Mental health approach to teenage alcohol prevention is successful, finds new study
Gerald Hurowitz, M.D.·Published 24 January 2013·10 min read
Key points
Targeted psychological interventions aimed at teenagers at risk of emotional and behavioural problems significantly reduce their drinking behaviour, and that of their schoolmates, according to the results from a large randomised controlled trial published today in JAMA Psychiatry.
King's College London is one of the top 30 universities in the world (2012/13 QS international world rankings), and was The Sunday Times 'University of the Year 2010/11', and the fourth oldest in England.
Action on Addiction is the only UK charity working across the addiction field in research, prevention, treatment and rehabilitation, professional workforce development, professional education and support for families and children.
The 'Adventure Trial' is led by Dr Patricia Conrod, King's College London's Institute of Psychiatry, in collaboration with the University of Montreal and Sainte-Justine University Hospital Center (Canada) and was commissioned by Action on Addiction.
Targeted psychological interventions aimed at teenagers at risk of emotional and behavioural problems significantly reduce their drinking behaviour, and that of their schoolmates, according to the results from a large randomised controlled trial published today in JAMA Psychiatry. The authors argue that the intervention could be administered in schools throughout the UK to help prevent teenage alcohol abuse.
The 'Adventure Trial' is led by Dr Patricia Conrod, King's College London's Institute of Psychiatry, in collaboration with the University of Montreal and Sainte-Justine University Hospital Center (Canada) and was commissioned by Action on Addiction.
The trial involved 21 schools in London that were randomly allocated to either receive the intervention, or the UK statutory drug and alcohol education curriculum. A total of 2,548 year-10 students (average age 13.8 years) were classed as high or low-risk of developing future alcohol dependency. Those classed as high-risk fit one of four personality risk profiles: anxiety, hopelessness, impulsivity or sensation seeking. All students were monitored for their drinking behaviour over two years. Four members of staff in each intervention school were trained to deliver group workshops targeting the different personality profiles. 11 schools received the intervention where 709 high-risk teenagers were invited to attend two workshops that guided them in learning cognitive-behavioural strategies for coping with their particular personality profiles.
Dr Patricia Conrod, from King's Institute of Psychiatry and lead author of the paper, says: "Through the workshops, the teenagers learn to better manage their personality traits and individual tendencies, helping them to make good decisions for themselves. Depending on their personality profiles, they might learn cognitive-behavioural strategies to better manage high levels of anxiety, to manage their tendency to have pessimistic reactions to certain situations or to control their tendency to react impulsively or aggressively. Our study shows that this mental health approach to alcohol prevention is much more successful in reducing drinking behaviour than giving teenagers general information on the dangers of alcohol."
After two years, high-risk students in intervention schools were at a 29% reduced risk of drinking, 43% reduced risk of binge drinking and 29% reduced risk of problem drinking compared to high-risk students in control schools. The intervention also significantly delayed the natural progression to more risky drinking behaviour (such as frequent binge drinking, greater quantity of drinking, and severity of problem drinking) in the high-risk students over the two years.
Additionally, over the two year period, low-risk teenagers in the intervention schools, who did not receive the intervention, were at a 29% reduced risk of taking up drinking and 35% reduced risk of binge drinking compared to the low-risk group in the non-intervention schools, indicating a possible 'herd effect' in this population.
Written and revised by
Gerald Hurowitz, M.D.
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Teenage drinking is such a health risk that pediatricians are now being told to screen all teenagers—and even sixth graders—for alcohol use. That new policy from the American Academy of Pediatrics can be a powerful tool for parents to help their children avoid trouble with alcohol. But first, parents need to learn to give teenagers some privacy in the doctor's office.
"Tenacious parents who will not leave the examination room" are cited as a major barrier to routine screening for alcohol and drug use by pediatricians in the new teen alcohol screening policy. And what 13-year-old would want to tell Mom she pounded five Vodka Cruisers at a party? "We want to keep families involved," Patricia Kokotailo, director of adolescent medicine at the University of Wisconsin School of Medicine and Public Health told me, "but some things are very difficult for teenagers to express if it's not confidential." She is also lead author of the new guidelines. When Kokotailo sees teenagers in the office, she usually talks with them privately before speaking to the family as a whole, but doesn't reveal anything that children want kept private.
Mounting research showing that the teenage brain is in the midst an amazing developmental phase was a chief driver behind the call for universal screening for alcohol use. That brain growth spurt gives teens remarkable cognitive powers, but also leaves their brains more vulnerable to the damaging effects of alcohol, drugs, and tobacco. Recent research has also shown that the earlier teenagers start drinking, the more likely they are to have problems as adults with school, jobs, and relationships.
Dr Conrod adds: "Not only does the intervention have a significant effect on the teenagers most at risk of developing problematic drinking behaviour, there was also a significant positive effect on those who did not receive the intervention, but who attended schools where interventions were delivered to high-risk students. This 'herd effect' is very important from a public health perspective as it suggests that the benefits of mental health interventions on drinking behaviour also extend to the general population, possibly by reducing the number of drinking occasions young people are exposed to in early adolescence."
Children learn at a very young age the difference between wrong and right and look to you as parents to teach them the proper behaviors they will need to carry with them for the rest of their lives. Early prevention methods should start at home and should involve as many as the following procedures as possible.
Develop a good, healthy relationship with your teen - Allow your teen to communicate openly. Let them know that you are there for them when they need you under any circumstances. Establish curfews and house rules - Sit down with your teen and come up with some curfews and rules together. If they help establish their own guidelines, they will be more inclined to obey by them. Let them know your expectations of them and that you do not allow any alcohol use for any reason. Be consistent and fair with discipline/rules - Don't be too harsh when disciplining your child. Develop rules that are fair and be consistent when applying those rules. Reward and praise your teen for good behavior. Be a good example/role model - Children and teenagers look up to you and model the behaviors you set. Try to set good examples of your own drinking habits and show them how you yourself drink or don't drink responsibly. Know who your teen's friends/peers are - Get to know who your teen is hanging around with. Make sure they are socializing with other teens who are responsible as well. Know where your teen is - Make sure you know where your teen is at all times. Have them call you with their whereabouts so you can keep track of them. Keep your teen involved - Have your teen get involved with any activities they may enjoy. Teens who are involved in sports or other activities tend to have higher self-esteem. They will be more inclined to take care of themselves and keep healthy. Teach them the facts about alcohol - First, eductate yourself about alcohol as much as you can. Provide your teen with the correct information because misinformation can be very dangerous. Teach them the reasons why alcohol is harmful and what it can do to their bodies/health. Let them know the reasons why alcohol is illegal under 21.
If you believe that your teen has already experimented with alcohol, put a stop to it immediately.
Dr Conrod concludes: "This intervention could be widely administered to schools: it is successful from a public health perspective, appreciated by students and staff, and because we train school staff rather than professional psychologists, the intervention remains relatively inexpensive to roll-out."
Approximately 6 out of 10 people aged 11-15 in England report drinking, and in the UK approximately 5,000 teenagers are admitted to hospital every year for alcohol related reasons. Across the developed world, alcohol accounts for approximately 9% of all deaths of people aged 15-29, and so far, universal community or school-based interventions have proven difficult to implement and shown limited success.
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Nick Barton, Chief Executive of Action on Addiction says: "Dr Conrod's study which helps young people reduce their chances of developing an addiction to alcohol and/or drugs in the future is an exciting development for prevention work in the UK. This is generally recognised as inadequate, and as we see regularly in the media, currently fails to address binge drinking and drug taking among young people. We treat a large number of people who began misusing substances in their school years, and we welcome any evidence-based research which may help to reverse this trend."
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If you have a teenager, be alert to signs and symptoms that may indicate a problem with alcohol:
Loss of interest in activities and hobbies and in personal appearance Bloodshot eyes, slurred speech, problems with coordination and memory lapses Difficulties or changes in relationships with friends, such as joining a new crowd Declining grades and problems in school Frequent mood changes and defensive behavior
You can help prevent teenage alcohol use. Start by setting a good example with your own alcohol use. Talk openly with your child, spend quality time together, and become actively involved in your child's life. Let your child know what behavior you expect - and what the consequences will be if he or she doesn't follow the rules.
Notes to editors:
For a copy of the paper or interviews with the author, please contact Seil Collins, Press Officer, King's College London, Institute of Psychiatry. Email: [email protected] or tel: (+44) 0207 848 5377/mob: (+44) 07718 697176
Encourage Healthy Alternatives to Alcohol One reason kids drink is to beat boredom. So it makes sense to encourage your child to participate in supervised after-school and weekend activities that are challenging and fun. According to a recent survey of preteens, the availability of enjoyable, alcohol-free activities is a big reason for deciding not to use alcohol.
If your community doesn't offer many supervised activities, consider getting together with other parents and teens to help create some. Start by asking your child and other kids what they want to do, because they will be most likely to participate in activities that truly interest them. Find out whether your church, school, or community organization can help you sponsor a project.
Paper reference: Conrod, P. et al. "A cluster randomized trial evaluating a selective, personality-targeted prevention program for adolescent alcohol misuse: Primary two-year outcomes and possible secondary herd effects" JAMA Psychiatry
About King's College London:
King's College London is one of the top 30 universities in the world (2012/13 QS international world rankings), and was The Sunday Times 'University of the Year 2010/11', and the fourth oldest in England. A research-led university based in the heart of London, King's has more than 24,000 students (of whom more than 10,000 are graduate students) from nearly 140 countries, and more than 6,100 employees. King's is in the second phase of a ?1 billion redevelopment programme which is transforming its estate.
King's has an outstanding reputation for providing world-class teaching and cutting-edge research. In the 2008 Research Assessment Exercise for British universities, 23 departments were ranked in the top quartile of British universities; over half of our academic staff work in departments that are in the top 10 per cent in the UK in their field and can thus be classed as world leading. The College is in the top seven UK universities for research earnings and has an overall annual income of nearly ?525 million (year ending 31 July 2011).
King's has a particularly distinguished reputation in the humanities, law, the sciences (including a wide range of health areas such as psychiatry, medicine, nursing and dentistry) and social sciences including international affairs. It has played a major role in many of the advances that have shaped modern life, such as the discovery of the structure of DNA and research that led to the development of radio, television, mobile phones and radar.
King's College London and Guy's and St Thomas', King's College Hospital and South London and Maudsley NHS Foundation Trusts are part of King's Health Partners. King's Health Partners Academic Health Sciences Centre (AHSC) is a pioneering global collaboration between one of the world's leading research-led universities and three of London's most successful NHS Foundation Trusts, including leading teaching hospitals and comprehensive mental health services.
The College is in the midst of a five-year, ?500 million fundraising campaign – World questions|King's answers – created to address some of the most pressing challenges facing humanity as quickly as feasible. The campaign's five priority areas are neuroscience and mental health, leadership and society, cancer, global power and children's health.
About Action on Addiction:
Action on Addiction is the only UK charity working across the addiction field in research, prevention, treatment and rehabilitation, professional workforce development, professional education and support for families and children.
One in three people suffer from an addiction. It breaks up families, damages communities and destroys lives. In some way it touches us all. Action on Addition believes that it is important to take an integrated and dynamic approach to improving the understanding of addiction and people's responses to it.
Action on Addiction has treatment centres throughout England as well as a specialist family support service (Families Plus) and an expert training centre for the treatment of addiction. They fund important and innovative research into addiction, working closely with the National Addiction Centre (part of the Institute of Psychiatry, King's College London) and the Mental Health Research and Development Unit at the University of Bath.
Action on Addiction has been helping people with addiction problems for over 25 years. In January 2012 HRH The Duchess of Cambridge became patron of Action on Addiction.
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