CHICAGO – An intervention that allows at-risk adolescents to explore the strengths and weaknesses of their individual personalities can delay the onset of risky drinking for at least 6 months, possibly decreasing the growth of alcohol use later in the teen years.
Patricia Conrod, Ph.D., developed different programs for each of four personality types who manifest a high risk of early-onset drinking and substance abuse: sensation-seeking, negative thinking, anxiety-sensitivity, and impulsivity. The manualized program, delivered in school and consisting of two 90-minute sessions, was so effective that it prevented early-onset drinking in 50% of the sensation-seeking group and in one of every four of those who participated overall, Dr. Conrod said at the annual meeting of the Research Society for Alcoholism.
“I believe that because each intervention targeted a dominant personality trait for each adolescent, the students experienced the interventions as meaningful and relevant,” Dr. Conrod said in an interview. “They told us that this is the first time that they have ever spoken about their emotions and are considering for the first time the notion that they have personal control over their emotional reactions and behavior.”
Furthermore, she said, the young people found it helpful to learn that others were struggling with similar issues.
Dr. Conrod, a clinical lecturer at the Institute of Psychiatry, King's College London, first developed the program in Canada, where it proved similarly successful in a study of 300 high school students with a mean age of 16 years (J. Clin. Child Adolesc. Psychol. 2006;35:550–63). The current study examined the program's effect in younger students (mean age 14 years).
More than 2,600 students in 13 London high schools completed the Substance Use Risk Profile Scale, which assesses the four dimensions of personality that are linked to different motivations for drug use and misuse. Those who scored more than one standard deviation above the school mean on one of the personality risk subscales were randomized to either the intervention group corresponding with their personality type, or to no intervention except standard drug education.
The final study group comprised 348 students. The intervention groups received the two 90-minute in-school sessions. The manuals contained real-life experiences shared by other high-risk youth of that personality. The first session included goal-setting exercises to explore personality and ways of coping with it; psychoeducational strategies teaching students about their personality and associated problematic coping behaviors; and cognitive-behavioral exercises.
The second session involved discussion of personality-specific cognitive distortions that resulted in problematic behavior. The negative thinking group focused on challenging negative thoughts; the anxiety-sensitivity group explored catastrophic thoughts; the impulsivity group focused on aggressive thinking and acting without thought; and the sensation-seekers examined reward seeking and boredom susceptibility.
The control group received the standard drug education sessions contained in the national curriculum.
All students reported their alcohol use at baseline and at 6 and 12 months. All of the control groups except for the impulsivity group demonstrated an increase in drinking between 6 and 12 months. The sensation-seeking control group demonstrated a sharp increase in drinking by 6 months, which then leveled off. Most notable was the marked increase in binge drinking among sensation-seeking youth who had already started to drink at baseline, with a 50% increase in binge drinking by 6 months in this group.
These measures of alcohol use indicate the natural history of drinking behavior in high-risk groups, Dr. Conrod said. “Youth with these personality risk factors show a rapid escalation in drinking behavior between the ages of 14 and 15, such that by age 15, the majority of high-risk youth are misusing alcohol and binge drinking.”
Students in the intervention group showed a different pattern of alcohol use. By 12 months, they showed no significant changes in their drinking status. There was no significant increase in binge drinking among the intervention groups from baseline to 6 months, although there was a significant increase (8%) from 6 to 12 months, which suggested that the 10% increase in the control group was maintained, while the intervention group experienced a 6-month delay in the onset of bingeing.
When the intervention groups were examined separately, the effect on the sensation-seekers was most pronounced, with a number needed to treat of only two. The program had a significant effect on the negative thinkers at 6 months, but not 12. There were no significant changes at either time for the impulsivity group or the anxiety sensitivity group–perhaps because these groups do not begin their drinking careers quite as early as the other two groups, Dr. Conrod said, “as the previous study with older high-risk adolescents did show improvements in these groups.”