Conrod Patricia, Stewart Sherry H, Seguin Jean, Pihl Robert, Masse Benoit, Spinney Sean, Lynch Samantha
Department of Psychiatry and Addiction, Faculty of Medicine, University of Montreal, Montreal (Conrod, Seguin, Lynch); CHU Sainte-Justine Mother-Child University Hospital, Montreal (Conrod, Seguin, Masse, Spinney, Lynch); Department of Psychiatry and Department of Community Health and Epidemiology, Faculty of Medicine, and Department of Psychology and Neuroscience, Faculty of Science, Dalhousie University, Halifax, Canada (Stewart); Department of Psychology, Faculty of Arts and Science, McGill University, Montreal (Pihl); School of Public Health, University of Montreal, Montreal (Masse).
Am J Psychiatry. 2025 May 1;182(5):473-482. doi: 10.1176/appi.ajp.20240042. Epub 2025 Jan 15.
Rates of substance use disorders (SUDs) remain significantly above national targets for health promotion and disease prevention in Canada and the United States. This study investigated the 5-year SUD outcomes following a selective drug and alcohol prevention program targeting personality risk factors for adolescent substance misuse.
The Co-Venture trial is a cluster randomized trial involving 31 high schools in the greater Montreal area that agreed to conduct annual health behavior surveys for 5 years on the entire 7th grade cohort of assenting students enrolled at the school in 2012 or 2013. Half of all schools were randomly assigned to be trained and assisted in the delivery of the personality-targeted PreVenture Program to all eligible 7th grade participants. The intervention consisted of a brief (two-session) group cognitive-behavioral intervention that is delivered in a personality-matched fashion to students who have elevated scores on one of four personality traits linked to early-onset substance misuse: impulsivity, sensation seeking, anxiety sensitivity, or hopelessness.
Mixed-effects multilevel Bayesian models were used to estimate the effect of the intervention on the year-by-year change in probability of SUD. When baseline differences were controlled for, a time-by-intervention interaction revealed positive growth in SUD rate for the control group (b=1.380, SE=0.143, odds ratio=3.97) and reduced growth for the intervention group (b=-0.423, SE=0.173, 95% CI=-0.771, -0.084, odds ratio=0.655), indicating a 35% reduction in the annual increase in SUD rate in the intervention condition relative to the control condition. Group differences in SUD rates were reliably nonzero (95% confidence) at the fourth and fifth year of assessment. Secondary analyses revealed no significant intervention effects on growth of anxiety, depression, or total mental health difficulties over the four follow-up periods.
This study showed for the first time that personality-targeted interventions might protect against longer-term development of SUD.
在加拿大和美国，物质使用障碍（SUDs）的发生率仍显著高于健康促进和疾病预防的国家目标。本研究调查了一项针对青少年物质滥用的人格风险因素的选择性药物和酒精预防计划实施5年后的SUD结果。
“共同冒险”试验是一项整群随机试验，涉及大蒙特利尔地区的31所高中，这些学校同意对2012年或2013年入学的同意参与的全体7年级学生进行为期5年的年度健康行为调查。所有学校中有一半被随机分配接受培训，并在向所有符合条件的7年级参与者提供针对人格的预防风险计划（PreVenture Program）方面得到协助。干预措施包括一个简短的（两节课）小组认知行为干预，以与人格相匹配的方式提供给在与早期物质滥用相关的四种人格特质之一上得分较高的学生：冲动性、寻求刺激、焦虑敏感性或绝望感。
使用混合效应多级贝叶斯模型来估计干预对SUD概率逐年变化的影响。在控制基线差异后，时间与干预的交互作用显示，对照组的SUD发生率呈正增长（b = 1.380，标准误 = 0.143，优势比 = 3.97），而干预组的增长有所降低（b = -0.423，标准误 = 0.173，95%可信区间 = -0.771，-0.084，优势比 = 0.655），这表明干预组的SUD发生率年增长率相对于对照组降低了35%。在评估的第四年和第五年，SUD发生率的组间差异可靠地不为零（95%置信度）。二次分析显示，在四个随访期内，干预对焦虑、抑郁或总体心理健康困难的增长没有显著影响。
本研究首次表明，针对人格的干预措施可能预防SUD的长期发展。
