preventure: a drug and alcohol prevention program targeting four … · 2017. 11. 16. ·...
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Hanie Edalati, PhD & Patricia J. Conrod, PhD Département de psychiatrie, Université de Montréal
CHU Ste-Justine
Disclosures: Consultancy fees from Janssen, Health Canada and NIH research projects
No personal financial gain from PreVenture
Preventure: A drug and alcohol prevention program targeting four personality risk factors for substance
misuse in adolescents.
Alcohol Conference for Youth, Tallinn, Nov. 2017
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Public Health Intervention Strategies
Tx
Indicated
Selective
Universal
Evidence-based programmes: Limited evidence for knowledge-based programmes Life Skills Training Program Strengthening Families Good Behaviour Game Mild-moderate effects Impact on SUD??
Brief motivational interventions for heavy drinkers Time-limited effects
-moderate generic
treatment effects -complicates and complicated by comorbid disorders -”decade of harm”
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Journal of Substance Abuse, 2001
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Substance Use Risk Profile Scale Woicik et al., ACER, 2009
1. I am content.* 2. I often don't think things through before I speak. 3. I would like to skydive. 4. I am happy.* 5. I often involve myself in situations that I later regret being involved in. 6. I enjoy new and exciting experiences even if they are unconventional. 7. I have faith that my future holds great promise.* 8. It's frightening to feel dizzy or faint. 9. I like doing things that frighten me a little. 10. It frightens me when I feel my heart beat change. 11. I usually act without stopping to think. 12. I would like to learn how to drive a motorcycle. 13. I feel proud of my accomplishments.* 14. I get scared when I'm too nervous. 15. Generally, I am an impulsive person. 16. I am interested in experience for its own sake even if it is illegal. 17. I feel that I'm a failure. 18. I get scared when I experience unusual body sensations. 19. I would enjoy hiking long distances in wild and uninhabited territory. 20. I feel pleasant.* 21. It scares me when I'm unable to focus on a task. 22. I feel I have to be manipulative to get what I want. 23. I am very enthusiastic about my future.* Asterisk (*) indicates reverse keyed item.
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Substance Use Risk Profile Scale
• 4 dimensions: – Anxiety sensitivity, Hopelessness, Impulsivity and Sensation Seeking
• Internal consistency (Woicik et al., 2009)
• Concurrent validity (Woicik et al., 2009; Schlaucht et al., 2014)
• Incremental validity (Woicik et al., 2009)
• Predictive validity (Krank et al., 2010)
• Test-retest reliability (Woicik et al., 2009)
• Sensitivity/specificity (Castellanos-Ryan et al, 2013)
• Generalisability, applications in different cultural and clinical contexts (Jolin-Castonguay et al., 2013; Schlaucht et al., 2014)
• Translated: French, German, Spanish, Czech, Dutch, Cantonese, Japanese, Sri Lankan (Robles-García et al., 2014; Omiya et al., 2012; Malmberg, et al., 2013; Chandrika Ismail, et al., 2009; Jolin-Castonguay et al., 2013)
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Hopelessness Anxiety Sensitivity Impulsivity Sensation Seeking-
R‡
Selecting HR
adolescents based
on ROC cut-offs
Selecting HR
adolescents (1SD >
mean cut-offs )†
% S, FP S, FP S, FP S, FP S, FP S, FP
Monthly binging (13%) 20, 12 27, 31 61, 32 48, 30 72, 49 70, 42
Drinking problems (17%) 49, 34 32, 31 55, 31 36, 30 84, 63 75, 53
Smoking (9%) 61, 49 33, 30 55, 33 38, 30 81, 65 72, 55
Drug use (21%) 60, 49 27, 22 54, 30 43, 28 91, 75 74, 52
BSI depression (23%) 54, 31 42, 28 51, 30 34, 30 91, 70 73, 47
Emotional problems (13%) 54, 34 59, 27 46, 34 32, 31 91, 72 80, 53
Conduct problems (41%) 26, 13 33, 29 58, 20 35, 28 77, 50 72, 46
Hyperactivity problems
(32%) 26, 15 37, 28 58, 25 38, 28 78, 55 74, 49
Sensitivity and false positive rates (1-specificity) of Age 14 SURPS subscales in the prediction
of Age 16 substance use, emotional and behavioural symptoms in British high school
students (N = 1057). (Castellanos-Ryan et al., Alcohol Clin Exp Res. 2013 Jan;37 Suppl 1:E281-90. doi: 10.1111/j.1530-
0277.2012.01931)
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Cognitive correlates of risk (Castellanos, Rubia, & Conrod,
Alcohol Clin Exp Res. 2011 Jan;35(1):140-55. doi: 10.1111/j.1530-0277.2010.01331)
100 high and low risk youth reporting either CD, SUD, CD+SUD, or neither followed for 2 years
• IMP – poor response inhibition (SSRT) mediates antisocial and substance-related behaviour
• SS – intact response inhibition
Impulsivity at age 14 Conduct problems
at 16-17
Poor Response Inhibition
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Cognitive correlates of risk (Castellanos, Rubia, & Conrod,
Alcohol Clin Exp Res. 2011 Jan;35(1):140-55. doi: 10.1111/j.1530-0277.2010.01331)
100 high and low risk youth reporting either CD, SUD, CD+SUD, or neither followed for 2 years
• IMP – poor response inhibition (SSRT) mediates antisocial and substance-related behaviour
• SS – intact response inhibition but interactions with incentive reward to predict SUD.
Sensation seeking
at age 14 Substance misuse
at 16-17
Reward-induced impulsivity
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Impulsivity ++PreSupp Motor Area (stopping)
Impulsivitypoor inhibition
--Bilateral Frontal (failed
inhibition)
Sensation Seeking
++OFC / –IFG (reward
anticipation)
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PERSONALITY TRAITS
CO-OCCURING DISORDER
Sensation Seeking
Hopelessness
Anxiety Sensitivity
Externalising Problems
Poor response inhibition and emotional reactivity
Sensitivity to reward and the incentive/reinforcing properties of substances
Negative affect regulation
Anxiety Disorders
Mood Disorders
Hyperarousal and sensitivity to dampening effects of substances/ increased withdrawal symptoms
MOTIVATIONAL PROFILE
DISIN
HIB
ITED TR
AITS
INH
IBITED
/ NEU
RO
TIC TR
AITS
Conrod and Nikolaou, Journal of Child Psychology and Psychiatry, 2016
Stimulant -
-------
Drug/ Alcohol Misuse
------- Sedative
SUBSTANCE USE
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Personality-Targeted Interventions Conrod et al., Psych Addictive Beh, 2000
Conrod et al., JCCAP, 2006
• Structure – Two 90-minute group sessions – School-based – Selective (students with personality elevations, 45%) – Personality-specific groups
• Content – Psycho-educational Component – Motivational Component
• Motivational interviewing techniques • Goal setting exercises (for prevention trials; Conrod et al., 2010)
– Cognitive-Behavioral Component • Personality-specific cognitive distortions
Anxiety sensitivity: decatastrophizing & exposure (Barlow & Craske, 1988)
Hopeless: negative thought challenging (Beck & Young, 1985)
Impulsive: Response inhibition “stop”, “focus”, “choose” (Kendall & Braswell, 1985) Negative attribution biases
Sensation seeking: thought challenging for boredom & need for stimulation Reward sensitivity
Dr. Patricia Conrod
Professor, Department of Psychiatry, University of Montréal
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Selecting Students?
• Identifies students with a particular personality profile using…
• SURPS (Substance Use Risk Profile Survey)
– 23 item survey
• Students who score in the top 16% on a trait (>1 SD)
• Represents their dominant way of responding to the world
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Personality-Targeted Interventions: The Evidence
• Phase I: Proof of concept (Conrod et al., 2006)
• Phase II: Efficacy (Preventure)
• Phase III: Effectiveness (Adventure)
• Phase IV: Process, secondary outcomes, pathways, delivery models (Coventure)
• Phase V: Special populations, contexts, generalisability, optimisation (Interventure)
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Validated Prevention Program through 8 Randomised Trials
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45% of students score >1 SD
95% of students assent to survey
85% of students sign up for program
82% follow-up
Preventure Trial London, UK
Conrod, P.J., Castellanos-
Ryan, N. & Strang, J.
(2010). Archives Gen
Psychiatry.
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Preventure Trial:
Survival as a non-cannabis user
β = -0.3 (Robust SE = 0.2), p=0.09; OR = 0.7, CI = 0.5-1.0
Conrod, P.J., Castellanos-Ryan, N. & Strang, J. (2010). Archives Gen Psychiatry.
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Preventure Trial:
Survival as a non-cocaine user
Β= -1.4; robust SE=0.4, p<.001; OR=0.2; 95% CI= 0.1 -0.5
Conrod, P.J., Castellanos-Ryan, N. & Strang, J. (2010). Archives Gen Psychiatry.
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1268 (54.6%) Low personality risk
1025 (52.4%) Low personality risk
Followed 6, 12, 18 & 24 months
Followed 6, 12, 18 & 24 months
Adventure Trial Conrod et al., 2013, JAMA-Psychiatry.
45% students invited
95% of students assent to survey and intervention
92% of parents passively consent
to their child’s participation
82% follow-up
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PreVenture Training for High-School Teachers
and Counselors
• 2-3 Day Workshop – Theoretical background and screening using SURPS
– Basic principles and practices in counseling and psychological intervention (CBT and MI)
– Tailoring interventions for personality-specific profiles, role play.
• 3 hours of supervised practice running groups – Evaluation and feedback on Preventure Fidelity Scale
• Manualised Intervention: – therapist manual (step-by-step)
– each student receives a personality-specific workbook.
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1268 (54.6%)
Low Risk/
Risque réduit
1025 (52.4%)
Low risk/
Risque réduit
Followed /suivi
6, 12, 18 & 24 mo
Followed /suivi
6, 12, 18 & 24 mo
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Australian CAP Trial (Teesson, et al., Psychological Medicine, 2017)
PreVenture (45%) vs. Climate Universal (100%) vs. CAP (100% + 45%) vs. Control (0%) Table 2. Two-part latent growth model parameters and standard errors examining the effects of universal, targeted and combined intervention programs on the likelihood and frequency of any drinking, the likelihood
and frequency of binge drinking, and likelihood and extent of alcohol-related harm.
Part 1: Dichotomous portion of the model
Intercept Slope
b (SE) p-value b (SE) p-value
Any drinkinga.
Climate vs Control 0.23 (0.18) 0.209 -0.38 (0.089) 0.000
Preventure vs Control 0.56 (0.14) 0.000 -0.36 (0.10) 0.000 CAP vs Control 0.24 (0.17) 0.148 -0.19 (0.08) 0.025 CAP vs Climate 0.02 (0.17) 0.928 0.19 (0.08) 0.021
Binge Drinkingb.
Climate vs Control 0.42 (0.29) 0.152 -0.51 (0.17) 0.002
Preventure vs Control 0.70 (0.24) 0.004 -0.41 (0.17) 0.014 CAP vs Control 0.33 (0.25) 0.180 -0.36 (0.10) 0.001
CAP vs Climate -0.08 (0.22) 0.709 0.15 (0.16) 0.349
Alcohol-related harmc
Climate vs Control 0.63 (0.20) 0.002 -0.23 (0.14) 0.087 Preventure vs Control 0.94 (0.18) 0.000 -0.38 (0.13) 0.005
CAP vs Control 0.53 (0.23) 0.019 -0.19 (0.13) 0.154 CAP vs Climate -0.10 (0.20) 0.618 0.04 (0.10) 0.687
Baseline differences
Post intervention differences in growth
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Does Preventure Work for Students with Pre-Existing Diagnoses?
Two-year Preventure outcomes by baseline level of ADHD or Conduct Problems
ADHD
Conduct Problems
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How do students react to the program?
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One thing I liked about the sessions
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One thing I didn’t like about the sessions
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Most important thing I learned
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Why do so many students want to take part in the program?
• Youth and Community Engagement
• Culturally and Developmentally Validated
• Positive Psychology
• Resilience-Building
• Skills-Focused
• Personalized
• Brief
• https://youtu.be/u3EO6f305Zw
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What is PreVenture? Brief, coping skills interventions targeting personality risk factors
for adolescent substance misuse
2-90 Minute “workshops” CBT &
Motivational Interviewing Skills
Understand how their personality style leads to
certain emotional and behavioural reactions
Students grouped according to
4 personal profiles
PreVenture
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Conclusions • Interventions targeting specific personality and cognitive
risk factors appear effective in reducing and delaying onset of substance use while concurrently reducing externalising and internalising problems.
• Effects appear to be in the moderate range and have been shown to last up to 3 years.
• Intervention shown to be effective when delivered as a prevention strategy, early intervention strategy or brief intervention for substance misuse.
• Group and individual formats have been shown to be effective
• Face-to-face and distance delivered formats are feasible • Both mental health professionals and educational
professions can be trained to deliver the intervention with proven effectiveness.
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Thank you!
Canadian Institutes of Health Research (CIHR) FRSQ chercheur Boursier-Senior European Commisssion FP6-Health and FP7-Social Sciences and Humanities Mental Health Medical Research Council of Australia ABMRF Action on Addiction Fondation Ste-Justine National Insitutes of Health (NIH) European Medical Research Board (ERAB) Medical Research Council-UK Hanie Edalati [email protected] Patricia Conrod [email protected] [email protected] www.conrodventurelab.com/servicespveng
https://www.nytimes.com/2016/10/04/well/family/the-4-traits-that-put-kids-at-risk-for-addiction.html