis users by 30%,
as non-cocaine users by 80%, and non-users of other illicit
drugs by 50% over the 2-year follow-up period compared to
high-risk youth in control group (48). Receiving interventions
in the UK Adventure trial was also associated with significant
reduction in rates of cannabis use at the 6-month follow-up
and reductions in frequency of cannabis use at 12- and 18-
month follow-up (50). With respect to specific personality profile,
adolescents with high scores in sensation seeking were shown
to be at higher risk for cannabis use and particularly benefited
from the interventions with regard to delaying or reducing
binge drinking (47) and delaying the onset of cannabis use (50).
Youth in anxiety sensitivity group specifically benefited from
the intervention in terms of showing fewer coping motives for
drinking alcohol (46). Altogether, results across studies indicate
a consistent moderate effect of Preventure on most substance use
outcomes (27).
EFFECTS ON MENTAL HEALTH
PROBLEMS AND OTHER RELEVANT
OUTCOMES
There is a high comorbidity between substance misuse and a
range of concurrent psychiatric disorders in adolescents (51).
Specific personality traits have been identified as common
underlying risk factors that explain the co-occurrence between
substance misuse and psychiatric symptoms and disorders [e.g.,
(31)]. Preventure includes key components from CBT for major
psychiatric disorders relevant to each type of the personality
traits. This can be helpful in reducing psychiatric symptoms and
improve mental health of adolescents receiving intervention (38).
For example, CBT strategies for depression (52), are applied
in the hopelessness intervention, CBT for panic disorder in
the case of anxiety sensitivity (53,54), and CBT for attention-
deficit/hyperactivity disorder (ADHD) in the case of impulsivity
(55) are integrated in the interventions and manuals used for each
specific personality profile.
Secondary data analyses from previous trials have indicated
that adolescents who received the Preventure programme
improved on psychological problems including internalizing and
externalizing outcomes. Results from the two-year follow-up
trial with 1,024 adolescents (i.e., Adventure trial) indicated that
receiving Preventure programme was associated with reduction
in experiencing severe depression (26% reduction), anxiety (21%
reduction), and conduct symptoms (21% reduction) over 2-year
follow-up in the full sample (56). In addition, interventions
significantly reduced the odds of severe depressive symptoms
and conduct problems (56). An earlier trial similarly showed
that interventions were associated with 18.2% reduction in self-
report panic attacks and 15.3% in truancy (i.e., school avoidance)
in anxiety sensitivity groups, reduction in depression scores in
hopeless groups, and 8.5% reduction in shoplifting in the entire
sample of 13–16 years old adolescents (N=423, UK Preventure
trial), with a stronger effect on this outcome for the impulsivity
group (18% reduction in shoplifting) (40). Findings from the
Australian CAP trial report very similar and longer-term benefits
on mental health outcomes and suggest that these effects are
specific to school-based interventions that target personality
risk (57).
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Edalati and Conrod Preventure Programme for Adolescent Substance Use
In addition to the positive effects on psychological outcomes,
there is no indication that intervention effects are limited
to the least problematic students at schools: adolescents with
pre-existing mental health symptoms including depression,
anxiety, ADHD, and conduct problem symptoms equally benefit
(or receive more benefit) from Preventure with regard to
their alcohol use outcomes. Secondary data analysis from the
Adventure cluster-randomized trial (n=3021) indicated that
high-risk adolescents with depression and anxiety symptoms
equally benefited from the interventions with regard to reduction
in their alcohol use and related problems. Adolescents who
reported higher symptoms of externalizing problems (ADHD
and conduct problems) at baseline indicated more reduction
in alcohol consumption at earlier follow-up periods (6 months
post-intervention) and more reduction in their alcohol-related
problems over the 24-month period compared to those with
lower levels of these problems (58).
The programme has also been associated with some
improvements in the rates of peer victimization and bullying
perpetrations in schools receiving the interventions. Results
from a study using the data from Adventure trial indicated
that interventions were associated with reduction in peer
victimization in the entire sample (Conrod et al., under
review). In addition, there was a significant decrease in bullying
perpetration among high-risk students in the intervention
group, particularly among impulsive adolescents (Conrod et al.,
under review). This effect is particularly important given the
high rates of co-occurrence between peer victimization and
substance use during adolescence and the role of personality
in susceptibility to victimization and perpetration of bullying
(59,60). These findings suggest that Preventure programme
can provide an opportunity to deliver effective interventions for
targeting adolescent substance use while also providing solutions
for broader emotional and behavioral wellbeing in schools.
EFFECTS ON SPECIFIC GROUPS OF
ADOLESCENTS
Most school-based intervention programmes have been
evaluated at the community-level impact, whereas, the effect
of contextual risk factors is also an important consideration
in the evaluation of these programmes. Since contextual risk
factors, such as socioeconomic status and peer victimization,
increase the risk of early alcohol and substance misuse among
adolescents [e.g., (60,61)], it is probable that they also influence
the effectiveness of substance use prevention programmes. Two
recent studies involving secondary analyses of Preventure trials
reported that the programme is particularly effective for youth
with more significant risk profiles (29,62).
A trial of Preventure in the Netherlands examined the effects
of this programme on alcohol outcomes in 699 adolescents
aged 13–15 years with different education levels within the
Dutch school system (62). This study found that receiving
Preventure reduced binge drinking, binge drinking frequency,
alcohol use and alcohol use frequency in lower educated young
adolescents (e.g., vocational training), but not in the higher
education group (e.g., pre-university education) (62). Another
study sought to investigate the potential moderating effects of
socioeconomic status and peer victimization on the effectiveness
of the Preventure programme in reducing adolescent alcohol
use over a 2-year period using the data from Adventure
cluster-randomized trial (N=3021). Findings indicated that
Preventure programme was equally beneficial for high-risk
adolescents in different socioeconomic status and those exposed
to peer victimization in terms of their alcohol outcomes and
related problems (29). Receiving interventions was additionally
beneficial for adolescents reporting peer victimization regarding
their alcohol-related harm compared to non-victimized youth
(29). Given previous findings linking peer victimization to risk
for alcohol misuse and the tendency to report risky coping
motives (e.g., to cope with negative emotions and to conform)
(63), implementing the school-based Preventure programme
provides an opportunity to deliver effective substance use
interventions for victimized adolescents, who are at risk of long-
term mental health concerns and substance misuse (64).
While Preventure is primarily designed to target the risk
of substance use and related problems within the general
populations of high-risk adolescents, it can be modified
and adapted for use with youth populations with more
complex or more specific needs. We recently launched a pilot
project with high-risk adolescents in child welfare services to
adapt Preventure for youth with experiences of trauma and
maltreatment. In a recent manuscript, we reviewed the available
interventions for reducing substance use problems in adolescents
involved in the child welfare system and discussed the promises
of personality-targeted interventions for reducing substance use
problems in these populations (28). This review suggested that
the Preventure programme is potentially a valuable targeted
intervention for reducing high risk for substance use and mental
health problems in adolescents involved in child welfare services,
and for filling the gap in service delivery for these vulnerable
populations (28).
LIMITATIONS AND FUTURE DIRECTIONS
Preventure programme has been evaluated in five trials with
high-risk youth using school platform in different countries (40,
41,44,45,49). Findings from these trials indicated a fairly robust
effect on reduction of alcohol use outcomes. However, research
on the efficacy of this approach on other types of substances is still
limited and needs further investigations. For example, although
results from previous trials have showed a significant reduction
in likelihood of uptake and use of illicit substance misuse (48,50),
none of the previous trials reported any outcome related to
smoking behavior or prescription drug use. Recent and ongoing
trials of Preventure seek to address this gap. Two ongoing
trials (Co-Venture and Inter-Venture) assess smoking behaviors.
In addition, a new project, Canadian Underage Substance use
Prevention (CUSP) trial (Conrod et al., 2018–2022), involving a
total of 12,150 students in secondary schools across Canada, will
investigate the effectiveness of the Preventure programme when
delivered through a train-the-trainers model on illicit substance
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Edalati and Conrod Preventure Programme for Adolescent Substance Use
use in high-risk adolescents with prescription drug misuse as a
novel secondary outcome. In addition to investigating different
types of substances, personality-targeted interventions have yet
to be tested in populations with higher proportion of high-risk
adolescents, such as adolescents with histories of trauma or those
reporting concurrent mental health problems. Our new project
to adapt Preventure for youth with experiences of trauma and
maltreatment in child welfare services, and the Inter-venture
trial, which seeks to proactively identify and assist youth who are
at higher risk of transition to significant psychiatric symptoms,
are designed to address this gap. The impact of interventions
on youth with special education needs or those with mental
disabilities still needs an investigation. Moreover, there is a need
to examine the effect of these interventions on other related
problematic behaviors, such as risky driving and sexual behaviors,
eating behaviors and risk for psychotic disorders. Finally, some
studies, such as the CAP trial, have evaluated that programme
against an evidence-based universal programme and showed
equivalent effects on drinking behavior and slightly superior
effects on higher risk outcomes, such as drinking problems (65).
While this constitutes one form of control comparison, staunch
methodologists might require additional research comparing the
outcomes of the personality-targeted approach with a placebo
control intervention delivered to high risk youth. While this
might add to the quality of the evidence of this intervention
approach, iatrogenic effects of psychosocial interventions with
high risk youth have been reported in the literature [e.g., (66,67)].
Therefore, any future attempt at placebo-controlled intervention
designs should be very carefully considered.
CONCLUSIONS
Findings from this article point to the importance of
interventions which target modifiable risk factors associated
with higher risk of initiation and development of substance use
disorders, such as personality factors. Preventure programme
is an evidence-based programme which has shown to be
effective in reducing the risk for underage alcohol and illicit
drug use, substance use related harms, and risk of transitioning
to significant mental health problems in adolescence, with
results last for up to 3 years. Additional efforts should be
made to make school-based targeted interventions more
accessible for high-risk youth in communities with insufficient
resources to improve substance use and mental health
outcomes.
AUTHOR CONTRIBUTIONS
HE and PC designed the concept of the Mini Review. HE wrote
the first draft. PC edited for intellectual content.
FUNDING
HE is supported through postdoctoral fellowship by the
Canadian Institutes of Health Research (CIHR). PC is supported
through a senior research fellowship from the Fonds de recherche
du Québec—Santé (FRQS), and the following Research Chair:
Fondation Julien/Marcelle et Jean Coutu en Pediatrie Sociale en
Communaute de l’ Universite de Montreal.
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Conflict of Interest Statement: The authors declare that the research was
conducted in the absence of any commercial or financial relationships that could
be construed as a potential conflict of interest.
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