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Personality risk factors for substance use: Prevalence in Australian adolescents and the personality-targeted Preventure intervention Dr Emma Barrett 1,

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Presentation on theme: "Personality risk factors for substance use: Prevalence in Australian adolescents and the personality-targeted Preventure intervention Dr Emma Barrett 1,"— Presentation transcript:

1 Personality risk factors for substance use: Prevalence in Australian adolescents and the personality-targeted Preventure intervention Dr Emma Barrett 1, Dr Nicola Newton 1, Prof Maree Teesson 1, Prof Patricia Conrod 2, A/Prof Tim Slade 1, Katrina Champion 1, Erin Kelly 1, Julia Rosenfeld 1 1 National Drug and Alcohol Research Centre, University of NSW, Australia 2 Department of Psychiatry, Universite of Montreal, Montreal, Canada The National Drug and Alcohol Research Centre at the University of NSW is supported by funding from the Australian Government.

2 Personality and substance use - Specific personality factors have been shown to be related to:  different patterns of substance misuse (Conrod et al., 2000)  distinct motivations for substance use (Comeau et al., 2001; Woicik et al., 2009)  differential sensitivity to alcohol reinforcement (Conrod et al., 1997; 1998) - Two broad personality profiles predict substance misuse (Cooper et al., 1995)  neurotic/internalising personality  negative affect coping motives  drinking  disinhibited/externalising personality  positive affect related drinking - Research has identified 4 personality profiles that are linked to adolescent substance misuse and patterns of psychopathology (Comeau et al., 2001; Woicik et al., 2009)

3 ‘High risk’ personality profiles Negative Thinking Early onset of alcohol use, drink to cope with negative feelings Anxiety Sensitivity Impulsivity Sensation Seeking Later onset (young adulthood), increased levels of drinking, more responsive to anxiety- reducing effect of alcohol Early onset of substance use and associated harms, engage in high-risk/externalising behaviour, poor response inhibition Heavy consumption (binge), more risk of adverse drinking outcomes, drink due to enhancement/euphoric (intoxicating) effects Depression Panic-related disorders Anti-social, risk-taking behaviours

4 Preventure - School-based, personality-targeted prevention program for high risk adolescents - Designed to target four personality profiles:  Negative Thinking (NT)  Anxiety Sensitivity (AS)  Impulsivity (IMP)  Sensation Seeking (SS) - Brief (2x90min sessions), group-based intervention delivered by facilitator and co-facilitator, students guided through manuals

5 Preventure components - Different to treatment given that individuals have not yet demonstrated drinking problems - Not focussed on substance use, rather on personality-specific cognitive distortions and motives - Based on  motivational interviewing: goal setting, pros and cons  cognitive-behavioural therapy: understanding links between thoughts, physical sensations, actions; identifying and challenging personality-specific cognitive distortions: NT: Internalising, over-generalisation, false conclusions AS: Over-estimating the possibility, thinking the worst IMP: Not thinking things through, aggressive thinking SS: thinking in extremes, needing to stand out

6 Efficacy of Preventure - Been shown to be effective in RCTs carried out in the UK and Canada  reduce quantity and frequency of drinking and binge drinking at 4mths  delay growth of alcohol use and binge drinking at 6mths  reduce problem drinking symptoms at 2 years  reduce number and frequency of illicit substances used, reduce odds of taking up  marijuana, cocaine, and other drugs over 2 year period  reduce depression (NT), panic symptoms and drinking motives (AS), risk taking behaviour (IMP) at 6mths (Castellanos et al., 2006; Conrod et al., 2006 ; 2008, 2010; 2011) - Yet to be trialled in Australia

7 Why use Preventure in Australia? -‘For children and young people under 18 years of age, not drinking alcohol is the safest option’ (Australian Guidelines to Reduce Health Risks from Drinking Alcohol, NHMRC 2009) - Substance use among adolescents of significant concern % Age (yrs) 2010 National Drug Strategy Household Survey (NDSHS)

8 Fits within the NSW PDHPE Syllabus Objectives: Students will... Outcomes: A student... Strand 1: Self and relationships enhance their sense of self, improve their capacity to manage challenging circumstances and develop caring and respectful relationships 4.1 describes and analyses the influences on a sense of self 4.2 identifies and selects strategies that enhance their ability to cope and feel supported 4.3 describes the qualities of positive relationships and strategies to address the abuse of power Strand 2: Movement skill and performance move with confidence and competence, and contribute to the satisfying and skilled performance of others 4.4 demonstrates and refines movement skills in a range of contexts and environments 4.5 combines the features and elements of movement composition to perform in a range of contexts and environments Strand 3: Individual and community health take actions to protect, promote and restore individual and community health 4.6 describes the nature of health and analyses how health issues may impact on young people 4.7 identifies the consequences of risk behaviours and describes strategies to minimise harm 4.8 describes how to access and assess health information, products and services Strand 4: Lifelong physical activity participate in and promote enjoyable lifelong physical activity 4.9 describes the benefits of a balanced lifestyle and participation in physical activity 4.10 explains how personal strengths and abilities contribute to enjoyable and successful participation in physical activity

9 Addresses skills that enhance learning Objectives: Students will... Outcomes: A student... develop and apply the skills that enable them to adopt and promote healthy and active lifestyles Communicating: 4.11 selects and uses communication skills and strategies clearly and coherently in a range of new and challenging situations Decision-making: 4.12 assess risk and social influences and reflects on personal experience to make informed decisions Interacting: 4.13 demonstrates cooperation and support of others in social, recreational and other group contexts Moving: 4.14 engages successfully in a wide range of movement situations that displays an understanding of how and why people move Planning: 4.15 devises, applies and monitors plans to achieve short-term and long-term goals Problem-solving: 4.16 clarifies the source and nature of problems and draws on personal skills and support networks to resolve them

10 Aims  To examine the prevalence of ‘high risk’ personality profiles among Australian adolescents  To describe the first trial of the Preventure intervention in Australian schools

11 Method - Thirteen schools (5 public, 8 private; N = 1091) randomised to Preventure - Administered the baseline survey  Substance Use Risk Profile Scale (SURPS; Conrod & Woicik, 2002) to screen for ‘high risk’ adolescents - Implemented the Preventure intervention with ‘high risk’ adolescents  Two sessions per group, 1 week apart  Run by Registered Psychologists and a co-faciliator  Obtained feedback from students (CSQ-8; Attkison and Zwick, 1982)

12 SURPS Negative Thinking (7 items) Negative Thinking (7 items) 1. I am content or satisfied* 4. I am happy* 7. I have faith that my future holds great promise* 13. I feel proud of my achievements* 17. I feel that I’m a failure 20. I feel pleasant* 23. I am very enthusiastic about my future* 1. I am content or satisfied* 4. I am happy* 7. I have faith that my future holds great promise* 13. I feel proud of my achievements* 17. I feel that I’m a failure 20. I feel pleasant* 23. I am very enthusiastic about my future* * Items to be reversed for scoring

13 SURPS Anxiety Sensitivity (5 items) Anxiety Sensitivity (5 items) 8. It’s frightening to feel dizzy or faint 10. It frightens me when I feel my heart beat change 14. I get scared when I’m too nervous 18. I get scared when I experience unusual body sensations (feelings) 21. It scares me when I am unable to focus on a task 8. It’s frightening to feel dizzy or faint 10. It frightens me when I feel my heart beat change 14. I get scared when I’m too nervous 18. I get scared when I experience unusual body sensations (feelings) 21. It scares me when I am unable to focus on a task

14 SURPS Impulsivity (5 items) Impulsivity (5 items) 2. I often don’t think things through before I speak 5. I often involve myself in situations that I later regret being involved in 11. I usually act without stopping to think 15. Generally, I am an impulsive person 22. I feel I have to be crafty or manipulative (sneaky) to get what I want 2. I often don’t think things through before I speak 5. I often involve myself in situations that I later regret being involved in 11. I usually act without stopping to think 15. Generally, I am an impulsive person 22. I feel I have to be crafty or manipulative (sneaky) to get what I want

15 SURPS Sensation Seeking (6 items) Sensation Seeking (6 items) 3. I would like to skydive 6. I enjoy new and exciting experiences even if they are out of the ordinary 9. I like doing things that frighten me a little 16. I am interested in experience for its own sake, even if its illegal 19. I would enjoy hiking long distances in wild and uninhabited territory 3. I would like to skydive 6. I enjoy new and exciting experiences even if they are out of the ordinary 9. I like doing things that frighten me a little 16. I am interested in experience for its own sake, even if its illegal 19. I would enjoy hiking long distances in wild and uninhabited territory

16 Rates of personality profiles in Australian adolescents (N = 2274) Groupn% NT1818% AS28212% IMP22210% SS25011% Low risk133959% 41% GroupLowMedHigh NT<=910-14>=15 AS<=910-13>=14 IMP<=910-13>=14 SS<=1311-18>=19 Prevalence of NT, AS, IMP and SSSURPS norms for Australian adolescents

17 Sample characteristics (N = 1091) CharacteristicsHigh risk (n = 467)Low risk (n = 624)Total (N = 1091)p Demographic Gender (% male) Age (M, SD) 80 13.25 (0.56) 82 13.28 (0.49) 81 13.27 (0.52) p = 0.292 p = 0.259 Substance use Ever tried alcohol (%) Ever had full serve (%) Had full serve in past 6mths (%) Intentions to use alcohol (%) 70 27 18 53 61 11 6 45 65 18 11 49 p < 0.05 p < 0.005 p < 0.05 Mental health Psychological distress (median K6) Strengths and difficulties (median SDQ) 6 (0-24) 12 (0-35) 4 (0-24) 7 (0-30) 5 (0-24) 9 (0-35) p < 0.005 Behaviour Truancy (%) Aggression (median RPQ) 12 10 (0-46) 7 5.5 (0-46) 9 7 (0-46) p < 0.05 p < 0.005

18 Implementation of Preventure - n = 467 students were invited to take part in the Preventure sessions  423 (91%) students completed S1  397 (85%) students completed S1 and S2 - 162 sessions were run between March and Nov, 2012  Mean no. of students per group = 5 (range 2-9)  Average minutes per session = 71 (SD = 13.3) - Flexible, fit into school schedule and setting - Required minimal effort from teachers - Important to ensure privacy/minimise disruptions Risk profile No. of groups NT18 AS23 IMP18 SS22 Total81

19 Some NT case examples Situation Physical sensations Thoughts Action Got bad marks in an exam; lost my phone; had a fight with a friend; my grandfather passed away; couldn’t find any of my friends at school; I was bullied at school* Sad, hopeless, no energy, tired, irritated, angry, vulnerable, headache, lonely, sick, down, crap I will stuff it up; I cant do this; I will ruin it for the team; he doesn’t like me anymore; I’m not good enough to be around; I will never make friends now; I should just give up; Why should I bother anyway; I am useless Ripped up my study notes; went to my room to sleep; told myself to stop feeling sorry and to just deal with it; went and talked to my mum; ate chocolate; listened to music

20 Some AS case examples Situation Preparing for an exam; presenting a speech; before a running race in athletics; before a rugby match; meeting new people; school dance; party Physical sensations Thoughts Action Head spins, butterflies, sick feeling in stomach, sweaty palms, shaky, jittery, nervous, cant focus, beating heart, red face, headache What will happen if I fail?; What’s wrong with my body?; Why do I feel so nervous?; Everybody is looking at me; I wont fit in; I’m not going to get through this at all; I’m going to totally embarrass myself Stressed too much and stopped studying; stumbled my words and sweated so much I left the party; stayed at home; talked to my friends to get my mind off it; listened to music

21 Some IMP case examples Situation Physical sensations Action Thoughts Disagreement with mum; fight with brother; teacher embarrassed me; angry at my parents; my friends were laughing and talking about me Adrenaline, frustration, angry, crying, shaky, tense, flushed I’m very angry and frustrated and don’t know what to do with life; leave me alone; you’re wrong; I’m so annoyed; I’m so fed up; I hate you; what have I done to you?; I’ll get you Stormed off; punched my brother; went to the shops without telling parents; slammed the doors; punched walls; walked away to cool off; stopped and thought it over

22 Some SS case examples Situation Physical sensations Thoughts Action Knock and run; prank at school; trying to study on the weekend but friends wanted me to party; going to a party and not telling parents; water fight at home; a mate dares you to do something; skipped class Shaking, heart racing, excitement, feeling hyper, sweating, dizzy, happy, light headed, butterflies, energetic, pumped, fearless, alive, rush This is so much fun; I’m worried but more excited; I’m going to burst soon; How much trouble can I cause without getting caught?; I cant believe I’m doing this; I wish this would never end Ran and knocked on doors and hid; snuck out; partied with friends; didn’t get caught; got caught and got suspended

23 What did the students think? - What did you like about the sessions? ‘It opens up a part of our personality we were unaware of’ (Female, IMP) ‘It helped us reflect on who we are and what we aim for’ (Male, SS) ‘They (facilitators) could understand us and help us and didn’t judge us’ (Female, SS) ‘We found out real stories of children in Australia and that it is not just us’ (Female, SS) ‘We got to understand what anxiety is and how to get rid of the feelings’ (Female, AS) ‘It helped me identify and challenge my bad thoughts and feelings’ (Male, AS) ‘Free lollies’ (Male, IMP) - What didn’t you like about the sessions? ‘More lollies’ (Female, IMP) ‘Can be uncomfortable talking about personal stories’ (Male, AS) ‘Not enough time; maybe needed more sessions – a bit rushed’ (Male, SS) ‘It takes up lesson time – perhaps lunch?’ (Female, IMP)

24 Conclusions - Preventure is a program that is  relevant for Australian adolescents - 40% ‘high risk’  accepted by schools/teachers - fits within the Syllabus  well received by students - report it is useful and effective - Next step is to examine substance use and associated harms at follow up  expect that Preventure will demonstrate similar effects in reducing substance use and associated harms amongst high-risk youth in Australia, as it did in the UK and Canada.

25 Thank you!  e.barrett@unsw.edu.au


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