The effect of contextual risk factors on the effectiveness of brief personality‐targeted interventions for adolescent alcohol use and misuse : a cluster‐randomized trial

Background A range of school‐based prevention programs has been developed and used to prevent, delay, or reduce alcohol use among adolescents. Most of these programs have been evaluated at the community‐level impact. However, the effect of contextual risk factors has rarely been considered in the evaluation of these programs. The aim of this study was to investigate the potential moderating effects of 2 important contextual risk factors (i.e., socioeconomic status [SES] and peer victimization) on the effectiveness of the school‐based personality‐targeted interventions (Preventure program) in reducing adolescent alcohol use over a 2‐year period using a cluster‐randomized trial. Methods High‐risk adolescents were identified using personality scores on the Substance Use Risk Profile Scale and randomized to intervention and control groups. Two 90‐minute cognitive behavioral therapy‐based group sessions targeted 1 of 4 personality risk profiles: Anxiety Sensitivity, Hopelessness, Impulsivity, or Sensation Seeking. Multilevel linear modeling of alcohol use, binge drinking, and drinking‐related harm was conducted to assess the moderating effect of baseline peer victimization and SES. Results Results indicated that the Preventure program was equally beneficial to all adolescents, regardless of SES and victimization history, in terms of their alcohol outcomes and related harm. Receiving the intervention was additionally beneficial for adolescents reporting peer victimization regarding their alcohol‐related harm compared to nonvictimized youth (β = −0.29, SE = 0.11, p = 0.014). Conclusions Findings suggest that the content of personality‐targeted interventions is beneficial for all high‐risk youth regardless of their SES or experience of peer victimization. The current study suggests that using targeted approaches, such as targeting underlying personality risk factors, may be the most appropriate substance use prevention strategy for high‐risk youth, as it is beneficial for all high‐risk youth regardless of their contextual risk factors

Exploring the relationship between perceived neglect and violence and problematic alcohol use in adolescents, undergraduate students, and clinical patients

The present dissertation aimed to understand how perceived maltreatment including neglect and violence places individuals at risk for problematic alcohol use through the development of a framework of vulnerability. We tested the role of dual process pathways including system 1 (alcohol automatic memory associations) and system 2 (future orientation, and alcohol outcome expectancies) processes, risky personality traits, and current perceived stress as the underlying structure between perceived maltreatment and alcohol use and problematic drinking in three groups of participants : adolescents (n = 145), undergraduate students (n = 510), and clinical patients under treatment for substance use disorders (n=100). In all three groups, perceived maltreatment was associated with higher current perceived stress, development of risky personality traits, and lower future orientation and positive or coping alcohol expectancies. Only maltreated undergraduate students indicated more alcohol-related coping memory associations. In adolescents, more alcohol feeling good expectancy, higher sensation seeking and impulsivity mediated the relationship between violence and recency of alcohol use. In undergraduate students, more alcohol-related coping memory associations, lower future orientation, and higher sensation seeking mediated the relationship between higher frequency of alcohol use and problematic drinking. Higher impulsivity also mediated the relationship between violence and problematic alcohol use in this group. The best dual processes pathway that connected violence to problematic alcohol use was via alcohol coping association and future orientation in undergraduate students, in that those with higher levels of violence showed impaired future orientation, and were more likely to shape alcohol-related coping memory associations, and that this cognitive pathway resulted in higher rates of problematic alcohol use. In general, neglected males and females exposed to violence indicated a pattern similar to internalizing problems. In contrast, a pattern of externalizing problems were increased in neglected females and males exposed to violence by adding sex to the analysis. Our findings suggest that intervention programs for problematic drinking should consider screening for experiences of violence. Maltreated individuals with alcohol problems would benefit from interventions that improve rational thinking and behavioural inhibition, and learning how to cope effectively with the stress and the experience of maltreatment.Graduate Studies, College of (Okanagan)Graduat