Dr. Patricia Conrod's presentation from the March 7 Mentor-ADEPIS seminar 'Targeted prevention interventions and the case of PreVenture'

1. Targeted prevention interventions and
the case of PreVenture
Patricia J. Conrod, Ph.D.
Professeure Titulaire, Université de Montréal, CHU Hôpital Ste Justine
Senior Clinical Lecturer & Consultant Clinical Psychologist, Addictions
Department, Institute of Psychiatry, King’s College London

2. Public Health Intervention Strategies
Tx
Indicated
Selective
Universal
Limited evidence for
efficacy knowledge-
based programmes
Evidence-based
programmes:
Life Skills Training
Program
Strengthening Families
Good Behaviour Game
Brief motivational
interventions for heavy
drinkers
Time-limited effects
-moderate generic
treatment effects
-complicates and
complicated by
comorbid disorders
-”decade of harm”

3. Journal of Substance Abuse, 2001

7. PERSONALITY
TRAITS
CO-OCCURING
DISORDER
Impulsivity
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
DISINHIBITEDTRAITSINHIBITED/NEUROTICTRAITS
Conrod & Nikolaou, JCPP, 2016
Stimulant
--------
Drug/
Alcohol
Misuse
-------
Sedative
SUBSTANCE
USE

8. Substance Use Risk Profile Scale (SURPS)
(Woicik et al., 2009)
 4 dimensions in 23 items:
 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)

9. 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
Table 5. Sensitivity and false positive rates (1-specificity) of the f baseline SURPS subscales in the prediction of substance use, emotional and behavioural
symptoms within the next 18 months (by T4) in the overall sample (N = 1057). (Castellanos-Ryan et al., 2011)

10. Personality-Targeted Interventions:
Conrod et al., Psych Addictive Beh, 2000
 Psychoeducational 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

11. Personality-Targeted
Interventions: The Evidence
Phase I: Proof of concept (Conrod et al., 2000; Conrod et al., 2006).
Phase II: Efficacy (Conrod et al., 2008; 2010; 2011)
Phase III: Effectiveness (Conrod et al., 2013; O’Leary-Barrett et al., 2013)
Phase IV: Process, secondary outcomes, pathways, delivery models
(www.Co-venture.ca; Conrod et al., in progress)
Phase V: Special populations, contexts, generalisability, optimisation
(www.capstudy.org.au; Newton et al., 2012; Mushquash, et al., 2008;2013; Dutch Preventure -
Lemmens et al., 2011), TRUANCY Trial, PRIMEVenture, Distance-Delivered Interventions (Olthuis,
et al., 2013;2014); UNIVenture

12. Preventure Trial – UK
(Conrod, 2003; funded by Action on Addiction)
 Phase II: Efficacy trial
 Primary aims: Efficacy when tested under more rigorous design?
 Secondary aims: Adapted for UK context? Prevention? Illicit drugs?
 Participants:
 secondary school students across London
 Age range: 13 – 15 (median 14)
 68% female
 Ethnicity: 39% white (British and other), 10% South Asian, 30% African
or Caribbean, 21% Other or mixed.
 Consent:
 Parent consent required for both baseline survey (passive) and
intervention (active).
 Active student consent required for both survey and intervention.
 Interventions: Random assignment –
 Personality targeted interventions (NT, SS, IMP, AS)
 No intervention control

14. Preventure Trial 2-year outcomes:
Survival as a non-cannabis user
OR = 0.7, CI = 0.5-1.0
Conrod, P.J., Castellanos-Ryan, N. & Strang, J. (2010). Archives Gen
Psychiatry.

15. OR=0.2; 95% CI= 0.1 -0.5
Conrod, P.J., Castellanos-Ryan, N. & Strang, J. (2010). Archives Gen Psychiatry.
Preventure Trial 2-year outcomes:
Survival as a non-cocaine user

16. UK Adventure Trial:
Effectiveness when delivered by teachers
 Phase III trial funded by Action on Addiction,
2006-2010
 Hypotheses
 Primary:
 Effectiveness when delivered by schools and teachers
 3-day training workshop for teachers, supervised practice and
fidelity assessment.
 Secondary:
 Mental health benefits?
 ‘Herd effects’?: secondary effects on general population?

17. Teacher Training Protocol
 3-day Workshop
 Theory
 Generic counselling skills (emphathy!)
 Targeting personality in treatment and prevention
 Practical Supervision
 Session 1 + Feedback
 Session 2 + Feedback

18. UK
Adventure
Trial

22. 1268 (54.6%)
Low personality risk
1025 (52.4%)
Low personality risk
Followed 6, 12, 18 & 24
months
Followed 6, 12, 18 & 24
months

23. ADVENTURE TRIAL: Two-Year Drinking Outcomes
and Herd Effects
Conrod et al., JAMA-Psychiatry, 2013
0.3
0.35
0.4
0.45
0.5
0.55
0.6
0.65
0.7
0.75
0.8
T2 T3 T4 T5
P(Drink = yes) * log(Freq)
Control Low Risk Control High Risk Intervention Low Risk Intervention High Risk

24. Une chose que j'ai aimé en ce qui concerne les
séances

25. Process Research:
Student Feedback (Adventure)
What I liked
 Helped with controlling anger and thinking first” (IMP)
 “Helped me understand more about other people” (IMP)
 “It was easy to express feelings as everyone was
encouraging and thoughtful” (AS)
 “Learning ways to avoid problems” (AS)
 “It also don’t make you feel alone, that it’s only you”
(sic)
 “I had fun and it helped me with my choices” (SS)
 “Teaches us how to push aside the bad thoughts in certain
situations” (SS)
 “You can say how you feel without being embarrassed” (NT)
 “Finding a way to deal with negative thinking” (NT)

26. Process Research:
Student Feedback (Adventure)
What I didn’t like
 “More sessions please!” (IMP)
 “Maybe put it in a way so you can act out the scenes”
(IMP)
 “It ended” (SS)
 “A little bit long” (SS)
 Make the sessions a bit longer” (AS)
 “Nothing- 5/5” (AS)
 “The pictures are a bit weird” (NT)
 “Nothing was boring but some situations didn’t apply to
me” (NT)

27. Une chose que je n'ai pas aimé

28. Trials in progress
 New adaptations:
 Dutch (BMC Public Health, 2011),
 Australian (Newton et al., JCPP, 2016)
 French Canadian (www.Co-Venture.ca)
 Czech
 on going in Mexico
 Implementation Models:
 Phase IV: CAP-STUDY, NMHR-Australia (Teesson,
Conrod, et al., 2011-2016).
 Climate vs. Teacher-delivered Preventure vs. Climate and
Preventure (CAP) vs. Control
 Cluster randomised trial in Australian high schools
 Examining potential role for stepped-care strategy
 PREVENTURE outcomes in Australia (Newton et al.,
JCPP, 2016

29. Mediators of alcohol and drug
prevention
 Delay onset of substance misuse (O’Leary-Barrett, submitted;
Spoth et al., 2009; Spoth et al., 2014)
 Drinking onset
 binge drinking
 Smoking ? (Whelan et al., 2014)
 Impulsivity and prosocial peer networks (Castellanos-Ryan et
al., 2013).
 Early onset alcohol misuse and adolescent brain
development (e.g., Nagel, 2005)

30. Mediators of 2-year intervention
effects
Mediation Analysis:
MacKinnon’s products of coefficients method
referring to the impact of each mediator
individually when controlling for gender,
ethnicity and baseline symptoms
O’Leary-Barrett, et al., 2015, JCCP

31. 1854 (84%) of control sample
completed 24-month FU
1854 (84%) of control sample
completed 36-month FU
1854 (84%) of control sample
completed 48-month FU
1854 (84%) of control sample
completed 24-month FU
1854 (84%) of control sample
completed 36-month FU
1854 (84%) of control sample
completed 48-month FU
1004 invited to take part in
interventions
251 (25%) score high in NT
251 (25%) score high in AS
251 (25%) score high in IMP
251 (25%) score high in SS
1004 Not invited to take part in
interventions:
251 (25%) score high in NT
251 (25%) score high in AS
251 (25%) score high in IMP
251 (25%) score high in SS
32 public and private schools, each with approximately 150 Year 7 students, recruited from
Greater Montreal Area, randomly assigned to treatment condition.
2208 (92%) students complete screening
survey and consent to trial
1004 (45.5%) high
risk
1854 (84%) of control sample
completed12-month FU
1004 (45.5%) high risk1204 (54.5%) low
risk
1204 (54.5%) low
risk
Baseline
24mo
36mo
48mo
12mo
16 schools (50%) Control Condition
2208 (92%) students complete screening
survey and consent to trial
16 schools (50%) Intervention Condition
1854 (84%) of control sample
completed12-month FU
Preventure
training of
school staff
Early Use
Cognitive dev
Em / Behav
Problems
Academic
Failure
ADDICTION
OUTCOMES
NEURO-
Venture
Brain structure-
function
NEURO-
Venture
Brain structure-
function
NEURO-
Venture
Brain structure-
function

32. Conclusions
 Evidence supporting the efficacy and effectiveness of targeted interventions
for the prevention of substance use and mental health problems is
mounting.
 We have demonstrated that it is feasible to implement CBT interventions in
schools across a number of different political and educational contexts.
 Results inform models of substance misuse etiology
 Provides a strong mental health and neurodevelopmental perspective on
youth drug and alcohol prevention
 Evidence of disease and communicable components of substance abuse
vulnerability
 Are communities promoting evidence-based programmes in schools?
 Greater Montreal Area currently implementing programme, with plans to train Laval and Lac
St-Jean.

34. Two-part models with growth functions
(Conrod et al., JAMA Psychiatry, 2013)

35. Teacher Training Protocol
 3-day Workshop
 Theory
 Generic counselling skills (emphathy!)
 Targeting personality in treatment and prevention
 Practical Supervision
 Session 1 + Feedback
 Session 2 + Feedback

37. Merci
Patricia Conrod
Patricia.conrod@umontreal.ca