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, 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 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."
Notes to editors:
For a copy of the paper or interviews with the author, 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/mob: (+44) 07718 697176
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
About King's College London:
King's College London is one of the top 30 universities in the world (2012/13 QS international world rankings), and was The Sunday Times 'University of the Year 2010/11', and the fourth oldest in England. A research-led university based in the heart of London, King's has more than 24,000 students (of whom more than 10,000 are graduate students) from nearly 140 countries, and more than 6,100 employees. King's is in the second phase of a £1 billion redevelopment programme which is transforming its estate.
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King's College London and Guy's and St Thomas', King's College Hospital and South London and Maudsley NHS Foundation Trusts are part of King's Health Partners. King's Health Partners Academic Health Sciences Centre (AHSC) is a pioneering global collaboration between one of the world's leading research-led universities and three of London's most successful NHS Foundation Trusts, including leading teaching hospitals and comprehensive mental health services. For more information, visit: www.kingshealthpartners.org.
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About Action on Addiction:
Action on Addiction is the only UK charity working across the addiction field in research, prevention, treatment and rehabilitation, professional workforce development, professional education and support for families and children.
One in three people suffer from an addiction. It breaks up families, damages communities and destroys lives. In some way it touches us all. Action on Addition believes that it is important to take an integrated and dynamic approach to improving the understanding of addiction and people's responses to it.
Action on Addiction has treatment centres throughout England as well as a specialist family support service (Families Plus) and an expert training centre for the treatment of addiction. They fund important and innovative research into addiction, working closely with the National Addiction Centre (part of the Institute of Psychiatry, King's College London) and the Mental Health Research and Development Unit at the University of Bath.
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JAMA Psychiatry