This article was written by Inge Kersbergen. Inge is currently working on her Masters at Radboud University Nijmegen (Netherlands), and she will soon be starting a PhD at the University of Liverpool.
When I was in secondary school, we received a yearly questionnaire (the SchoolVragenLijst) that measured school-related attitudes and mental well-being (e.g., anxiety, problem behaviour). Based on the test scores, a few students (about 15 a year) were invited to a CBT based self-esteem class given by regular teachers, in which they were taught new coping skills and received new tools to handle challenges. This was thought to increase their school performance and their overall well-being.
The reason I’m telling you this, is because a recent study showed that a similar intervention reduced alcohol use and risky drinking behaviour in adolescents. Unlike other prevention programs, this intervention does not target attitudes towards alcohol. In fact, alcohol and drug use are only a minor focus of the intervention. The main focus of the intervention is providing teens with tools and strategies to counteract four different 'risk profiles' that are related to alcohol misuse (impulsivity, sensation seeking, hopelessness, and anxiety sensitivity). Providing them with these tools is thought to reduce their need to drink alcohol to cope, and so we would expect to see reductions in their alcohol consumption and problem drinking behaviour.
The researchers tested this hypothesis in a randomized controlled trial with 2633 students recruited from 21 secondary schools in London, who had an average age of 13.7 years. The Substance Use Risk Profile Scale was used to identify high risk teens in those schools. This questionnaire taps into the four risk profiles mentioned before. High risk teens in the test schools were offered a short intervention specific for their risk profile. In control schools, teens received drug education as usual. The four different interventions were based on Cognitive Behavioural Therapy (CBT) and Motivational Enhancement Therapy (MET) principles and were given in two 90-minute sessions that were led by trained school staff. Interventions specifically targeted personality traits belonging to each of the risk profiles. Each of the interventions provided information on the personality trait in question and its associated risky coping behaviour, such as interpersonal dependence, avoidance, aggression, and substance misuse. The students were encouraged to identify and challenge cognitive distortions that were specific to their personality profile and could lead to specific adverse behaviours (for instance, aggression in the case of impulsivity). Every six months for two years after the intervention, the researchers asked all of the students (including the ones that did not receive the intervention) whether or not they drank alcohol and if so, how much. Additionally, they measured the frequency of binge drinking and the severity of alcohol problems.
Results showed that the intervention was successful in a few different ways. Students in intervention schools were 29% less likely to drink alcohol than students in the control schools, regardless of risk status. Additionally, high risk teens in intervention schools were 43% less likely to engage in binge drinking and 29% less likely to report problem drinking behaviour than the high risk teens in control schools.
This intervention, therefore, seems to be a good way to prevent adolescent alcohol use and misuse. Not only did it have a positive influence on the high risk students’ drinking habits, but it also decreased the odds of drinking for low-risk students who did not receive the intervention, so long as other students in their school did ('herd effects'). Besides alcohol use, one could think of additional benefits. Providing high risk teens with coping tools may not only decrease their alcohol use, it might decrease risky behaviour in general (such as substance use, unprotected sex, etc.). With a little more information on why this intervention works and whether and how it could improve well-being in other domains, it has a strong potential for becoming a part of general education. If my school was able to arrange a yearly self-esteem course of ten sessions, other schools could certainly implement this two-session intervention in their curriculum.
Article of interest: Conrod, P.J., O’Leary-Barrett, M., Newton, N., Topper, L., Castellanos-Ryan, N., Mackie, C., & Girard, A. (2013). Effectiveness of a Selective, Personality-Targeted Prevention Program for Adolescent Alcohol Use and Misuse. A Cluster Randomized Controlled Trial. JAMA Psychiaty, 70(3), 334-342.