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

4.
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

5.
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)

6.
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)

7.
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

8.
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

9.
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

10.
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.

11.
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

12.
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?

13.
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

14.
UK
Adventure
Trial

15.
1268 (54.6%)
Low personality risk
1025 (52.4%)
Low personality risk
Followed 6, 12, 18 & 24
months
Followed 6, 12, 18 & 24
months

16.
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

17.
Une chose que j'ai aimé en ce qui concerne les
séances

18.
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)

19.
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)

20.
Une chose que je n'ai pas aimé

21.
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

22.
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)

23.
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

24.
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

25.
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.

26.
Two-part models with growth functions
(Conrod et al., JAMA Psychiatry, 2013)

27.
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

28.
Merci
Patricia Conrod
Patricia.conrod@umontreal.ca