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Mental health approach to teenage alcohol prevention is successful

Targeted psychological interventions aimed at teenagers at risk of emotional and behavioural problems significantly reduce their drinking behaviour, and that of their schoolmates, according to the results from a large randomised controlled trial published today in JAMA Psychiatry. The authors argue that the intervention could be administered in schools throughout the UK to help prevent teenage alcohol abuse.

The ‘Adventure Trial’ is led by Dr Patricia Conrod from King’s College London’s Institute of Psychiatry, in collaboration with the University of Montreal and Sainte-Justine University Hospital Center (Canada) and was commissioned by Action on Addiction.

The trial involved 21 schools in London that were randomly allocated to either receive the intervention, or the UK statutory drug and alcohol education curriculum. A total of 2,548 year-10 students (average age 13.8 years) were classed as high or low-risk of developing future alcohol dependency. Those classed as high-risk fit one of four personality risk profiles: anxiety, hopelessness, impulsivity or sensation seeking. All students were monitored for their drinking behaviour over two years. Four members of staff in each intervention school were trained to deliver group workshops targeting the different personality profiles. 11 schools received the intervention where 709 high-risk teenagers were invited to attend two workshops that guided them in learning cognitive-behavioural strategies for coping with their particular personality profiles.

Dr Patricia Conrod, from the Addictions Department at King’s Institute of Psychiatry and lead author of the paper, says: “Through the workshops, the teenagers learn to better manage their personality traits and individual tendencies, helping them to make good decisions for themselves. Depending on their personality profiles, they might learn cognitive-behavioural strategies to better manage high levels of anxiety, to manage their tendency to have pessimistic reactions to certain situations or to control their tendency to react impulsively or aggressively. Our study shows that this mental health approach to alcohol prevention is much more successful in reducing drinking behaviour than giving teenagers general information on the dangers of alcohol.”

After two years, high-risk students in intervention schools were at a 29% reduced risk of drinking, 43% reduced risk of binge drinking and 29% reduced risk of problem drinking compared to high-risk students in control schools. The intervention also significantly delayed the natural progression to more risky drinking behaviour (such as frequent binge drinking, greater quantity of drinking, and severity of problem drinking) in the high-risk students over the two years.

Additionally, over the two year period, low-risk teenagers in the intervention schools, who did not receive the intervention, were at a 29% reduced risk of taking up drinking and 35% reduced risk of binge drinking compared to the low-risk group in the non-intervention schools, indicating a possible ‘herd effect’ in this population. 

Dr Conrod adds: “Not only does the intervention have a significant effect on the teenagers most at risk of developing problematic drinking behaviour, there was also a significant positive effect on those who did not receive the intervention, but who attended schools where interventions were delivered to high-risk students. This ‘herd effect’ is very important from a public health perspective as it suggests that the benefits of mental health interventions on drinking behaviour also extend to the general population, possibly by reducing the number of drinking occasions young people are exposed to in early adolescence.”

Dr Conrod concludes: “This intervention could be widely administered to schools: it is successful from a public health perspective, appreciated by students and staff, and because we train school staff rather than professional psychologists, the intervention remains relatively inexpensive to roll-out.”

Approximately 6 out of 10 people aged 11-15 in England report drinking, and in the UK approximately 5,000 teenagers are admitted to hospital every year for alcohol related reasons. Across the developed world, alcohol accounts for approximately 9% of all deaths of people aged 15-29, and so far, universal community or school-based interventions have proven difficult to implement and shown limited success.

Nick Barton, Chief Executive of Action on Addiction says: “Dr Conrod’s study which helps young people reduce their chances of developing an addiction to alcohol and/or drugs in the future is an exciting development for prevention work in the UK.  This is generally recognised as inadequate, and as we see regularly in the media, currently fails to address binge drinking and drug taking among young people.  We treat a large number of people who began misusing substances in their school years, and we welcome any evidence-based research which may help to reverse this trend.”

Paper reference: Conrod, P. et al. “A cluster randomized trial evaluating a selective, personality-targeted prevention program for adolescent alcohol misuse: Primary two-year outcomes and possible secondary herd effects” JAMA Psychiatry doi:10.1001/jamapsychiatry.2013.651

For further information, please contact Seil Collins, Press Officer, King’s College London, Institute of Psychiatry. Email: seil.collins@kcl.ac.uk or tel: +44 0207 848 5377

For further information about the PreVenture programme, click here.

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