Hanie Edalati, PhD & Patricia J. Conrod, PhD Département de psychiatrie, Université de Montréal

CHU Ste-Justine

Disclosures: Consultancy fees from Janssen, Health Canada and NIH research projects

No personal financial gain from PreVenture

Preventure: A drug and alcohol prevention program targeting four personality risk factors for substance

misuse in adolescents.

Alcohol Conference for Youth, Tallinn, Nov. 2017

Public Health Intervention Strategies

Tx

Indicated

Selective

Universal

Evidence-based programmes: Limited evidence for knowledge-based programmes Life Skills Training Program Strengthening Families Good Behaviour Game Mild-moderate effects Impact on SUD??

Brief motivational interventions for heavy drinkers Time-limited effects

-moderate generic

treatment effects -complicates and complicated by comorbid disorders -”decade of harm”

Journal of Substance Abuse, 2001

Substance Use Risk Profile Scale Woicik et al., ACER, 2009

1. I am content.* 2. I often don't think things through before I speak. 3. I would like to skydive. 4. I am happy.* 5. I often involve myself in situations that I later regret being involved in. 6. I enjoy new and exciting experiences even if they are unconventional. 7. I have faith that my future holds great promise.* 8. It's frightening to feel dizzy or faint. 9. I like doing things that frighten me a little. 10. It frightens me when I feel my heart beat change. 11. I usually act without stopping to think. 12. I would like to learn how to drive a motorcycle. 13. I feel proud of my accomplishments.* 14. I get scared when I'm too nervous. 15. Generally, I am an impulsive person. 16. I am interested in experience for its own sake even if it is illegal. 17. I feel that I'm a failure. 18. I get scared when I experience unusual body sensations. 19. I would enjoy hiking long distances in wild and uninhabited territory. 20. I feel pleasant.* 21. It scares me when I'm unable to focus on a task. 22. I feel I have to be manipulative to get what I want. 23. I am very enthusiastic about my future.* Asterisk (*) indicates reverse keyed item.

Substance Use Risk Profile Scale

• 4 dimensions: – Anxiety sensitivity, Hopelessness, Impulsivity and Sensation Seeking

• Internal consistency (Woicik et al., 2009)

• Concurrent validity (Woicik et al., 2009; Schlaucht et al., 2014)

• Incremental validity (Woicik et al., 2009)

• Predictive validity (Krank et al., 2010)

• Test-retest reliability (Woicik et al., 2009)

• Sensitivity/specificity (Castellanos-Ryan et al, 2013)

• Generalisability, applications in different cultural and clinical contexts (Jolin-Castonguay et al., 2013; Schlaucht et al., 2014)

• Translated: French, German, Spanish, Czech, Dutch, Cantonese, Japanese, Sri Lankan (Robles-García et al., 2014; Omiya et al., 2012; Malmberg, et al., 2013; Chandrika Ismail, et al., 2009; Jolin-Castonguay et al., 2013)

Hopelessness Anxiety Sensitivity Impulsivity Sensation Seeking-

R‡

Selecting HR

adolescents based

on ROC cut-offs

Selecting HR

adolescents (1SD >

mean cut-offs )†

% S, FP S, FP S, FP S, FP S, FP S, FP

Monthly binging (13%) 20, 12 27, 31 61, 32 48, 30 72, 49 70, 42

Drinking problems (17%) 49, 34 32, 31 55, 31 36, 30 84, 63 75, 53

Smoking (9%) 61, 49 33, 30 55, 33 38, 30 81, 65 72, 55

Drug use (21%) 60, 49 27, 22 54, 30 43, 28 91, 75 74, 52

BSI depression (23%) 54, 31 42, 28 51, 30 34, 30 91, 70 73, 47

Emotional problems (13%) 54, 34 59, 27 46, 34 32, 31 91, 72 80, 53

Conduct problems (41%) 26, 13 33, 29 58, 20 35, 28 77, 50 72, 46

Hyperactivity problems

(32%) 26, 15 37, 28 58, 25 38, 28 78, 55 74, 49

Sensitivity and false positive rates (1-specificity) of Age 14 SURPS subscales in the prediction

of Age 16 substance use, emotional and behavioural symptoms in British high school

students (N = 1057). (Castellanos-Ryan et al., Alcohol Clin Exp Res. 2013 Jan;37 Suppl 1:E281-90. doi: 10.1111/j.1530-

0277.2012.01931)

Cognitive correlates of risk (Castellanos, Rubia, & Conrod,

Alcohol Clin Exp Res. 2011 Jan;35(1):140-55. doi: 10.1111/j.1530-0277.2010.01331)

100 high and low risk youth reporting either CD, SUD, CD+SUD, or neither followed for 2 years

• IMP – poor response inhibition (SSRT) mediates antisocial and substance-related behaviour

• SS – intact response inhibition

Impulsivity at age 14 Conduct problems

at 16-17

Poor Response Inhibition

Cognitive correlates of risk (Castellanos, Rubia, & Conrod,

Alcohol Clin Exp Res. 2011 Jan;35(1):140-55. doi: 10.1111/j.1530-0277.2010.01331)

100 high and low risk youth reporting either CD, SUD, CD+SUD, or neither followed for 2 years

• IMP – poor response inhibition (SSRT) mediates antisocial and substance-related behaviour

• SS – intact response inhibition but interactions with incentive reward to predict SUD.

Sensation seeking

at age 14 Substance misuse

at 16-17

Reward-induced impulsivity

Impulsivity ++PreSupp Motor Area (stopping)

Impulsivitypoor inhibition

--Bilateral Frontal (failed

inhibition)

Sensation Seeking

++OFC / –IFG (reward

anticipation)

PERSONALITY TRAITS

CO-OCCURING DISORDER

Sensation Seeking

Hopelessness

Anxiety Sensitivity

Externalising Problems

Poor response inhibition and emotional reactivity

Sensitivity to reward and the incentive/reinforcing properties of substances

Negative affect regulation

Anxiety Disorders

Mood Disorders

Hyperarousal and sensitivity to dampening effects of substances/ increased withdrawal symptoms

MOTIVATIONAL PROFILE

DISIN

HIB

ITED TR

AITS

INH

IBITED

/ NEU

RO

TIC TR

AITS

Conrod and Nikolaou, Journal of Child Psychology and Psychiatry, 2016

Stimulant -

-------

Drug/ Alcohol Misuse

------- Sedative

SUBSTANCE USE

Personality-Targeted Interventions Conrod et al., Psych Addictive Beh, 2000

Conrod et al., JCCAP, 2006

• Structure – Two 90-minute group sessions – School-based – Selective (students with personality elevations, 45%) – Personality-specific groups

• Content – Psycho-educational Component – Motivational Component

• Motivational interviewing techniques • Goal setting exercises (for prevention trials; Conrod et al., 2010)

– Cognitive-Behavioral Component • Personality-specific cognitive distortions

Anxiety sensitivity: decatastrophizing & exposure (Barlow & Craske, 1988)

Hopeless: negative thought challenging (Beck & Young, 1985)

Impulsive: Response inhibition “stop”, “focus”, “choose” (Kendall & Braswell, 1985) Negative attribution biases

Sensation seeking: thought challenging for boredom & need for stimulation Reward sensitivity

Dr. Patricia Conrod

Professor, Department of Psychiatry, University of Montréal

Selecting Students?

• Identifies students with a particular personality profile using…

• SURPS (Substance Use Risk Profile Survey)

– 23 item survey

• Students who score in the top 16% on a trait (>1 SD)

• Represents their dominant way of responding to the world

Personality-Targeted Interventions: The Evidence

• Phase I: Proof of concept (Conrod et al., 2006)

• Phase II: Efficacy (Preventure)

• Phase III: Effectiveness (Adventure)

• Phase IV: Process, secondary outcomes, pathways, delivery models (Coventure)

• Phase V: Special populations, contexts, generalisability, optimisation (Interventure)

Validated Prevention Program through 8 Randomised Trials

45% of students score >1 SD

95% of students assent to survey

85% of students sign up for program

82% follow-up

Preventure Trial London, UK

Conrod, P.J., Castellanos-

Ryan, N. & Strang, J.

(2010). Archives Gen

Psychiatry.

Preventure Trial:

Survival as a non-cannabis user

β = -0.3 (Robust SE = 0.2), p=0.09; OR = 0.7, CI = 0.5-1.0

Conrod, P.J., Castellanos-Ryan, N. & Strang, J. (2010). Archives Gen Psychiatry.

Preventure Trial:

Survival as a non-cocaine user

Β= -1.4; robust SE=0.4, p<.001; OR=0.2; 95% CI= 0.1 -0.5

Conrod, P.J., Castellanos-Ryan, N. & Strang, J. (2010). Archives Gen Psychiatry.

1268 (54.6%) Low personality risk

1025 (52.4%) Low personality risk

Followed 6, 12, 18 & 24 months

Followed 6, 12, 18 & 24 months

Adventure Trial Conrod et al., 2013, JAMA-Psychiatry.

45% students invited

95% of students assent to survey and intervention

92% of parents passively consent

to their child’s participation

82% follow-up

PreVenture Training for High-School Teachers

and Counselors

• 2-3 Day Workshop – Theoretical background and screening using SURPS

– Basic principles and practices in counseling and psychological intervention (CBT and MI)

– Tailoring interventions for personality-specific profiles, role play.

• 3 hours of supervised practice running groups – Evaluation and feedback on Preventure Fidelity Scale

• Manualised Intervention: – therapist manual (step-by-step)

– each student receives a personality-specific workbook.

1268 (54.6%)

Low Risk/

Risque réduit

1025 (52.4%)

Low risk/

Risque réduit

Followed /suivi

6, 12, 18 & 24 mo

Followed /suivi

6, 12, 18 & 24 mo

Australian CAP Trial (Teesson, et al., Psychological Medicine, 2017)

PreVenture (45%) vs. Climate Universal (100%) vs. CAP (100% + 45%) vs. Control (0%) Table 2. Two-part latent growth model parameters and standard errors examining the effects of universal, targeted and combined intervention programs on the likelihood and frequency of any drinking, the likelihood

and frequency of binge drinking, and likelihood and extent of alcohol-related harm.

Part 1: Dichotomous portion of the model

Intercept Slope

b (SE) p-value b (SE) p-value

Any drinkinga.

Climate vs Control 0.23 (0.18) 0.209 -0.38 (0.089) 0.000

Preventure vs Control 0.56 (0.14) 0.000 -0.36 (0.10) 0.000 CAP vs Control 0.24 (0.17) 0.148 -0.19 (0.08) 0.025 CAP vs Climate 0.02 (0.17) 0.928 0.19 (0.08) 0.021

Binge Drinkingb.

Climate vs Control 0.42 (0.29) 0.152 -0.51 (0.17) 0.002

Preventure vs Control 0.70 (0.24) 0.004 -0.41 (0.17) 0.014 CAP vs Control 0.33 (0.25) 0.180 -0.36 (0.10) 0.001

CAP vs Climate -0.08 (0.22) 0.709 0.15 (0.16) 0.349

Alcohol-related harmc

Climate vs Control 0.63 (0.20) 0.002 -0.23 (0.14) 0.087 Preventure vs Control 0.94 (0.18) 0.000 -0.38 (0.13) 0.005

CAP vs Control 0.53 (0.23) 0.019 -0.19 (0.13) 0.154 CAP vs Climate -0.10 (0.20) 0.618 0.04 (0.10) 0.687

Baseline differences

Post intervention differences in growth

Does Preventure Work for Students with Pre-Existing Diagnoses?

Two-year Preventure outcomes by baseline level of ADHD or Conduct Problems

ADHD

Conduct Problems

How do students react to the program?

One thing I liked about the sessions

One thing I didn’t like about the sessions

Most important thing I learned

Why do so many students want to take part in the program?

• Youth and Community Engagement

• Culturally and Developmentally Validated

• Positive Psychology

• Resilience-Building

• Skills-Focused

• Personalized

• Brief

• https://youtu.be/u3EO6f305Zw

What is PreVenture? Brief, coping skills interventions targeting personality risk factors

for adolescent substance misuse

2-90 Minute “workshops” CBT &

Motivational Interviewing Skills

Understand how their personality style leads to

certain emotional and behavioural reactions

Students grouped according to

4 personal profiles

PreVenture

Conclusions • Interventions targeting specific personality and cognitive

risk factors appear effective in reducing and delaying onset of substance use while concurrently reducing externalising and internalising problems.

• Effects appear to be in the moderate range and have been shown to last up to 3 years.

• Intervention shown to be effective when delivered as a prevention strategy, early intervention strategy or brief intervention for substance misuse.

• Group and individual formats have been shown to be effective

• Face-to-face and distance delivered formats are feasible • Both mental health professionals and educational

professions can be trained to deliver the intervention with proven effectiveness.

Thank you!

Canadian Institutes of Health Research (CIHR) FRSQ chercheur Boursier-Senior European Commisssion FP6-Health and FP7-Social Sciences and Humanities Mental Health Medical Research Council of Australia ABMRF Action on Addiction Fondation Ste-Justine National Insitutes of Health (NIH) European Medical Research Board (ERAB) Medical Research Council-UK Hanie Edalati hanie.edalati@umontreal.ca Patricia Conrod patricia.conrod@umontreal.ca Genevieve.woods@hec.ca www.conrodventurelab.com/servicespveng

https://www.nytimes.com/2016/10/04/well/family/the-4-traits-that-put-kids-at-risk-for-addiction.html