Preventure - a personality-targeted intervention to prevent substance use disorders in vulnerable youth

The PreVenture programme has been evaluated in three separate randomised controlled trials (RCTs) in Europe: two in England (Conrod et al., 2008, 2010, 2011, 2013; Castellanos-Ryan, et al., 2006; O’Leary-Barrett et al., 2010, 2013; Mahu et al., 2014; Perrier-Menard, et al., 2018).and one in the Netherlands (Lammers et al., 2015, 2017)., all involving youth aged between 13 and 16 years..

All studies were conducted with students scoring more than one standard deviation above the mean of the school on any of the subscales the Substance Use Risk Profile Scale (SURPS), comprising hopelessness, anxiety sensitivity, impulsivity and sensation seeking, as the intent-to-treat sample.
Two studies (cluster randomised trials) additionally reported the impact of the programme on the whole population of similarly aged students, including students who were not delivered any intervention. The Dutch study had an additional inclusion criterion, namely that participants must have had a lifetime use of at least one glass of alcohol.

United Kingdom Trial: PreVenture

The first European trial to evaluate the PreVenture Programme was conducted across 12 London Boroughs in the United Kingdom. There was a lower increase in the self-reported quantity and frequency of drinking (modelled as an intercept across 4 six-monthly assessments over two years). The intervention showed to reduce alcohol consumption six months post intervention, and these early intervention effects were maintained over the course of the two-year follow-up. There were no effects on binge drinking at any time-point. The experience of negative consequences of drinking (problem drinking symptoms) was lower in the intervention group compared to the control condition at all time-points. At 12 and 24 month follow-ups, Preventure participants expressed a lower need to drink in order to cope with difficult feelings (statistically significant at these time-points but not at six and 18 months). There was no effect on students’ motivation to drink to feel good as opposed to avoiding feeling bad on any time-point. (Conrod et al., 2011; Conrod et al., 2008).

This trial also reported the effects on self-reported drug use assessed six, 12, 18 and 24 months after the intervention. The programme was associated with a statistically significant reduction in frequency of drug use at all time-points and for the number of drugs used at 12 and 24 months (but not at the other time-points, although the overall effect remained significant). There was a statistically significant effect favouring the intervention for the probability of cocaine use at all time-points, no effect on marijuana use at any specific time-point, and a statistically significant effect favouring the intervention on the probability of other drug use at 12 and 24 months (but not the earlier time-points)(Conrod et al., 2010).

A third publication examined in a randomised trial the effect of the programme on young people’s mental health and risk-taking behaviours. Six months after the programme ended, results showed a moderate effect of the NT intervention on depression scores, and a similar effect of the AS intervention on panic attack and truancy (i.e., school avoidance). (Castellanos-Ryan, et al., 2006).

United Kingdom Trial (2): Adventure

The second English trial was cluster randomised, and involved training school-based counsellors and teachers on the delivery of the Preventure programme. At 6-months post intervention, the programme was shown to have a statistically significant effect favouring the intervention on self-reported drinking status and binge drinking 6 months after baseline. Controlling for other variables, there was also a statistically significant positive effect on quantity and frequency of drinking and drinking-related problems (O’Leary-Barrett et al., 2010).

A second study (Conrod et al., 2013) reported on the 24-month outcomes of this cluster randomised trial in youth evaluated as high and low risk for early onset substance misuse. This analysis indicated population-level reductions in onset and frequency of drinking, and selective effects on quantity of alcohol consumed, binge drinking, alcohol problems. The programme was effective in reducing high risk drinking behaviours in high-risk youth, and additionally showed indirect effects on drinking initiation and frequency of drinking in the low-risk students.

Another secondary analysis (Mahu et al., 2014) examined cannabis use outcomes specifically and reported that the intervention was only considered to be associated with significant reduction in cannabis use when those lost to follow-up were considered as likely cannabis users.

A study examined (Perrier-Menard, et al., 2018) the potential moderator effects of baseline mental health symptoms, traumatic experiences, and socio-economic status revealed that only baseline attention- hyperactivity and conduct symptoms moderate intervention effects on adolescent drinking outcomes, with the intervention showing more beneficial effects on outcomes in those reporting higher levels of externalising symptoms at baseline. Source: .

In the third study in England, the effects on self-reported drug use were assessed six, 12, 18 and 24 months after the intervention. The programme had a statistically significant effect favouring the intervention for the frequency of drug use at all time-points and for the number of drugs used at 12 and 24 months (but not at the other time-points, although the overall effect remained significant). There was a statistically significant effect favouring the intervention for the probability of cocaine use at all time-points, no effect on marijuana use at any time-point, and a statistically significant effect favouring the intervention on the probability of other drug use at 12 and 24 months (but not the earlier time-points).

The fourth English study looked at the effect of the programme on young people’s mental health and risk-taking behaviours. Six months after the programme ended, there was a statistically significant effect favouring the intervention on shoplifting and panic attacks but not on truancy, vandalism, sex without contraception, sex with someone not known well or depression symptoms.

A final study (O’Leary-Barrett et al., 2013) reported on the secondary mental health outcomes of this trial, including severity of mental health symptoms, and likelihood of transitioning to clinically significant levels of mental health concerns. This study reported that the intervention was associated with significant reductions in self-reported symptoms of depression, anxiety, suicidal ideation and conduct problems. The interventions were also shown to be associated with a 20-25% reduction in likelihood of transitioning to severe mental health symptoms.
These intervention effects indicate that personality-targeted interventions designed to prevent alcohol misuse, can concurrently reduce other relevant psychological problems in youth.

The Dutch Preventure Trial:

A Dutch study from 2015 reported that Preventure, appears to have little or no effect on overall prevalence of binge drinking in adolescents in the Netherlands but may reduce the development of binge drinking over time. Alcohol use, binge drinking rates and problem drinking were not significantly different between the intervention (42.9%) and control group (49.2%) at 12 months follow-up. However, the post-hoc latent-growth analyses revealed significant effects of the intervention programme on the development (growth) of binge drinking (β = –0.16, P = 0.05), and binge drinking frequency (β = –0.14, P = 0.05) over the course of the follow-up period (Lammers et al., 2015).

A secondary analysis on subgroups of participants revealed that the program also appears to have effect on the prevalence of binge drinking and alcohol use among specific groups of adolescents in the Netherlands, particularly anxious and sensation seeking SS youth and those attending vocational schools. (Lammers, et al., 2017).