Preventure - a personality-targeted intervention to prevent substance use disorders in vulnerable youth
At a glance
Country of origin
Level(s) of intervention
- Indicated prevention,
- Targeted intervention
This short indicated prevention intervention comprises two 90-minute sessions delivered by a counsellor and co-facilitator. The sessions targets specific high-risk personality traits: negative thinking; anxiety sensitivity; impulsivity; and sensation seeking. The sessions are intended to educate participants about their personality types and to identify and challenge personality-specific cognitive distortions that lead to problematic behaviours.
Keywords
No dataLinks to this programme in other registries
Implementation Experiences
Read the experiences of people who have implemented this programme.Contact details
Patricia Conrod
Université de Montréal
Centre de Recherche, CHU Ste-Justine
Montréal, QC, H3T 1C5
Email: patricia.conrod[at]umontreal.ca
Overview of results from the European studies
Studies overview
The programme has been evaluated in four cluster randomised controlled trials (RCTs) in England and one in Netherlands, with two involving children aged 13-16 years, and three involving children aged approximately 14 years. All studies were conducted with students scoring more than one standard deviation above the mean of the school on any of the subscales the Substance Use Risk Profile Scale (SURPS) comprising hopelessness, anxiety sensitivity, impulsivity and sensation seeking. The Dutch study had an additional inclusion criterion, namely that participants must have had a lifetime use of at least one glass of alcohol.
In the first study in England, there was a lower increase in the self-reported quantity and frequency of drinking (analysed as a composite measure) among the intervention students six months after the intervention ended (the effect was not statistically significant at the 12, 18 and 24 months follow-up). There no effect on binge drinking at any time-point. The experience of negative consequences of drinking (problem drinking symptoms) was higher in the control condition at all time-points. At 12 and 24 month follow-ups, Preventure participants expressed a lower need to drink in order to cope with difficult feelings (statistically significant at these time-points but not at six and 18 months). There was no effect on students’ motivation to drink to feel good as opposed to avoiding feeling bad on any time-point.
In the second English study, the programme had a statistically significant effect favouring the intervention on self-reported drinking status and binge drinking 6 months after baseline (unclear, but appears to posttest). Controlling for other variables, there was also a statistically significant positive effect on quantity and frequency of drinking and drinking-related problems.
In the third study in England, the effects on self-reported drug use were assessed six, 12, 18 and 24 months after the intervention. The programme had a statistically significant effect favouring the intervention for the frequency of drug use at all time-points and for the number of drugs used at 12 and 24 months (but not at the other time-points, although the overall effect remained significant). There was a statistically significant effect favouring the intervention for the probability of cocaine use at all time-points, no effect on marijuana use at any time-point, and a statistically significant effect favouring the intervention on the probability of other drug use at 12 and 24 months (but not the earlier time-points).
The fourth English study looked at the effect of the programme on young people’s mental health and risk-taking behaviours. Six months after the programme ended, there was a statistically significant effect favouring the intervention on shoplifting and panic attacks but not on truancy, vandalism, sex without contraception, sex with someone not known well or depression symptoms.
A Dutch study from 2015 did not find any effects on self-reported depression, anxiety, hyperactivity or delinquency at two, six or 12 months after the end of the intervention.
A Dutch study from 2017 found that Preventure appears to have effect on the prevalence of binge drinking and alcohol use among specific groups in young adolescents in the Netherlands, particularly the SS personality trait and lower educated adolescents.
The studies mostly include only volunteering kids, explaining the sometimes low number of participants. This is also typical and to expected for such indicated programmes since they target only very specific personality profiles or behaviours.
Countries where evaluated
- Netherlands,
- United Kingdom
Characteristics
Protective factor(s) addressed
- Individual and peers: coping skills
- Individual and peers: positive self-concept and self-efficacy
Risk factor(s) addressed
- Individual and peers: early initiation of drug/alcohol use
- Individual and peers: other
- Individual and peers: sensation-seeking
Outcomes targeted
- Depression or anxiety
- Alcohol use
- Use of illicit drugs
- Crime
Description of programme
The intervention is a manualised indicated approach, with two 90-minute group sessions being delivered by a counsellor and a co-facilitator in schools. The sessions have three aspects: a psycho-educational component, a motivational interviewing component and a cognitive behavioural component. Each session incorporates the real-life experiences of high-risk personality young people. Session one involves goal-setting exercises designed to help young people cope with particular personality traits. The session revolves around educating participants about their personality types and the problems that can go along with them. Using a cognitive behavioural model, participants are encouraged to dissect personal experiences using the components of an emotional response. The second session focuses on identifying and challenging personality-specific cognitive distortions that lead to problematic behaviours. Those identified as negative-thinking personality types challenge negative-based cognitions such as generalising and internalisations. Those with anxiety sensitivity are encouraged to challenge catastrophic cognitions. Impulsive students focus on aggressive thinking and failure to think things through, while sensation-seeking students challenge the distortions that lead to reward-seeking and boredom susceptibility.
Implementation Experiences
Contact details
Jeroen Lammers
Trimbos Institute
jlammers[a]trimbos.nl
Main obstacles
With respect to individual professionals
The professionals did not have the right skills to implement Preventure in schools. Besides, the Preventure approach did not match the different levels of schools (in the Netherlands there is a school system with different levels of schools — lower level schools and higher level schools). In particular the lower level schools, which have students with special needs, had different requirements.
With respect to social context
Schools have different norms and cultures and different populations of students. You have to take account of this.
With respect to organisational and economic context
Financing the implementation: each region/municipality has its own finance system. The addiction care centres and the health centres receive finance from the municipality to carry out prevention activities at the schools (e.g. the Preventure programme). The amount of financial support differs per municipality. Some addiction care centres do have more potential to carry out Preventure than others.
How they overcame the obstacles
With respect to individual professionals
Together with the professionals we carried out several pilots at lower level schools. There were two goals: to train the professionals (to make them familiar with the method) and to adapt the Preventure programme to the special needs of the different schools.
With respect to social context
We had good contact and conversations with the schools and the prevention professionals before starting the implementation.
With respect to organisational and economic context
In the implementation pilots we looked at different funding methods and involving different organisations, other than the addiction care centres, in carrying out Preventure.
Lessons learnt
With respect to individual professionals
You need to involve the professionals in the process of implementation. Form a team and cooperate with the schools as a team.
With respect to social context
Have good contact and conversations with the schools and the prevention professionals before starting the implementation.
With respect to organisational and economic context
The implementation process is different in every municipality/region. The local prevention professionals play an important role in determining the best implementation at the schools.
Strengths
A good addition to the existing offer of universal prevention programmes. The intervention fits better with vulnerable groups (e.g. students with lower levels of education).
Weaknesses
Financial costs of the implementation; prevention professionals need special skills, e.g. a knowledge of cognitive behavioural therapy (CBT).
Opportunities
The programme could be adapted for other vulnerable groups of students (special needs education) and other age groups (e.g. 16-18 years).
Threats
Ethical issues: the selection procedure at schools (students are selected by screening for one of four personality traits) must be carried out carefully to avoid stigmatising students.
Recommendations
With respect to individual professionals
Good training and careful selection of the prevention professionals (counsellors for the sessions at schools).
With respect to social context
Create a good infrastructure at local and regional levels.
With respect to organisational and economic context
Obtain funding at municipality level.
Number of implementations
Contact details
michal.miovsky[a]lf1.cuni.cz
Main obstacles
With respect to individual professionals
1. Create a simple plan for implementation process with no clear conditions what are the requirements given by authors.
2. Following implementation procedure step by step and no improvising and changing rules.
With respect to social context
1. Cultural differences.
2. Different situation in participating regions and schools.
With respect to organisational and economic context
We asked for help our Ministry of Education and conducted implementation and adaptation study and project. We created and prepared a local training system and centralised our leadership with sensitive balancing local differences and needs. The most critical problem was missing licencing policy and clear information about all requirements by authors.
How they overcame the obstacles
With respect to individual professionals
1. We contacted author at the beginning and asked for help and permission to adopt and use the tool but there was not clear contract and clear requirements, including missing license policy. We initiated the implementation project despite this unclear situation what was critical mistake and wrong decision.
2. We asked for help our Ministry of Education and conducted implementation and adaptation study and project. We created and prepared a local training system and centralised our leadership with sensitive balancing local differences and needs.
With respect to social context
We had to invite more extensively our local teams from schools and local NGOs and invested more money into the extensive qualitative evaluation e.g. in terms of adaptation of pictures and descriptions and instructions. This work represented a separate study and extra budget for local collaborators.
With respect to organisational and economic context
We were able to manage – the author did not agree with our final framework and full adaptation without extensive RCT study what was out of our budget and real capacity. We did everything, including really extensive implementation study and needs assessment etc., but the PreVenture team did not agree with our final proposal and we had to stop entire process. So, we have no permission to use the tool and train local trainers.
Lessons learnt
With respect to individual professionals
No. 1 is clear contract with author and clear licence policy given by author. There is necessary to know exactly all particular requirements and final price for all items.
With respect to social context
To take adaptation very seriously and don’t underestimate culture differences - many things are not so automatic as it looks like... This tool is relatively highly sensitive and adaptation has to be done very accurately and repeatedly tested on target population.
With respect to organisational and economic context
No. 1 is clear contract with author and clear licence policy given by author. There is necessary to know exactly all particular requirements and final price for all items. We did all steps very carefully and responsibly and spent significant budget on it. We have trained people by original team in UK and we paid for this trainings and supervisions extra money etc, etc. but the PreVenture team was not able to express what is the final price as well as conditions and requirements and stopped negotiation when we were not able to conduct RCT study on the Czech population.
Strengths
Perfect tool.
Highly motivated local professionals.
Positive feedback by local professionals
Weaknesses
Copyright/missing clear licensing policy. Contract with author/conditions/rules.
Opportunities
Highly professional intervention and comparability.
Threats
Copyright/missing clear licensing policy.
Recommendations
With respect to individual professionals
Higher selection criteria and motivation.
With respect to social context
Good and clear plan and communication with all participants in all regions and respect local differences and needs.
With respect to organisational and economic context
The most important thing is to have a clear contract with author and clear licence policy given by author. There is necessary to know exactly all particular requirements and final price for all items.
REPLY FROM THE PROGRAMME OWNER 24.05.2022-
The Preventure Program is a turn-key program that has been validated in 6 clinical trials around the world. It is designed to be implemented independently with guidance and support from the PreVenture team. The implementation referred to above was done in 2015, before the program was established as a turn-key protocol. Our pricing is straightforward and clearly indicated. Pricing information is available upon request. In addition, the PreVenture team engages in research and partners with institutions on a case by case basis depending on the rigor and novelty of the research design with certain time constraints.
Note from the authors
Programme implemented in 2012.
