The validity of the Substance Use Risk Profile Scale (SURPS) among Australian adolescents

Effect of a selective personality-targeted prevention program on 7-year illicit substance related outcomes: A secondary analysis of a cluster randomized controlled trial

BACKGROUND

This study evaluated the efficacy of the selective personality-targeted PreVenture program in reducing cannabis and stimulant use over a 7-year period spanning adolescence and early adulthood.

METHODS

A cluster randomized controlled trial was conducted in 14 Australian schools. Schools were randomized to PreVenture, a brief personality-targeted selective intervention, comprising two 90-minute facilitator-led sessions delivered one week apart, or a control group (health education as usual). Only students who scored highly on one of four personality traits (anxiety sensitivity, negative thinking, impulsivity, sensation seeking) were included. Students completed online self-report questionnaires between 2012 and 2019: at baseline; post-intervention; 1-, 2-, 3-, 5.5- and 7-years post-baseline. Outcomes were past 6-months cannabis use, stimulant use (MDMA, methamphetamine or amphetamine) and cannabis-related harms.

RESULTS

The sample comprised 438 adolescents (Mage=13.4 years; SD=0.47) at baseline. Retention ranged from 51% to 79% over the 7-years. Compared to controls, the PreVenture group had significantly reduced odds of annual cannabis-related harms (OR=0.78, 95% CI=0.65-0.92). However, there were no significant group differences in the growth of cannabis use (OR=0.84, 95% CI=0.69-1.02) or stimulant use (OR=1.07, 95% CI=0.91-1.25) over the 7-year period.

CONCLUSIONS

PreVenture was effective in slowing the growth of cannabis-related harms over time, however owing to missing data over the 7-year trial, replication trials may be warranted to better understand the impact of the PreVenture intervention on cannabis and stimulant use among young Australians. Alternative implementation strategies, such as delivering the intervention in later adolescence and/or providing booster sessions, may be beneficial.

High peak drinking levels mediate the relation between impulsive personality and injury risk in emerging adults

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.

Structure of psychopathology in adolescents and its association with high-risk personality traits

The present study examined high-risk personality traits and associations with psychopathology across multiple levels of a hierarchical-dimensional model of psychopathology in a large adolescent, general population sample. Confirmatory factor analyses were run using data from two randomized controlled trials of Australian adolescents (N = 8,654, mean age = 13.01 years, 52% female). A higher-order model - comprised of general psychopathology, fear, distress, alcohol use/harms, and conduct/inattention dimensions - was selected based on model fit, reliability, and replicability. Indirect-effects models were estimated to examine the unique associations between high-risk personality traits (anxiety sensitivity, negative thinking, impulsivity, and sensation seeking) and general and specific dimensions and symptoms of psychopathology. All personality traits were positively associated with general psychopathology. After accounting for general psychopathology, anxiety sensitivity was positively associated with fear; negative thinking was positively associated with distress; impulsivity was positively associated with conduct/inattention; and sensation seeking was positively associated with alcohol use/harms and conduct/inattention, and negatively associated with fear. Several significant associations between personality traits and individual symptoms remained after accounting for general and specific psychopathology. These findings contribute to our understanding of the underlying structure of psychopathology among adolescents and have implications for the development of personality-based prevention and early intervention programs.

Prescription opioid misuse in relation to addiction susceptibility among women at a Saudi university

Objectives

The trends of prescription opioid misuse are understudied in Arab populations, let alone among university students. Additionally, little is known about the psychological traits that increase susceptibility for such behaviors in this region. Thus, this study aimed to assess the prevalence of prescription opioid misuse and its association with addiction susceptibility, as measured by the Substance Abuse Risk Profile Scale (SURPS).

Methods

We sampled university students from King Saud University's women's campus. Data on prescription opioid misuse, SURPS traits, and demographic characteristics were collected using an electronic self-administered survey.

Results

Lifetime prescription opioid misuse was 48.5%, while past-month misuse was 28.9%. On average, SURPS subscale scores for impulsivity (mean = 11.6; SD = 2.8) hopelessness (mean = 12.3; SD = 3.5), sensation seeking (mean = 16.4; SD = 3.8), and anxiety sensitivity (mean = 14.6; SD = 2.6). Anxiety sensitivity composite scores significantly differed between students reporting misuse and those who did not. Moreover, the odds for prescription opioid misuse increased by 7% for every 1 unit increase in anxiety sensitivity (AOR = 1.07; 95% CI = 1.00, 1.14), when controlling for other SURPS measures and student characteristics.

Conclusion

The prevalence of prescription opioid misuse in our study is higher than what is reported in global student populations. This may reflect unmonitored availability of controlled substances and unsupervised medical prescriptions. Additionally, high levels of anxiety sensitivity may be driving such misuse. Further surveillance of prescription drug misuse among university students and motivators for such behavior is needed for planning prevention and control interventions.

Prevalence and correlates of addictive eating behaviours in a large cohort of Australian adolescents

OBJECTIVE

Research shows highly palatable foods can elicit addictive eating behaviours or 'food addiction'. Early adolescence is theorised to be a vulnerable period for the onset of addictive eating behaviours, yet minimal research has examined this. This study explored the prevalence and correlates of addictive eating behaviours in a large early adolescent sample.

METHODS

6640 Australian adolescents (Mage = 12.7 ± 0.5, 49%F) completed an online survey. Addictive eating was measured with the Child Yale Food Addiction Scale (YFAS-C). Negative-binomial generalised linear models examined associations between addictive eating symptoms and high psychological distress, energy drink consumption, sugar-sweetened beverage (SSB) consumption, alcohol use, and cigarette use.

RESULTS

Mean YFAS-C symptom criteria count was 1.36 ± 1.47 (of 7). 18.3% of participants met 3+ symptoms, 7.5% endorsed impairment and 5.3% met the diagnostic threshold for food addiction. All examined behavioural and mental health variables were significantly associated with addictive eating symptoms. Effects were largest for high psychological distress and cigarette use; with those exhibiting high psychological distress meeting 0.65 more criteria (95%CI = 0.58-0.72, p < 0.001) and those who smoked a cigarette meeting 0.51 more criteria (95%CI = 0.26-0.76, p < 0.001). High psychological distress and consumption of SSB and energy drinks remained significant when modelling all predictors together.

CONCLUSION

In this large adolescent study, addictive eating symptoms were common. Further research should establish directionality and causal mechanisms behind the association between mental ill-health, alcohol and tobacco use, and addictive eating behaviours. Cross-disciplinary prevention initiatives that address shared underlying risk factors for addictive eating and mental ill-health may offer efficient yet substantial public health benefits.

Personality-specific pathways from bullying victimization to adolescent alcohol use: a multilevel longitudinal moderated mediation analysis

Bullying victimization is common in adolescence and has been associated with a broad variety of psychopathology and alcohol use. The present study assessed time-varying associations between bullying victimization and alcohol use through internalizing and externalizing symptoms and whether this indirect association throughout time is moderated by personality. This 5-year longitudinal study (3,800 grade 7 adolescents) used Bayesian multilevel moderated mediation models: independent variable was bullying victimization; moderators were four personality dimensions (anxiety sensitivity, hopelessness, impulsivity, and sensation seeking); internalizing symptoms (anxiety, depressive symptoms) and externalizing symptoms (conduct, hyperactivity problems) were the mediators; and alcohol use, the outcome. Results indicated significant between, within, and lagged effects on alcohol use through internalizing and externalizing symptoms. There were significant between and within effects on alcohol use through internalizing symptoms for adolescents with high anxiety sensitivity and hopelessness, and significant between, within, and lagged effects on alcohol use through externalizing symptoms for adolescents with high impulsivity and sensation seeking. These findings implicate two risk pathways that account for how bullying victimization enhances alcohol use risk and emphasize the importance of personality profiles that can shape the immediate and long-term consequences of victimization.

The 3-year effects of a personality-targeted prevention program on general and specific dimensions of psychopathology

This study aimed to examine the effect of a personality-targeted prevention program (Preventure) on trajectories of general and specific dimensions of psychopathology from early- to mid-adolescence. Australian adolescents (N = 2190) from 26 schools participated in a cluster randomized controlled substance use prevention trial. This study compared schools allocated to deliver Preventure (n = 13 schools; n = 466 students; Mage = 13.42 years), a personality-targeted selective intervention, with a control group (n = 7 schools; n = 235 students, Mage = 13.47 years). All participants were assessed for psychopathology symptoms at baseline, 6-, 12-, 24- and 36-months post-baseline. Outcomes were a general psychopathology factor and four specific factors: fear, distress, alcohol use/harms and conduct/inattention), extracted from a higher-order model. Participants who screened as 'high-risk' on at least one of four personality traits (negative thinking, anxiety sensitivity, impulsivity and sensation seeking) were included in intention-to-treat analyses. Intervention effects were examined using multi-level mixed models accounting for school-level clustering. Among high-risk adolescents, growth in general psychopathology was slower in the Preventure group compared to the control group (b = -0.07, p = 0.038) across the three years. After controlling for effects on general psychopathology, there were no significant, additional effects on the lower order factors. This study provides evidence for the effectiveness of a selective personality-targeted intervention in altering trajectories of general psychopathology during adolescence. This finding represents impacts on multiple symptom domains and highlights the potential for general psychopathology as an intervention target.

Associations Between Personality Traits and Energy Balance Behaviors in Emerging Adulthood: Cross-Sectional Study

BACKGROUND

Internalizing and externalizing personality traits are robust risk factors for substance use and mental health, and personality-targeted interventions are effective in preventing substance use and mental health problems in youth. However, there is limited evidence for how personality relates to other lifestyle risk factors, such as energy balance-related behaviors, and how this might inform prevention efforts.

OBJECTIVE

This study aimed to examine concurrent cross-sectional associations between personality traits (ie, hopelessness, anxiety sensitivity, impulsivity, and sensation seeking) and sleep, diet, physical activity (PA), and sedentary behaviors (SB), 4 of the leading risk factors for chronic disease, among emerging adults.

METHODS

Data were drawn from a cohort of young Australians who completed a web-based, self-report survey in 2019 during early adulthood. A series of Poisson and logistic regressions were conducted to examine the concurrent associations between the risk behaviors (sleep, diet, PA, and sitting and screen time) and personality traits (hopelessness, anxiety sensitivity, impulsivity, and sensation seeking) among emerging adults in Australia.

RESULTS

A total of 978 participants (mean age 20.4, SD 0.5 years) completed the web-based survey. The results indicated that higher scores on hopelessness were associated with a greater daily screen (risk ratio [RR] 1.12, 95% CI 1.10-1.15) and sitting time (RR 1.05, 95% CI 1.0-1.08). Similarly, higher scores on anxiety sensitivity were associated with a greater screen (RR 1.04, 95% CI 1.02-1.07) and sitting time (RR 1.04, 95% CI 1.02-1.07). Higher impulsivity was associated with greater PA (RR 1.14, 95% CI 1.08-1.21) and screen time (RR 1.06, 95% CI 1.03-1.08). Finally, higher scores on sensation seeking were associated with greater PA (RR 1.08, 95% CI 1.02-1.14) and lower screen time (RR 0.96, 95% CI 0.94-0.99).

CONCLUSIONS

The results suggest that personality should be considered when designing preventive interventions for lifestyle risk behaviors, particularly in relation to SB, such as sitting and screen time.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12612000026820; https://tinyurl.com/ykwcxspr.

Who are Australia's young heavy drinkers? a cross-sectional population study

OBJECTIVE

In light of the recent declines in youth drinking, the socio-demographic correlates of (1) annual total alcohol consumption (volume) and (2) monthly single occasion risky drinking among underage young people (14-17-year-olds) and young adults (18-24-year-olds) were examined.

METHODS

Cross-sectional data were drawn from the 2019 National Drug Strategy Household Survey (n=1,547). Multivariable negative binomial regression analyses identified the socio-demographic correlates of total annual volume and monthly risky drinking.

RESULTS

Those who spoke English as first language reported higher total volume and rates of monthly risky drinking. Not being in school predicted total volume for 14-17-year-olds, as did having a certificate/diploma for 18-24-year-olds. Living in affluent areas predicted a greater total volume for both age groups, and risky drinking for 18-24-year-olds. Young men in regional areas and working in labour and logistics reported higher total volume than young women in the same groups.

CONCLUSIONS

There are important differences among young heavy drinkers related to gender, cultural background, socio-economic status, education, regionality and work industry.

IMPLICATIONS FOR PUBLIC HEALTH

Prevention strategies that are sensitively tailored towards high risk groups (e.g. young men in regional areas and working in trade and logistics) may be of public health benefit.

Is Anxiety Sensitivity Associated with COVID-19 Related Distress and Adherence among Emerging Adults?

We investigated whether anxiety sensitivity (AS) is associated with increased distress and adherence to public health guidelines during the COVID-19 pandemic among undergraduates, and whether increased distress mediates the relationship between AS and increased adherence. An online cross-sectional survey was conducted with 1318 first- and second-year undergraduates (mean age of 19.2 years; 79.5% females) from five Canadian universities. Relevant subscales of the Substance Use Risk Profile Scale (SURPS) and the Big Five Inventory-10 (BFI-10) were used to assess AS and neuroticism. Three measures tapped distress: the Patient Health Questionnaire-9 (PHQ-9) for depressive symptoms, the Generalized Anxiety Disorder-7 (GAD-7) for anxiety symptoms, and the Brief COVID-19 Stress Scales (CSS-B) for COVID-19-specific distress. The COVID-19 Adherence scale (CAD) assessed adherence to COVID-19 containment measures. AS was significantly independently associated with higher general distress (both anxiety and depressive symptoms) and higher COVID-19-specific distress, after controlling age, sex, study site, and neuroticism. Moreover, AS indirectly predicted greater adherence to COVID-19 preventive measures through higher COVID-19-specific distress. Interventions targeting higher AS might be helpful for decreasing both general and COVID-19-specific distress, whereas interventions targeting lower AS might be helpful for increasing adherence to public health containment strategies, in undergraduates.

Effect of Selective Personality-Targeted Alcohol Use Prevention on 7-Year Alcohol-Related Outcomes Among High-risk Adolescents: A Secondary Analysis of a Cluster Randomized Clinical Trial

IMPORTANCE

Alcohol consumption is one of the leading preventable causes of burden of disease worldwide. Selective prevention of alcohol use can be effective in delaying the uptake and reducing harmful use of alcohol during the school years; however, little is known about the durability of these effects across the significant transition from early adolescence into late adolescence and early adulthood.

OBJECTIVE

To examine the sustained effects of a selective personality-targeted alcohol use prevention program on alcohol outcomes among adolescents who report high levels of 1 of 4 personality traits associated with substance use.

DESIGN, SETTING, AND PARTICIPANTS

A cluster randomized clinical trial was conducted to assess the effectiveness of the selective personality-targeted PreVenture program on reducing the growth of risky alcohol use and related harms from early to late adolescence and early adulthood. Participants included grade 8 students attending 14 secondary schools across New South Wales and Victoria, Australia, in 2012 who screened as having high levels of anxiety sensitivity, negative thinking, impulsivity, and/or sensation seeking. Schools were block randomized to either the PreVenture group (7 schools) or the control group (7 schools). The primary end point of the original trial was 2 years post baseline; the present study extends the follow-up period from July 1, 2017, to December 1, 2019, 7 years post baseline. Data were analyzed from July 22, 2021, to August 2, 2022.

INTERVENTIONS

The PreVenture program is a 2-session, personality-targeted intervention designed to upskill adolescents to better cope with their emotions and behaviors.

MAIN OUTCOMES AND MEASURES

Self-reported monthly binge drinking, alcohol-related harms, and hazardous alcohol use measured by the Alcohol Use Disorders Identification Test-Concise consumption screener.

RESULTS

Of 438 participants (249 male [56.8%]; mean [SD] age, 13.4 [0.5] years) from 14 schools, 377 (86.2%) provided follow-up data on at least 2 occasions, and among those eligible, 216 (54.0%) participated in the long-term follow-up. Compared with the control condition, the PreVenture intervention was associated with reduced odds of any alcohol-related harm (odds ratio [OR], 0.81 [95% CI, 0.70-0.94]) and a greater mean reduction in the frequency of alcohol-related harms (β = -0.22 [95% CI, -0.44 to -0.003]) at the 7.0-year follow-up. There were no differences in the odds of monthly binge drinking (OR, 0.80 [95% CI, 0.56-1.13]) or hazardous alcohol use (OR, 0.87 [95% CI, 0.59-1.27]) at the 7.0-year follow-up. Exploratory analyses at the 5.5-year follow-up showed that compared with the control condition, the PreVenture intervention was also associated with reduced odds of monthly binge drinking (OR, 0.87, [95% CI, 0.77-0.99]) and hazardous alcohol use (OR, 0.91 [95% CI, 0.84-0.99]), but this was not sustained.

CONCLUSIONS AND RELEVANCE

This study demonstrated that a brief selective personality-targeted alcohol use prevention intervention delivered in the middle school years can have sustained effects into early adulthood.

TRIAL REGISTRATION

anzctr.org.au Identifier: ACTRN12612000026820.

Personality factors associated with suicidal ideation, plans and attempts in adolescents

BACKGROUND

Suicide is the leading cause of death among young Australians, therefore identifying factors that increase risk is important. The aims of this study was to investigate the association between personality domains and suicidal ideation, plans and attempts in a community-based sample of adolescents.

METHODS

1428 students from thirteen secondary schools in Australia completed a survey consisting of demographic information (gender and age), personality risk across four domains (Hopelessness, Impulsivity, Sensation Seeking and Anxiety Sensitivity) as measured by the Substance Use Risk Profile Scale, and psychological distress measured by the Distress Questionnaire 5 scale. Outcome measures included suicidal ideation, plans and attempts measured by the Youth Risk Behavior Survey.

RESULTS

Students were aged between 11 and 17 years old (mean: 13.3, SD = 1.2) with 59% identifying as female. Proportions of participants reporting suicidal ideation, plans and at least one attempt were 14%, 9% and 7% respectively. Hopelessness was associated with twice the odds (OR = 3.1 and 2.9) of suicidal thoughts and plans respectively. Hopelessness also had 45% increased odds for suicide attempt (OR = 2.1), however this was not significant in the suicidal ideation sub-group. Impulsivity and sensation seeking were associated with suicidal ideation (OR = 1.3), while only impulsivity was associated with attempt (OR = 1.5).

LIMITATIONS

The study was cross-sectional, considered suicidal thoughts and behaviors in past 12 months only and used one measure of personality.

CONCLUSIONS

Personality traits may be important for determining suicide risk in adolescents. Developing screening and interventions targeting personality may have implications for the detection and prevention of suicide.

Selective personality‐targeted prevention of suicidal ideation in young adolescents: post hoc analysis of data collected in a cluster randomised controlled trial

Objective

Design

Setting, participants

Intervention

Main outcome measure

Results

Conclusion

Trial registration (CAP study only)

Personality as a Possible Intervention Target to Prevent Traumatic Events in Adolescence

Traumatic events (severe injury, violence, threatened death) are commonly experienced by children. Such events are associated with a dose-response increasing risk of subsequent substance use, mental illness, chronic disease, and premature mortality. Preventing the accumulation of traumatic events is thus an urgent public health priority. Substance use risk personality profiles (impulsivity, sensation seeking, hopelessness, and anxiety sensitivity) may be an important target for preventing trauma exposure, given associations between these personality traits and risky behaviour, substance misuse, and injuries across adolescence. The current study aimed to investigate associations between personality at age 13 and the number of traumatic events experienced by age 18. It also examined associations between traumas before age 13 and personality at age 13. Participants were the control group of a cluster-randomised controlled trial examining prevention of adolescent alcohol misuse. Baseline data were collected at ages 12–13 (2012). Participants were followed-up at ages 18–19 (2017–2018). Personality profiles of hopelessness, anxiety sensitivity, impulsivity, and sensation seeking were measured at baseline using the Substance Use Risk Profile Scale. Traumatic events and age of exposure were measured at age 18–19 using the Life Events Checklist for DSM-5. Mixed-effect regression was conducted on 287 participants in Stata 17, controlling for sex. High scores on hopelessness, impulsivity, and sensation seeking at age 13 were associated with a greater number of traumatic events by age 18. Impulsivity and sensation seeking predicted the number of new traumatic events from age 13 to 18. Prior trauma exposure was associated with high hopelessness at age 13. Adolescents exhibiting high impulsivity or sensation seeking may be at greater risk of experiencing traumatic events. Additionally, early trauma exposure may contribute to the development of a hopelessness personality trait.

Personality-targeted prevention for adolescent tobacco use: Three-year outcomes for a randomised trial in Australia

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.

It's the Content That Counts: Longitudinal Associations between Social Media Use, Parental Monitoring, and Alcohol Use in an Australian Sample of Adolescents Aged 13 to 16 Years

(1) Background: More time spent on social media has been linked to increased alcohol use, with exposure to peer alcohol-related content on social media (content exposure) named as a critical factor in this relationship. Little is currently known about whether early content exposure may have lasting effects across adolescent development, or about the capacity of parental monitoring of social media use to interrupt these links. (2) Methods: These gaps were addressed in both cross-sectional and longitudinal contexts among a longitudinal sample of Australian secondary school students (n = 432) across the ages of 13–16. (3) Results: Evidence was found for links between social media use and alcohol use frequency in early development. Social media time at age 13 was significantly associated with concurrent alcohol use frequency. At age 13, alcohol use frequency was significantly higher among those who reported content exposure compared to those who reported no exposure. Longitudinally, the frequency of alcohol use over time increased at a faster rate among participants who reported content exposure at age 13. In terms of parental monitoring, no longitudinal effects were observed. However, parental monitoring at age 13 did significantly reduce the concurrent relationship between alcohol use frequency and content exposure. (4) Conclusion: The impact of social media content exposure on alcohol use in adolescence may be more important than the time spent on social media, and any protective effect of parental monitoring on content exposure may be limited to the time it is being concurrently enacted.

Which came first: Cannabis use or deficits in impulse control?

Impulse control deficits are often found to co-occur with substance use disorders (SUDs). On the one hand, it is well known that chronic intake of drugs of abuse remodels the brain with significant consequences for a range of cognitive behaviors. On the other hand, individual variation in impulse control may contribute to differences in susceptibility to SUDs. Both of these relationships have been described, thus leading to a "chicken or the egg" debate which remains to be fully resolved. Does impulsivity precede drug use or does it manifest as a function of problematic drug usage? The link between impulsivity and SUDs has been most strongly established for cocaine and alcohol use disorders using both preclinical models and clinical data. Much less is known about the potential link between impulsivity and cannabis use disorder (CUD) or the directionality of this relationship. The initiation of cannabis use occurs most often during adolescence prior to the brain's maturation, which is recognized as a critical period of development. The long-term effects of chronic cannabis use on the brain and behavior have started to be explored. In this review we will summarize these observations, especially as they pertain to the relationship between impulsivity and CUD, from both a psychological and biological perspective. We will discuss impulsivity as a multi-dimensional construct and attempt to reconcile the results obtained across modalities. Finally, we will discuss possible avenues for future research with emerging longitudinal data.

The school-led Preventure study: Protocol of a cluster-randomised controlled trial of effectiveness to prevent adolescent alcohol misuse, internalising problems, and externalising problems through a personality-targeted intervention delivered by school staff

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).

The long-term effectiveness of universal, selective and combined prevention for alcohol use during adolescence: 36-month outcomes from a cluster randomized controlled trial

AIM

To compare the long-term universal outcomes of the Climate Schools programme, the selective preventure programme and their combined implementation to standard substance use education in reducing the uptake of alcohol use, engagement in binge drinking and alcohol-related harms over a 3-year period.

DESIGN

A cluster-randomized controlled trial.

SETTING AND PARTICIPANTS

Substance use prevention programmes delivered in Australian secondary schools. Students from 26 Australian secondary schools (n = 2190), mean age at baseline 13.3 years (standard deviation = 0.48), 57.4% male. Schools were recruited between September 2011 and February 2012.

INTERVENTIONS

Schools were block-randomized to one of four groups: universal prevention (climate; 12 × 40-minute lessons); selective prevention (preventure; 2 × 90-minute sessions); combined prevention (climate and preventure; CAP); or health education as usual (control). The climate intervention delivered 12 × 40-minute lessons aimed at reducing alcohol and cannabis use and related harms. The preventure intervention delivered 2 × 90-minute group sessions to high-risk students. The CAP group implemented the climate programme to the entire year group and the preventure programme to the high-risk students.

MEASUREMENTS

Participants were all consenting 8th grade students (in 2012) assessed at baseline, post-intervention (6-9 months post-baseline) and at 12, 24 and 36 months post-baseline on measures of alcohol use, knowledge and related harms. Primary outcomes were alcohol use, binge drinking (five or more standard drinks) and alcohol-related harms, obtained from all students regardless of whether or not they received intervention. Intervention effects at 36 months post-baseline were estimated from generalized multi-level mixed models using data from all time-points and accounting for school-level clustering. Exploratory analyses examined intervention effects among low- and high-risk adolescents.

FINDINGS

Compared with students in the control condition, students in the climate, preventure and CAP groups demonstrated significantly slower increases in their likelihood to drink any alcohol [odds ratio (OR) = 0.64, 95% confidence interval (CI) = 0.50-0.82 for climate; OR = 0.55, 95% CI = 0.43-0.71 for preventure and OR = 0.67, 95% CI = 0.53-0.84 for CAP] to engage in binge drinking (OR = 0.60, 95% CI = 0.44-0.82 for climate; OR = 0.59, 95% CI = 0.44-0.80 for preventure and OR = 0.68, 95% CI = 0.51-0.92 for CAP) and to experience alcohol harms (OR = 0.63, 95% CI = 0.49-0.82 for climate; OR = 0.55, 95% CI = 0.43-0.71 for preventure and OR = 0.64, 95% CI = 0.50-0.81 for CAP). There was no strong evidence that the combined approach showed advantages over universal prevention. The direction and magnitude of effects were consistent in low- and high-risk adolescents.

CONCLUSIONS

The universal Climate Schools programme and the selective preventure programme were effective in reducing alcohol consumption and alcohol problems compared with standard Australian health education, when trialled individually and together over a 3-year period.

A randomised double-blind trial of cognitive training for the prevention of psychopathology in at-risk youth

BACKGROUND

The aim of this study was to evaluate the effectiveness of online cognitive training as a means of reducing psychopathology in at-risk youth.

METHODS

In a double-blind randomised controlled trial, 228 youths (mean age = 18.6, 74.6% female) were randomly allocated to either an intervention group (n = 114; online cognitive training focused on executive functioning) and a control group (n = 114; online cognitive training focused on other cognitive abilities). Participants were assessed online at baseline, post-training, 3-, 6- and 12-month follow-up. The primary outcome of the study was overall psychopathology as measured by the Strengths and Difficulties Questionnaire. Secondary outcomes were executive functioning ability (assessed using the n-back, trail-making and Stroop tasks), day-to-day functioning and risky drinking.

RESULTS

Mixed model intention-to-treat analyses indicated that psychopathology increased and day-to-day functioning decreased, regardless of intervention group. Those in the intervention group improved more than those in the control group in terms of the n-back task, but this was not statistically significant after adjusting for multiple comparisons. There were no statistically significant effects on risky drinking, or the trail-making and Stroop tasks.

CONCLUSION

This study failed to provide evidence for the efficacy of cognitive training as a stand-alone intervention for psychopathology.

Validation of the Substance Use Risk Profile Scale in Lithuanian population

Background

Personality traits are related with risk of hazardous alcohol use and alcohol dependence. The Substance Use Risk Profile Scale (SURPS) measures personality traits associated with addictive substance abuse. We examined psychometric properties of the SURPS in Lithuanian population.

Materials and methods

Two hundred forty-seven participants (mean age 37.22 ± 0.78 years), were recruited from the local community and from an inpatient addiction treatment centre. Internal consistency, stability, factor structure, content validity, and external validity of the SURPS were examined. Hazardous alcohol use was evaluated by Alcohol Use Disorder Identification Test (AUDIT). Alcohol dependence diagnosis was established by International Classification of Diseases - 10 (ICD - 10). We also performed gender analyses for associations of personality traits with alcohol dependence and hazardous use of alcohol.

Results

The SURPS scale demonstrated appropriate internal validity, good temporal stability, and adequate criterion validity and construct validity. The SURPS scores of hopelessness, anxiety sensitivity and impulsivity were higher in the alcohol dependence group than in the control group for both males and females. Impulsivity and sensation seeking were associated with hazardous alcohol use and these associations were more prevalent in females.

Conclusions

Lithuanian translation of the SURPS scale was appropriate. The SURPS demonstrated good sensitivity for discriminating on alcohol dependence and was more sensitive for discriminating on hazardous alcohol use for females.

A Novel Approach to Tackling Bullying in Schools: Personality-Targeted Intervention for Adolescent Victims and Bullies in Australia

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.

Evaluating the differential effectiveness of social influence and personality-targeted alcohol prevention on mental health outcomes among high-risk youth: A novel cluster randomised controlled factorial design trial

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.

Psychometric evaluation of the Turkish version of the Substance Use Risk Profile Scale in adolescents

The Substance Use Risk Profile Scale (SURPS) was developed as a self-report measure to screen four high-risk personality dimensions (hopelessness, anxiety sensitivity, impulsivity, and sensation seeking) that predict specific patterns of vulnerability to substance use and other problematic behavior. The scale has previously been shown to have adequate psychometric properties in various other languages. The aim of the present study was to evaluate the psychometric properties of the Turkish version of the SURPS. A cross-sectional total sampling design was adopted in which 875 Turkish participants took part (mean age 15.58 years, SD = 1.03). Using exploratory factor and correlational analyses, the internal consistency, test-retest reliability, construct validity, and concurrent validity were evaluated. The SURPS demonstrated good psychometric and construct validity. The results provide clear evidence that the Turkish version of the SURPS is valid and reliable. The Turkish version of the SURPS may become an important tool for daily clinical practice and clinical research.

Associations between personality and uptake of tobacco smoking: Do they differ across adolescence?

INTRODUCTION AND AIMS

Tobacco use is one of the leading causes of death globally, yet it is entirely preventable. Tobacco smoking typically begins in adolescence, and thus efforts to intervene early are vital. Personality has been identified as a risk factor for smoking in adolescence. The current study aimed to examine whether associations between personality traits (impulsivity, sensation-seeking, anxiety sensitivity and hopelessness) and new onset tobacco smoking differ across adolescence.

DESIGN AND METHODS

At baseline, 527 secondary-school students (mean age 13 years) completed a validated personality questionnaire and were surveyed on recent tobacco smoking. Participants were followed-up at 12-, 24- and 36-months. Logistic regression was conducted to examine prospective associations between the four personality types and tobacco smoking at each follow-up.

RESULTS

Results revealed age-related differences in the associations between personality and smoking in adolescence. Baseline sensation-seeking was significantly associated with new onset tobacco smoking at age 14; baseline impulsivity was significantly associated with new onset tobacco smoking at age 15; and baseline hopelessness was significantly associated with new onset tobacco smoking at age 16.

DISCUSSION AND CONCLUSIONS

This study extends knowledge by demonstrating age-specific effects on the association between personality and smoking. This has important implications for prevention and could inform the development of tailored smoking interventions to be delivered at different ages. Future research will examine personality-targeted intervention in reducing tobacco smoking in Australian adolescents across different ages.

The interactive effects of perceived peer drinking and personality profiles on adolescent drinking: a prospective cohort study

AIMS

(1) To classify Australian adolescents according to their alcohol consumption trajectories; and (2) to assess the direct and interactive effects of perceived peer drinking (PPD) and personality on adolescent drinking.

DESIGN

Prospective cohort study comprising secondary analysis of six waves of prospective data (collected between 2014 and 2016) from the control arm of the Climate Schools Combined Study.

SETTING

Nineteen schools across three Australian states.

PARTICIPANTS

A total of 1492 socio-demographically diverse students (mean age at baseline: 13.47; 68% female; 82% born in Australia).

MEASUREMENTS

Alcohol consumption trajectories were assessed using self-reported sipping of alcohol, full standard drink consumption, binge drinking and quantity and frequency of alcohol consumption. One item assessed PPD and personality was assessed using the Substance Use Risk Profile Scale.

FINDINGS

Eight hundred and sixty-four (58%) adolescents consumed alcohol across the study period. Four drinking trajectories were identified: abstaining (n = 513; reference group); onset (n = 361; initiated after baseline); persistent (n = 531; initiated prior to baseline); and decreasing (n = 50; consumed alcohol at baseline but ceased or decreased thereafter). A significant PPD × anxiety sensitivity (AS) interaction affected probability of belonging to the onset (P < 0.001) and persistent (P = 0.003) trajectories. The effect of PPD on probability of belonging to the onset trajectory was only significant when adolescents reported low [95% confidence interval (CI) = 1.464-2.646, P < 0.001], but not high AS. The effect of PPD on probability of belonging to the persistent drinking trajectory was stronger at low (95% CI = 2.144-3.283, P < 0.001), compared with high (95% CI = 1.440-2.308, P < 0.001) AS.

CONCLUSIONS

In Australian adolescents, self-reported drinking onset and persistent drinking appear to be more strongly associated with perceived peer drinking in those with low anxiety sensitivity than those with high anxiety sensitivity.

Validation of the Substance Use Risk Profile Scale (SURPS) With Bulgarian Substance Dependent Individuals

Background: The Substance Use Risk Profile Scale (SURPS) is a 23-item self-report questionnaire that assesses four well-validated personality risk factors for substance misuse (Impulsivity, Sensation Seeking, Anxiety Sensitivity, and Hopelessness). While the SURPS has been used extensively with adolescents at risk for substance dependence, its properties with adult substance-dependent populations have been understudied. Further, the validity of the Bulgarian version of the SURPS has not been evaluated. The aims of the present study were to examine the factor structure of the Bulgarian version of the SURPS, its psychometric properties, and its ability to distinguish individuals with substance dependence from healthy controls. Methods: Participants included 238 individuals ages 18 to 50 (45% female): 36 "pure" (i.e., mono-substance dependent) heroin users, 34 "pure" amphetamine users, 32 polysubstance users, 64 controls with no history of substance dependence, 43 unaffected siblings of heroin users, and 29 unaffected siblings of amphetamine users. We explored the factor structure of the Bulgarian version of the SURPS with confirmatory factor analyses, examined its reliability and validity, and tested for group differences between substance dependent and non-dependent groups. Results: Confirmatory factor analyses (CFA) replicated the original four-factor model of the SURPS. The four subscales of the SURPS demonstrated good internal consistency (Cronbach's alphas ranged from 0.71 to 0.85) and adequate concurrent validity. Significant group differences were found on the Impulsivity and Sensation Seeking subscales, with the three substance dependent groups scoring higher than controls. Conclusions: The SURPS is a valid instrument for measuring personality risk for substance use disorders in the Bulgarian population. The Bulgarian version of the SURPS demonstrates adequate to good reliability, concurrent validity, and predictive validity. Its ability to distinguish between groups with and without a history of substance dependence was specific to externalizing traits such as Impulsivity and Sensation Seeking, on which opiate, stimulant, and polysubstance dependent individuals scored higher than non-dependent controls.

Universal cannabis outcomes from the Climate and Preventure (CAP) study: a cluster randomised controlled trial

Background

The Climate and Preventure (CAP) study was the first trial to assess and demonstrate the effectiveness of a combined universal and selective approach for preventing alcohol use and related harms among adolescents. The current paper reports universal effects from the CAP study on cannabis-related outcomes over three years.

Methods

A cluster randomized controlled trial was conducted with 2190 students from twenty-six Australian high schools (mean age: 13.3 yrs., SD 0.48). Participants were randomised to one of four conditions; universal prevention for all students (Climate); selective prevention for high-risk students (Preventure); combined universal and selective prevention (Climate and Preventure; CAP); or health education as usual (Control). Participants were assessed at baseline, post intervention (6–9 months post baseline), and at 12-, 24- and 36-months, on measures of cannabis use, knowledge and related harms. This paper compares cannabis-related knowledge, harms and cannabis use in the Control, Climate and CAP groups as specified in the protocol, using multilevel mixed linear models to assess outcomes.

Results

Compared to Control, the Climate and CAP groups showed significantly greater increases in cannabis-related knowledge initially (p <  0.001), and had higher knowledge at the 6, 12 and 24-month follow-ups. There was no significant difference between the Climate and CAP groups. While no differences were detected between Control and the CAP and Climate groups on cannabis use or cannabis-related harms, the prevalence of these outcomes was lower than anticipated, possibly limiting power to detect intervention effects. Additional Bayesian analyses exploring confidence in accepting the null hypothesis showed there was insufficient evidence to conclude that the interventions had no effect, or to conclude that they had a meaningfully large effect.

Conclusions

Both the universal Climate and the combined CAP programs were effective in increasing cannabis-related knowledge for up to 2 years. The evidence was inconclusive regarding whether the interventions reduced cannabis use and cannabis-related harms. A longer-term follow-up will ascertain whether the interventions become effective in reducing these outcomes as adolescents transition into early adulthood.

Trial registration

This trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12612000026820) on the 6th of January 2012, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=347906&isReview=true

Electronic supplementary material

The online version of this article (10.1186/s13011-018-0171-4) contains supplementary material, which is available to authorized users.

Pathways to prevention: protocol for the CAP (Climate and Preventure) study to evaluate the long-term effectiveness of school-based universal, selective and combined alcohol misuse prevention into early adulthood

BACKGROUND

Alcohol use and associated harms are among the leading causes of burden of disease among young people, highlighting the need for effective prevention. The Climate and Preventure (CAP) study was the first trial of a combined universal and selective school-based approach to preventing alcohol misuse among adolescents. Initial results indicate that universal, selective and combined prevention were all effective in delaying the uptake of alcohol use and binge drinking for up to 3 years following the interventions. However, little is known about the sustainability of prevention effects across the transition to early adulthood, a period of increased exposure to alcohol and other drug use. This paper describes the protocol for the CAP long-term follow-up study which will determine the effectiveness of universal, selective and combined alcohol misuse prevention up to 7 years post intervention, and across the transition from adolescence into early adulthood.

METHODS

A cluster randomized controlled trial was conducted between 2012 and 2015 with 2190 students (mean age: 13.3 yrs) from 26 Australian high schools. Participants were randomized to receive one of four conditions; universal prevention for all students (Climate); selective prevention for high-risk students (Preventure); combined universal and selective prevention (Climate and Preventure; CAP); or health education as usual (Control). The positive effect of the interventions on alcohol use at 12-, 24- and 36-month post baseline have previously been reported. This study will follow up the CAP study cohort approximately 5- and 7-years post baseline. The primary outcome will be alcohol use and related harms. Secondary outcomes will be cannabis use, alcohol and other drug harms including violent behavior, and mental health symptomatology. Analyses will be conducted using multi-level, mixed effects models within an intention-to-treat framework.

DISCUSSION

This study will provide the first ever evaluation of the long-term effectiveness of combining universal and selective approaches to alcohol prevention and will examine the durability of intervention effects into the longer-term, over a 7-year period from adolescence to early adulthood.

TRIAL REGISTRATION

This trial was registered in the Australian New Zealand Clinical Trials Registry ( ACTRN12612000026820 ) on January 6th 2012.

Prospective associations between personality and bullying among Australian adolescents

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.

The Brain Games study: protocol for a randomised controlled trial of computerised cognitive training for preventing mental illness in adolescents with high-risk personality styles

INTRODUCTION

A broad range of mental disorders are now understood as aberrations of normal adolescent brain development. In both adolescents and adults, executive dysfunction has been implicated across a range of mental illnesses, and enhancing executive functioning may prove to be a useful prevention strategy for adolescents at risk for a range of psychopathology.

METHODS AND ANALYSIS

This study will consist of a double-blind, randomised controlled trial with a 12-month follow-up period. Participants will consist of 200 people aged 16-24 years who are at risk for a range of mental disorders based on personality risk factors, but have not experienced a lifetime mental illness as determined by a structured diagnostic interview. Participants will be randomly allocated to either an intervention group who complete an online cognitive training programme specifically targeting executive functioning ability or a control group who complete an online cognitive training programme that has limited executive functioning training potential. Superiority of the executive functioning training programme compared with the control training programme will be assessed at baseline, post-training and at 3-month, 6-month and 12-month follow-up. All assessments will be conducted online. The primary outcome of the study will be general psychopathology as measured by the Strengths and Difficulties Questionnaire. Secondary outcomes will include executive functioning ability, day-to-day functioning and alcohol consumption. All analyses will be undertaken using mixed-model repeated measures analysis of variance with planned contrasts.

ETHICS AND DISSEMINATION

Ethics approval has been obtained from the University of New South Wales Human Research Ethics Committee (HC15094). Results of the trial immediately post-treatment and at 12 months follow-up will be submitted for publication in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

ACTRN12616000127404; Pre-results.

Combined universal and selective prevention for adolescent alcohol use: a cluster randomized controlled trial

BACKGROUND

No existing models of alcohol prevention concurrently adopt universal and selective approaches. This study aims to evaluate the first combined universal and selective approach to alcohol prevention.

METHOD

A total of 26 Australian schools with 2190 students (mean age: 13.3 years) were randomized to receive: universal prevention (Climate Schools); selective prevention (Preventure); combined prevention (Climate Schools and Preventure; CAP); or health education as usual (control). Primary outcomes were alcohol use, binge drinking and alcohol-related harms at 6, 12 and 24 months.

RESULTS

Climate, Preventure and CAP students demonstrated significantly lower growth in their likelihood to drink and binge drink, relative to controls over 24 months. Preventure students displayed significantly lower growth in their likelihood to experience alcohol harms, relative to controls. While adolescents in both the CAP and Climate groups demonstrated slower growth in drinking compared with adolescents in the control group over the 2-year study period, CAP adolescents demonstrated faster growth in drinking compared with Climate adolescents.

CONCLUSIONS

Findings support universal, selective and combined approaches to alcohol prevention. Particularly novel are the findings of no advantage of the combined approach over universal or selective prevention alone.

Hopelessness and alcohol use: The mediating role of drinking motives and outcome expectancies

INTRODUCTION

Heavy drinking is a considerable public health concern. There is a broad evidence-base examining the separate contributions of personality characteristics, motives and alcohol-expectancies on subsequent alcohol use to identify those at risk. However, little is known about the complex relationships by which these variables may interact to predict drinking behavior. Feelings of hopelessness and anxiety sensitivity are hypothesized to be distal predictors of alcohol use, with outcome expectancies and drinking motives more proximal. Therefore, the aim of the current study was to examine whether hopelessness and anxiety sensitivity influenced alcohol use via drinking to cope and alcohol - outcome expectancies.

METHODS

We recruited 230 participants to complete an online questionnaire consisting of the brief drinking motives questionnaire, the Substance Use Risk Profile scale and Brief Comprehensive Effects of Alcohol scale. We conducted path analyses using structural equation modelling.

RESULTS

We demonstrated a significant direct effect of anxiety sensitivity on alcohol use, and a significant serial indirect effect of hopelessness through coping motives and alcohol outcome expectancies.

CONCLUSIONS

These findings suggest feelings of hopelessness may predict alcohol consumption through a complex pathway and future research should use these findings to identify individuals at risk of increased alcohol use.

The long-term effectiveness of a selective, personality-targeted prevention program in reducing alcohol use and related harms: a cluster randomized controlled trial

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.