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The PreVenture Programme: Personality-Targeted Interventions for Adolescent Substance Misuse

The PreVenture Programme: Personality-Targeted Interventions for Adolescent Substance Misuse is a school-based program designed to prevent alcohol and drug misuse among 13- to 15-year-old students. Tailored interventions are provided based on screening results for four personality dimensions that have been linked to increased risk for maladaptive alcohol and drug use: anxiety-sensitivity, hopelessness, impulsivity, and sensation seeking. Students who score one standard deviation above the school mean on any of these dimensions are invited to participate in two 90-minute group workshops focusing on developing adaptive coping skills for their personality profile.

Workshop sessions are manualized and guided by a trained facilitator and co-facilitator. The sessions incorporate psychoeducational approaches, motivational enhancement therapy, and cognitive-behavioral components. To make the program more relevant and appealing to participants, the manuals feature illustrative scenarios drawn from the real-life experiences of teens with the personality risk factors targeted by the intervention. Exercises include discussion of thoughts, emotions, and behaviors in a framework specific to each personality dimension.

Implementers are required to participate in a 3-day workshop followed by 3 hours of practical supervision, with ongoing consultation if required. Facilitators should be master's-level therapists or educational professionals who have completed the PreVenture training program. Cofacilitators can be bachelor's-level research assistants or undergraduate students with training in psychology.

Descriptive Information

Areas of Interest Substance abuse prevention
Outcomes Review Date: November 2011
1: Alcohol use
2: Quantity and frequency of alcohol use
3: Binge drinking
4: Alcohol-related problems
5: Drug use
Outcome Categories Alcohol
Drugs
Ages 13-17 (Adolescent)
Genders Male
Female
Races/Ethnicities Non-U.S. population
Settings School
Geographic Locations Urban
Suburban
Rural and/or frontier
Implementation History PreVenture was first implemented in 2001 in high schools in Nova Scotia and Vancouver, Canada. Approximately 2,260 high-risk youth from ethnically diverse communities in Canada and the United Kingdom have participated in the intervention through randomized clinical trials. The PreVenture training team has trained more than 100 implementers from Canada, the Czech Republic, the Netherlands, and the United Kingdom, who continue to deliver the intervention in their schools and youth support service agencies.
NIH Funding/CER Studies Partially/fully funded by National Institutes of Health: No
Evaluated in comparative effectiveness research studies: No
Adaptations PreVenture has been adapted for youth in the Netherlands and the Czech Republic and is currently being adapted for Australian, French Canadian, and Mexican populations. Mi'kmaq First Nations communities in Nova Scotia, Canada, collaborated with the developer to create a culturally grounded adaptation in 2003-2004, and First Nations and Inuit communities in three Canadian provinces participated in a feasibility study in 2005-2010 that included the production of culturally diverse program manuals.
Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories Selective

Quality of Research
Review Date: November 2011

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

Conrod, P. J., Stewart, S. H., Comeau, N., & Maclean, A. M. (2006).Efficacy of cognitive-behavioral interventions targeting personality risk factors for youth alcohol misuse. Journal of Clinical Child and Adolescent Psychology, 35(4), 550-563.  Pub Med icon

Study 2

Conrod, P. J., Castellanos-Ryan, N., & Mackie, C. (2011). Long-term effects of personality-targeted interventions to reduce alcohol use in adolescents. Journal of Consulting and Clinical Psychology, 79(3), 296-306.  Pub Med icon

Conrod, P. J., Castellanos-Ryan, N., & Strang, J. (2010). Brief, personality-targeted coping skills interventions and survival as a non-drug user over a 2-year period during adolescence. Archives of General Psychiatry, 67(1), 85-93.  Pub Med icon

Study 3

O'Leary-Barrett, M., Mackie, C. J., Castellanos-Ryan, N., Al-Khudhairy, N., & Conrod, P. J. (2010). Personality-targeted interventions delay uptake of drinking and decrease risk of alcohol-related problems when delivered by teachers. Journal of the American Academy of Child and Adolescent Psychiatry, 49(9), 954-963.  Pub Med icon

Supplementary Materials

Castellanos-Ryan, N., O'Leary-Barrett, M., Lassiter, A. M., Sully, L., & Conrod, P. (2012). Psychometric properties and diagnostic value of the Substance Use Risk Profile Scale. Manuscript submitted for publication.

Woicik, P. A., Stewart, S. H., Pihl, R. O., & Conrod, P. J. (2009). The Substance Use Risk Profile Scale: A scale measuring traits linked to reinforcement-specific substance use profiles. Addictive Behaviors, 34(12), 1042-1055.  Pub Med icon

Outcomes

Outcome 1: Alcohol use
Description of Measures Alcohol use was determined by asking students whether they consumed any alcohol in the past 6 months. The item was included in assessments administered at baseline and 6 months postintervention.
Key Findings In a study in Canada, high school students who were self-reported drinkers were screened for four personality risk factors: sensation seeking, impulsivity, anxiety-sensitivity, and hopelessness. Students who scored above the mean for any factor were randomly assigned to intervention and no-treatment control conditions. Students in the intervention group were invited to participate in PreVenture group sessions matched to their personality risk profile. Subsample analyses showed that intervention group students in the anxiety-sensitivity (AS) category were significantly more likely to be abstinent at 4-month follow-up than AS students in the control group (p < .05). Significant findings for alcohol use were not found for the other subgroups or for the intervention group as a whole.

In a study in England, secondary students in schools that had been randomly assigned to intervention and control conditions were screened for four personality risk factors: sensation seeking, impulsivity, anxiety-sensitivity, and hopelessness. The intervention group consisted of students in the intervention schools who scored above the mean in any of these areas and agreed to participate in PreVenture group sessions matched to their personality risk profile. Students in control schools who scored above the mean in personality risk served as the no-treatment control group. At 6-month follow-up, intervention students reported significantly less alcohol use than control students, even after controlling for covariates (p < .01).
Studies Measuring Outcome Study 1, Study 3
Study Designs Experimental
Quality of Research Rating 2.8 (0.0-4.0 scale)
Outcome 2: Quantity and frequency of alcohol use
Description of Measures Quantity and frequency of alcohol use were measured by asking students to report how many standard alcoholic beverages they typically consumed per day or per drinking occasion (e.g., "1 or 2" to "10 or more") and how often they drank alcohol (e.g., "less than monthly" to "daily or almost daily") during the past 4 or 6 months, depending on the study. These items were administered only to students who reported they consumed alcohol during the reporting period. In one study, assessments were administered at baseline and 4 months postintervention. In a second study, assessments were administered at baseline and 6, 12, 18, and 24 months postintervention. In a third study, assessments were administered at baseline and 6 months postintervention, and a composite score was generated by combining responses to the individual quantity and frequency measures.
Key Findings In a study in Canada, high school students who were self-reported drinkers were screened for four personality risk factors: sensation seeking, impulsivity, anxiety-sensitivity, and hopelessness. Students who scored above the mean for any factor were randomly assigned to intervention and no-treatment control conditions. Students in the intervention group were invited to participate in PreVenture group sessions matched to their personality risk profile. At 4-month follow-up, intervention students reported consuming an average of 3 or 4 drinks per drinking occasion, compared with an average of 5 or 6 drinks reported among control students (p < .05). Drinking frequency did not differ significantly between the intervention and control groups.

In a study in England, secondary students who scored above the school mean in sensation seeking, impulsivity, anxiety-sensitivity, and hopelessness were randomly assigned to intervention and no-treatment control conditions. The intervention consisted of PreVenture group sessions matched to the student's personality risk profile. In an analysis that included data from all five assessment points, intervention students had lower quantity/frequency of use scores overall compared with control students (p = .02). However, analyses of data from individual assessments showed significant differences in drinking quantity/frequency only at the first of the four follow-ups (p < .05), in part because drinking among control students stabilized after increasing rapidly over the first 6 months.

In another study in England, secondary students in schools that had been randomly assigned to intervention and control conditions were screened for four personality risk factors: sensation seeking, impulsivity, anxiety-sensitivity, and hopelessness. The intervention group consisted of students in the intervention schools who scored above the mean in any of these areas and agreed to participate in PreVenture group sessions matched to their personality risk profile. Students in control schools who scored above the mean in personality risk served as the no-treatment control group. At 6-month follow-up, intervention students had significantly lower quantity/frequency of use scores than control students, even after controlling for covariates (p < .05).
Studies Measuring Outcome Study 1, Study 2, Study 3
Study Designs Experimental
Quality of Research Rating 2.7 (0.0-4.0 scale)
Outcome 3: Binge drinking
Description of Measures Binge drinking was measured using a single question that asked students if they had consumed five or more alcoholic beverages (four or more for girls) on a single occasion in the past 4 or 6 months, depending on the study. The measure was administered at baseline and 4 months postintervention in one study, and at baseline and 6 months postintervention in another study.
Key Findings In a study in Canada, high school students who were self-reported drinkers were screened for four personality risk factors: sensation seeking, impulsivity, anxiety-sensitivity, and hopelessness. Students who scored above the mean for any factor were randomly assigned to intervention and no-treatment control conditions. Students in the intervention group were invited to participate in PreVenture group sessions matched to their personality risk profile. At 4-month follow-up, 42% of intervention students reported binge drinking, compared with 60% of control students (p < .01).

In a study in England, secondary students in schools that had been randomly assigned to intervention and control conditions were screened for four personality risk factors: sensation seeking, impulsivity, anxiety-sensitivity, and hopelessness. The intervention group consisted of students in the intervention schools who scored above the mean in any of these areas and agreed to participate in PreVenture group sessions matched to their personality risk profile. Students in control schools who scored above the mean in personality risk served as the no-treatment control group. At 6-month follow-up, among those who reported past drinking at baseline, intervention students were significantly less likely than controls to report binge drinking, even after controlling for covariates (OR = 0.45, 95% CI = 0.3-0.8; p < .001).
Studies Measuring Outcome Study 1, Study 3
Study Designs Experimental
Quality of Research Rating 2.8 (0.0-4.0 scale)
Outcome 4: Alcohol-related problems
Description of Measures Alcohol-related problems were measured using the Rutgers Alcohol Problems Index (RAPI) and abbreviated versions of the RAPI. The RAPI is a 23-item self-report measure that assesses behavioral symptoms of adolescent problem drinking (e.g., missed school because of drinking). Respondents indicate on a 5-point scale how many times they have experienced various negative consequences from their alcohol use. In one study, the full instrument was administered at baseline and 4 months postintervention, and respondents were asked about problems in the past 4 months. In this study, scores were dichotomized to presence or absence of problem drinking.

A second study used a shortened version of the RAPI, comprised of the 7 items most frequently endorsed in an earlier study. The assessments were administered at baseline and 6, 12, 18, and 24 months postintervention, and respondents were asked about problems in the past 6 months. An alcohol problem score was calculated by summing the total number of responses.

A third study used an 8-item version of the RAPI, again consisting of items most frequently endorsed by students in a previous trial. Lower scores indicate fewer drinking problems. An alcohol problems score was calculated by summing responses to the 8 items. Assessments were administered at baseline and 6 months postintervention, and students were asked about problems in the past 6 months.
Key Findings In a study in Canada, high school students who were self-reported drinkers were screened for four personality risk factors: sensation seeking, impulsivity, anxiety-sensitivity, and hopelessness. Students who scored above the mean for any factor were randomly assigned to intervention and no-treatment control conditions. Students in the intervention group were invited to participate in PreVenture group sessions matched to their personality risk profile. At 4-month follow-up, intervention students were significantly more likely than control students to report an absence of drinking-related problems (p < .01).

In a study in England, secondary students who scored above the mean in sensation seeking, impulsivity, anxiety-sensitivity, and hopelessness were randomly assigned to intervention and no-treatment control conditions. The intervention consisted of PreVenture group sessions matched to the student's personality risk profile. In an analysis that included data from all five assessment points, intervention students had lower alcohol problem scores overall than control students (p = .002).

In another study in England, secondary students in schools that had been randomly assigned to intervention and control conditions were screened for four personality risk factors: sensation seeking, impulsivity, anxiety-sensitivity, and hopelessness. The intervention group consisted of students in the intervention schools who scored above the mean in any of these areas and agreed to participate in PreVenture group sessions matched to their personality risk profile. Students in control schools who scored above the mean in personality risk served as the no-treatment control group. At 6-month follow-up, intervention students had significantly lower alcohol problem scores than control students, even after controlling for covariates (p < .01).
Studies Measuring Outcome Study 1, Study 2, Study 3
Study Designs Experimental
Quality of Research Rating 2.8 (0.0-4.0 scale)
Outcome 5: Drug use
Description of Measures Drug use was assessed using the Reckless Behavior Questionnaire 25 (RBQ 25), a 10-item measure that asks respondents to report how often they have engaged in various risky behaviors in the past 6 months. Three items assess the frequency of marijuana, cocaine, and other drug use, on a scale from "never" to ">10 times." For the study, responses to the three drug-related items were combined to create a drug use frequency score, dichotomized into yes or no variables, and then added to create a variable of the number of drugs used. Follow-up assessments were conducted in school at 6, 12, 18, and 24 months postintervention.
Key Findings In a study in England, secondary students who scored above the mean in sensation seeking, impulsivity, anxiety-sensitivity, and hopelessness were randomly assigned to intervention and no-treatment control conditions. The intervention consisted of PreVenture group sessions matched to the student's personality risk profile. In an analysis that included data from all five assessment points, intervention students reported less drug use overall than control students, both in frequency of use (p < .05) and the number of drugs used (p < .01).
Studies Measuring Outcome Study 2
Study Designs Experimental
Quality of Research Rating 2.4 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study Age Gender Race/Ethnicity
Study 1 13-17 (Adolescent) 55.9% Female
44.1% Male
100% Non-U.S. population
Study 2 13-17 (Adolescent) 64.3% Female
35.7% Male
100% Non-U.S. population
Study 3 13-17 (Adolescent) 55% Male
45% Female
100% Non-U.S. population

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

  1. Reliability of measures
  2. Validity of measures
  3. Intervention fidelity
  4. Missing data and attrition
  5. Potential confounding variables
  6. Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome Reliability
of Measures
Validity
of Measures
Fidelity Missing
Data/Attrition
Confounding
Variables
Data
Analysis
Overall
Rating
1: Alcohol use 2.0 3.0 3.0 3.0 2.5 3.0 2.8
2: Quantity and frequency of alcohol use 2.0 2.5 2.3 3.2 2.9 3.2 2.7
3: Binge drinking 2.0 2.5 3.0 3.0 2.8 3.3 2.8
4: Alcohol-related problems 2.0 3.3 2.3 3.2 2.9 3.2 2.8
5: Drug use 1.5 2.0 1.0 3.5 3.0 3.5 2.4

Study Strengths

All three studies were randomized controlled trials that used an intent-to-treat approach and had large, representative samples. Efforts were made to ensure that intervention participants received all program sections and components. Overall attrition was low, and any impact of attrition was greatly mitigated by the number of data points following program completion, very careful analyses of the threats posed by attrition, and conservative data imputation methods. The analytical approach was strong, and multiple strategies were employed that yielded convergent findings.

Study Weaknesses

Limited information was available concerning the psychometric properties of measures, and no psychometrics were provided for the abbreviated versions of the RAPI. While careful training of group leaders and facilitators was documented, there is no clear indication whether or how intervention fidelity was measured. Although the analyses controlled for demographics, gender and ethnicity were not examined separately, which is important given that the intervention targets students based on specific behavioral criteria and therefore may not work equally well for all youth. None of the studies used an attention-control condition or included another intervention as a comparison, making it difficult to determine if the outcomes resulted from the intervention or from increased personal attention to higher-risk children.

Readiness for Dissemination
Review Date: November 2011

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Al-Khudhairy, N., & Conrad, P. (2007). Adventure facilitation criteria scale (AFCS).

Beck, A. T., & Young, J. E. (1980). Cognitive therapy scale.

Castellanos-Ryan, N., & Conrod, P. (n.d.). Personality and addiction processes. In P. Miller (Ed.), Encyclopedia of addictive behaviors. Oxford: Elsevier.

Conrod, P. (n.d.). Preventing alcohol and drug misuse among high risk adolescents [PowerPoint slides].

King's College London, Section of Addiction Research, Division of Psychological Medicine. (2007). Student survey. England: Author.

PreVenture student manuals:

  • Conrod, P. J., Comeau, M. N., Stewart, S. H., & Javin Creative. (2004). PreVenture: Learning to deal with anxiety sensitivity. Halifax, Nova Scotia, Canada: 6148042 Canada.
  • Conrod, P. J., Comeau, M. N., Stewart, S. H., & Javin Creative. (2004). PreVenture: Learning to deal with impulsivity. Halifax, Nova Scotia, Canada: 6148042 Canada.
  • Conrod, P. J., Comeau, M. N., Stewart, S. H., & Javin Creative. (2004). PreVenture: Learning to deal with negative thinking. Halifax, Nova Scotia, Canada: 6148042 Canada.
  • Conrod, P. J., Comeau, M. N., Stewart, S. H., & Javin Creative. (2004). PreVenture: Learning to deal with sensation seeking. Halifax, Nova Scotia, Canada: 6148042 Canada.

PreVenture therapist manuals:

  • Conrod, P. J., Comeau, M. N., Stewart, S. H., & Javin Creative. (2004). PreVenture: Learning to deal with anxiety sensitivity. Halifax, Nova Scotia, Canada: 6148042 Canada.
  • Conrod, P. J., Comeau, M. N., Stewart, S. H., & Javin Creative. (2004). PreVenture: Learning to deal with impulsivity. Halifax, Nova Scotia, Canada: 6148042 Canada.
  • Conrod, P. J., Comeau, M. N., Stewart, S. H., & Javin Creative. (2004). PreVenture: Learning to deal with negative thinking. Halifax, Nova Scotia, Canada: 6148042 Canada.
  • Conrod, P. J., Comeau, M. N., Stewart, S. H., & Javin Creative. (2004). PreVenture: Learning to deal with sensation seeking. Halifax, Nova Scotia, Canada: 6148042 Canada.

Promotional and training DVDs

Q15 Core Counseling Components [handout]

Student Feedback Form

Substance Use Risk Profile Scale [Excel file]

Surveying and Participant Selection [handout]

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

  1. Availability of implementation materials
  2. Availability of training and support resources
  3. Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation
Materials
Training and Support
Resources
Quality Assurance
Procedures
Overall
Rating
2.8 2.8 2.8 2.8

Dissemination Strengths

The therapist manuals are well written and clearly organized. They contain appropriate information on the qualifications and roles of facilitators, as well as basic guidance for how to set up and facilitate sessions. The corresponding student manuals are easy to follow and use graphics to demonstrate the key concepts and examples. New implementers are required to complete a training provided by the developer's training team before starting program implementation. Trainees must demonstrate proficiency through practice sessions supervised by the trainer. The developer also provides supervisory support after training, either on site or through review of recorded sessions. A detailed observation rating protocol is available to assess how well facilitators adhere to the practice expectations of each of the four personality-specific components. The developer also provides an instrument that can be used to survey students for outcomes after their participation in the program.

Dissemination Weaknesses

The therapist manuals contain little guidance specific to the management of group dynamics and on how to integrate the intervention in the intended school settings. The training materials provided for review, including instructions for the administration and interpretation of evaluation instruments, were limited. It is unclear how new implementers should administer the evaluation tools or use the findings obtained using those tools. The process and timeline for scheduling training is unclear. No explicit guidance is provided on how new implementers should administer evaluation tools or on how to use the findings to improve implementation.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description Cost Required by Developer
Student manuals $10-$35 each, depending on the number ordered Yes
Therapist manuals Included with cost of training Yes
Additional therapist manuals $100 each No
2-day, on-site clinical training (includes set of therapist manuals for each participant) $2,000 for 1-5 participants, or $3,000 for 6-10 participants Yes
3-day, on-site expanded training $4,000 for up to 10 participants No
1-day, on-site counseling skills training for implementers without clinical background $750 per site No
4 hours of supervised practice $500 per participant Yes
Ongoing supervision of treatment sessions or program implementation $160 per hour No
Substance Use Risk Profile Scale Free Yes
Fidelity scale Free Yes
Young & Beck's Cognitive Therapy Scale Free Yes
Replications

Selected citations are presented below. An asterisk indicates that the document was reviewed for Quality of Research.

Conrod, P. J., Castellanos, N., & Mackie, C. (2008). Personality-targeted interventions delay the growth of adolescent drinking and binge drinking. Journal of Child Psychology and Psychiatry, 49(2), 181-190.  Pub Med icon

* Conrod, P. J., Castellanos-Ryan, N., & Mackie, C. (2011). Long-term effects of a personality-targeted intervention to reduce alcohol use in adolescents. Journal of Consulting and Clinical Psychology, 79(3), 296-306.  Pub Med icon

Conrod, P. J., O'Leary-Barrett, M., Newton, N., Topper, L., Castellanos-Ryan, N, Mackie, C., & Girard, A. (In press). A cluster randomized trial demonstrates the effectiveness of a selective, personality-targeted prevention program for adolescent alcohol misuse. JAMA Psychiatry.

Conrod, P. J., Stewart, S. H., Pihl, R. O., Cote, S., Fontaine, V., & Dongier, M. (2000). Efficacy of brief coping skills interventions that match different personality profiles of female substance abusers. Psychology of Addictive Behaviors, 14(3), 231-242.  Pub Med icon

Lammers, J., Goossens, F., Lokman, S., Monshouwer, K., Lemmers, L., Conrod, P., et al. (2001). Evaluating a selective prevention programme for binge drinking among young adolescents: Study protocol of a randomized controlled trial. BMC Public Health, 11, 126.  Pub Med icon

Watt, M., Stewart, S., Birch, C., & Bernier, D. (2006). Brief CBT for high anxiety sensitivity decreases drinking problems, relief alcohol outcome expectancies, and conformity drinking motives: Evidence from a randomized controlled trial. Journal of Mental Health, 15(6), 683-695.

Contact Information

To learn more about implementation or research, contact:
Patricia Conrod, Ph.D.
+ 15143454931 ext 4051
patricia.conrod@kcl.ac.uk; patricia.conrod@umontreal.ca

Consider these Questions to Ask (PDF, 54KB) as you explore the possible use of this intervention.