A program that takes personality into account may help to identify and reduce teen-drinking rates.
Researchers studied 2,643 ninth-graders in England, ages 13 or 14 years old, for a project known as the Adventure trial. Teachers were trained to provide alcohol-abuse interventions to children with four personality traits that put them at high risk of problem drinking and drug use: being sensitive to anxiety, feeling hopeless, being impulsive and seeking thrills. Each of the 21 schools the students attended was randomly assigned to either provide an Adventure intervention, which was specifically targeted at children with these profiles, or the standard drug-education programs that relied on a national addiction-prevention curriculum. The students were asked about their drinking habits — such as binge drinking and how often they drank — every six months for two years.
By the end of the study, all of the students who attended the schools using the targeted interventions showed a 29% lower rate of drinking compared with the children in schools relying on the traditional drug-education programs. The high-risk teens also had a 43% lower rate of binge drinking than similarly at-risk adolescents at the control schools. Having symptoms of an actual drinking problem — like difficulties in school or dangerous behavior — was reduced by 42% among high-risk students receiving targeted interventions and by 24% among the low-risk group who attended the targeted school, compared with those receiving the traditional drug-prevention programs.
That’s a significant reduction in drinking, say the authors. In contrast, typical prevention programs like D.A.R.E. (Drug Abuse Resistance Education) either don’t reduce drinking at all or only cut binging by around 10%, according to a recent Cochrane review. What’s more, these programs generally fail to address the cause of teen drinking, which means they often can’t provoke long-term changes in drinking behavior.
“A mental-health approach to alcohol and drug prevention looks like it’s much more effective and promising than simple drug education or alcohol education,” says Patricia Conrod, who is affiliated with both King’s College London and the University of Montreal, in Canada, and lead author of the study, published in JAMA Psychiatry.
The targeted approach used in the Adventure trial takes into account that the four personality traits that put children at high risk of problem drinking can lead kids to try alcohol for different reasons. The anxious and the hopeless are trying to self-medicate specific sources of distress, while those with poor impulse control may “just say yes” without much thought when drinking opportunities arise. Those seeking thrills may actively look for alcohol and other drugs that can provide them with an intense experience.
Teachers were trained to provide two 90-minute sessions that were tailored to address each profile. Rather than addressing alcohol or drug abuse directly, the teachers spoke more about the students’ reactions to life experiences and incorporated cognitive-behavioral principles of regulating behavior, for example, to help the anxious students to cope with stressful situations and to guide the impulsive students to think through their options before indulging in their first reaction.
The research was also guided by the fact that each trait is also linked with higher risk of specific psychiatric disorders, which themselves increase the risk and severity of addiction and alcoholism. Hopelessness raises risk for depression, while sensitivity to anxiety elevates the odds of anxiety disorders. Impulsivity and sensation seeking are both associated with conduct disorders and attention-deficit/hyperactivity disorder, or ADHD. Around 80% to 90% of those most likely to use drugs can be identified by using a 23-item scale measuring these traits.
But while the results among the high-risk students were encouraging, the study also hinted that the targeted interventions might have broader benefits for even those without the more-vulnerable personality profiles. Even among low-risk students, for example, binge-drinking rates were 35% lower among those attending schools where the targeted interventions were in place, compared with those in schools using the traditional drug-education counseling. The researchers attribute the decline to the herd effect, in which teens tend to model behaviors they see around them, and if high-risk students are drinking less, then their lower-risk friends, who tend to pick up drinking slightly later, will follow suit.
The findings support the idea that alcohol-prevention programs are most effective if they address why people, especially teens, start to drink in the first place. Children who turn to alcohol at young ages tend to be troubled, with chaotic homes, or they may be wired to constantly need stimulation and the novelty of new experiences. If they discover early — before they’ve had any time to learn alternative ways of coping — that drinking or relying on other drugs is the best strategy to deal with their experiences, they are more likely to become addicted.
“If you’re walking into a room feeling like everyone hates you and if you drink whenever you feel that way, you never learn to check out your [potentially biased] assumptions and just numb the thought,” Conrod says. By teaching teens to recognize how their own thoughts shape their reality — and to reframe those thoughts in more productive ways — the program may pre-empt the desperate need for escape that drives addiction from developing in the first place.
Researchers are now studying whether the intervention also reduces rates of mental illness and other types of addiction: if depressive, anxious and impulsive thoughts can be exposed and defused before they take root, the program may not only reduce rates of drinking problems but also drug problems, depression, anxiety and conduct disorder.