Prevention is better than cure, or so the old saying goes. So, following on with the alcohol theme this week I decided to turn our attention to alcohol abuse in young people. More specifically the idea that effective preventative intervention can involve more than just increasing adolescent knowledge about the harms of alcohol misuse.
Research has found that targeting the intervention to known risk factors for substance use disorders, such as family history, emotional and behavioural difficulties and personality factors can be very successful. One of the key aspects of this type of selective prevention approach is that it engages with the young people before the natural onset of drinking behaviour begins.
A recent report was published detailing the 24 month outcomes of a school-based alcohol prevention program aimed at youth with personality risk factors for alcohol misuse; anxiety, sensitivity, hopelessness, impulsivity and sensation-seeking. This personality-targeted approach involved providing brief, teacher-delivered-personality-specific coping skills interventions to high-risk (HR) youth. The interventions included elements from motivational enhancement therapy (MET) and basic cognitive therapy (CBT) for depression, panic anxiety and impulsivity but were specific in that they targeted personality traits rather than problems. It’s interesting to note that alcohol and drug use were a minor focus of the program.
The study followed a cluster-randomised design and involved a total of 1210 HR and 1433 low-risk (LR) students in Year 9 (mean age 13.7 years). 148 secondary schools from London were randomised to provide brief personality-targeted interventions to HR youth or statutory drug education in class. The primary objective was to report on the 24-month outcomes of intervention and the secondary objective was to observe any indirect ‘herd effects’ of the program on the LR youth who were not selected for intervention. All participants were assessed for drinking, binge drinking and problem drinking before and at 6-monthly intervals. This is what they found:
- The trial results indicate long-term benefits of the intervention on drinking outcomes for the HR students selected to receive brief personality-targeted interventions
- The targeted effects of the program were observed on all drinking outcomes and for the duration of the follow-up period, with the HR youth in intervention schools reporting 29% reduced odds of drinking, 43% reduced odds of binge drinking and 29% reduced odds of problem drinking relative to HR students in control schools
- The intervention was also shown to delay progression to more risky drinking behaviour, e.g. frequency of binge drinking, greater quantity of drinking and severity of problem drinking
- Results suggest there was a ‘herd effect’ in the study with a delayed intervention effect in the LR youth that gradually increased from 6 to 24months. By the end of the study the LR youth at intervention schools had 35% reduced odds of binge drinking relative to the LR control group
The authors concluded:
The potential herd effects of this targeted program should be further examined in future trials measuring teacher and student attitudes towards drinking, coping skills, and frequency in which youth revisit treatment materials on their own and with their friends.
Findings further support the personality-targeted approach to alcohol prevention and its effectiveness when provided by trained school staff.
This intervention is based on the idea that the training will improve young people’s management of their own personality; reducing the likelihood that alcohol will be used as a coping mechanism. Perhaps it’s time that we saw more of these targeted programs in schools. Think before you drink young ones!
Conrod PJ, O’Leary-Barrett M, Newton N, Topper L, Castellanos-Ryan N, Mackie C, Girard A. Effectiveness of a Selective, Personality-Targeted Prevention Program for Adolescent Use and Misuse. A cluster-randomised controlled trial. JAMA Psychiatry. Published online January 23, 2013. doi:10.1001/jamapsychiatry.2013.651.