Personality-focused program prevents adolescent SUD

A school-based personality-focused intervention shows potential in lowering the rates of substance use disorder (SUD) among adolescents, reports a study.

“Brief cognitive-behavioural interventions delivered in the 7th grade through a school-based selective program were associated with reduced rates of transitioning to SUD over the course of 5 years of adolescence,” the researchers said.

When controlling for baseline differences, SUD rates increased in the control group (odds ratio [OR], 3.97; b, 1.380) and decreased in the intervention group (OR, 0.655; b, ‒0.423) in a time-by-intervention interaction. This indicated a 35-percent reduction in the annual increase in SUD rate with the intervention. [Am J Psychiatry 2025;doi:10.1176/appi.ajp.20240042]

Between-group differences in SUD rates were “nonzero” during the fourth and fifth year of assessment. In secondary analyses, the intervention showed no significant effects on growth of anxiety, depression, or total mental health difficulties over the four follow-up periods.

“By the end of the trial, participants attending intervention schools were less likely to screen positive for SUD than their age-, gender-, and personality-matched counterparts,” the researchers said.

This cluster randomized trial involved 31 high schools in the greater Montreal area in Canada that agreed to conduct annual health behaviour surveys for 5 years on the 7th grade cohort of students enrolled in 2012 or 2013. The researchers randomized half of the schools to be trained and assisted in the delivery of the personality-targeted PreVenture Program to all eligible grade 7 participants.

The intervention consisted of a brief group cognitive-behavioural intervention, delivered in a personality-matched fashion to students who have elevated scores on one of four personality traits linked to early-onset substance misuse, namely impulsivity, sensation seeking, anxiety sensitivity, or hopelessness.

The researchers then used mixed-effects multilevel Bayesian models to examine the effect of the intervention on the year-by-year change in SUD probability.

Long-term effect

Results of this study supported those from five previous randomized trials of school-based personality-targeted interventions, which reported smaller values for number needed to treat on more proximal intervention outcomes, such as 6-month or 2-year drinking and drug use, binge drinking, alcohol harms. [Arch Gen Psychiatry 2010;67:85-93; JAMA Psychiatry 2013;70:334-342; Addiction 2015;110:1101-1109]

“The present findings extend the evidence base in support of this promising intervention approach by showing … that this personality-focused intervention reduces risk of transitioning to SUD over the longer term and has the potential to directly reduce the burden on the health system,” the researchers said.

On the other hand, the current study failed to replicate findings from previous studies, which showed decreases in growth of depression symptoms. [J Am Acad Child Adolesc Psychiatry 2013;52:911-920; Aust N Z J Psychiatry 2020;54:259-271]

“[D]espite reporting new findings on an overall index of mental health difficulties, which includes peer, conduct, inattention/hyperactivity, and emotional problems, we also did not find significant long-term intervention effects on these outcomes,” the researchers said.

“The present study was unique … in that all participants were systematically screened and offered psychological counselling by school mental health professionals if they indicated significant distress and suicidal ideation at any of the five assessments, which might have eclipsed the mental health benefits of the brief preventive intervention delivered in the first year of the study,” they added.