Teacher-Led Intervention Curbs High Schoolers' Alcohol Use

Caroline Cassels

January 23, 2013

A brief, targeted, school-based alcohol prevention program delivered by secondary school teachers successfully reduced drinking behaviors among high-risk youth, new research shows.

A randomized controlled trial conducted by investigators at the Universite de Montreal, Centre Hospitalier et Universitaire Ste Justine, in Canada, showed that a personality-targeted intervention significantly reduced the odds of drinking, binge drinking, growth in binge drinking, and problem drinking at 24 months, compared with control participants.

"This study found that it is feasible to train teachers to administer selective brief interventions, with fewer intervention schools reporting problems or opting to drop out of the trial protocol than control schools," the investigators, led by Patricia J. Conrad, PhD, write.

"The demonstration that this brief prevention program produced significant effects on the entire year group (29% reduction in drinking rates for all students) allows for comparisons with other evidence-based universal programs," the investigators add.

The study was published online January 23 in JAMA Psychiatry.

Simpler Solution?

According to the authors, community-based interventions aimed at reducing underage drinking have been effective. However, they involve "multilevel commitment and have proven difficult to implement in many contexts."

They also point out that universal education programs aimed at increasing knowledge about the harms of underage drinking among children and their parents have had a limited impact, "with mild and inconsistent effects on drinking outcomes and difficulty with implementation."

In light of the limitations of previous interventions, there is a new research focus on "personality-targeted" approaches to reduce underage drinking.

The Teacher-Delivered Personality-Targeted Interventions for Substance Misuse Trial, also known as the Adventure trial, used the personality-targeted approach, which involved providing brief, personality-specific coping skills interventions to youth with personality risk factors for alcohol misuse before the natural onset of drinking behavior. These risk factors included anxiety sensitivity, hopelessness, impulsivity, and sensation seeking.

Herd Effect

Previous research by this team of researchers to validate the intervention showed that when it was delivered by trained school staff in "real-world" conditions, it improved drinking outcomes at 6 months.

The primary outcome of the current study involved examining 24-month outcomes on teen drinking behavior; participants were in grade 9 at the start of the study.

A secondary outcome examined a potential "herd effect" to determine whether the impact of the intervention on high-risk teens who participated in the trial would have an indirect impact on the drinking behaviors of their non-high-risk peers who did not receive the intervention.

The study sample included 21 secondary schools in London, United Kingdom. Schools were randomly assigned to the intervention or to the control group. In schools receiving the intervention, 4 staff members per school were trained to deliver the intervention in 2- to 3-day training workshops. Participants included teachers, mentors, counselors, and educational specialists.

Student eligibility for the intervention was determined by identifying high-risk youth who in a baseline survey scored 1 standard deviation above the school mean on 1 of 4 subscales of the Substance Use Risk Profile Scale (SURPS). These included anxiety sensitivity, hopelessness, impulsivity, and sensation seeking. A total of 45% of the intervention sample met at least 1 of these inclusion criteria.

All high-risk (n = 1210) and low-risk (n = 1433) grade 9 students in the intervention schools were invited to participate in follow-up assessments at 6, 12, 18, and 24 months after the intervention.

Drinking status and behaviors, including binge drinking, were determined by asking students about the frequency and quantity of alcohol consumption in the past 6 months. Severity of alcohol problems was assessed using an abbreviated version of the Rutgers Alcohol Problem Index.

Across-the-Board Impact

The results revealed that the intervention had a positive impact on all drinking outcomes among high-risk students for the duration of the 24-month follow-up period.

The authors report that compared with their counterparts in control schools, high-risk youth in intervention schools reported 29% reduced odds of drinking, 43% reduced odds of binge drinking, and 29% reduced odds of problem drinking.

The investigators also found that the intervention delayed the progression to more risky drinking behaviors, including binge drinking, greater quantity of drinking, and severity of problem drinking in these students.

"The current findings not only provide replication of the efficacy of this intervention program for HR [high-risk] youth but also contribute to the evidence in support of its long-term effectiveness when administered by appropriately trained school staff," they write.

With an overall 29% reduction in drinking rates for all students, the authors note that the secondary outcomes of the trial provide evidence of an indirect herd effect, with this intervention a finding they describe as "particularly noteworthy."

Although the mechanism underlying the herd effect is unclear, the researchers note that it is possible that high-risk youth who received the intervention may have modeled improved drinking behaviors to their low-risk peers who already had a less risky drinking profile.

They note that the study demonstrated that it is possible to train teachers to administer such brief interventions.

"Considering the enormous costs of alcohol misuse to society and the brief and inexpensive nature of this targeted program, nationwide implementation could potentially translate to substantial savings to the public," the researchers write.

The investigators have disclosed no relevant financial relationships.

JAMA Psychiatry. Published online January 23, 2013. Abstract