The CAP Study: Evaluating a comprehensive universal and targeted intervention designed to prevent substance use and related harms in Australian adolescents.

Intervention

Intervention code Behaviour , Lifestyle , Prevention

Participating secondary schools will be randomly allocated to one of four groups. One group will serve as the control group and receive their usual drug education in school while the remaining three groups will receive either of the following interventions: Arm 1- Climate Schools Intervention (CL): The Climate Schools program aims to reduce the use of Australia’s most commonly used licit and illicit drugs: alcohol and cannabis, and related harms. The Program consists of twelve 40-minute lessons .... Participating secondary schools will be randomly allocated to one of four groups. One group will serve as the control group and receive their usual drug education in school while the remaining three groups will receive either of the following interventions: Arm 1- Climate Schools Intervention (CL): The Climate Schools program aims to reduce the use of Australia’s most commonly used licit and illicit drugs: alcohol and cannabis, and related harms. The Program consists of twelve 40-minute lessons delivered as part of the Year 8 PDHPE syllabus. The lessons are delivered weekly for 6 weeks (Climate Schools Alcohol module) and then approximately a 6 month break before the delivery of another 6 weekly lessons (Climate Schools Alcohol and Cannabis module). The first part of each lesson is completed individually over the internet where students are engaged through cartoon storylines which impart information about the short- and long-term effects of alcohol and cannabis, normative alcohol and cannabis use, refusal skills, and first aid. The second part of each lesson is a group or class activity delivered by the teacher which reinforces the information in the cartoons and allows interactive communication between students. Teachers are provided with a manual containing the activities, implementation guidelines, links to the education syllabus and summaries for each lesson. The first six lessons focus specifically on alcohol and are delivered approximately six months prior to the remaining six lessons which focus on cannabis. The overall duration of Arm 1 is approximately 6 months. Arm 2- Preventure Intervention (PR): The Preventure program is a brief personality-targeted substance use preventive intervention for high-risk adolescents aged 13-15 years. Unlike universal programs, this selected personality-targeted approach addresses personality risk-factors for early-onset substance misuse and other risky behaviours. Participating students will be screened at baseline using the 24-item Substance Use Risk Profile (SURPS) questionnaire which assesses variation in personality risk for substance abuse along four dimensions: Sensation Seeking, Impulsivity, Anxiety Sensitivity and Hopelessness (Woicik et al., 2009). The Preventure program is also consistent with new models which conceptualise substance use as being driven by personality traits such as impulsivity and disinhibition (Dick et al., 2008). This program involves two 90-minute group sessions (6-8 students per group) delivered one week apart by a trained clinical psychologist and co-facilitator. The interventions are conducted using manuals which incorporate psycho-educational and cognitive behavioural components, and include real life scenarios shared by high-risk youth in specifically-organised focus groups. In the first session, participants are guided in a goal setting exercise, designed to enhance motivation to change behaviour. Psycho-educational strategies are used to teach participants about their target personality variable and associated problematic coping behaviours like avoidance, interpersonal dependence, aggression, risky behaviours and substance misuse. They are then introduced to the cognitive behavioural model and guided in breaking down personal experience according to the physical, cognitive and behavioural components of an emotional response. A novel component to this intervention approach is the fact that all exercises discuss thoughts, emotions and behaviours in a personality-specific way, e.g. identifying situational triggers and cognitive distortions related to Sensation Seeking specifically. In the second session, participants are encouraged to identify and challenge personality-specific cognitive distortions that lead to problematic behaviours. The overall duration of Arm 2 is approximately 3 months. Arm 3- Climate Schools and Preventure Intervention (CAP): The CAP intervention will deliver the Climate Schools and Preventure programs, described above, simultaneously with the aim of providing a comprehensive ‘universal’ and ‘targeted’ model to prevent substance use and related harms in Australian adolescents. The overall duration of Arm 3 is approximately 9 months. CAP LONG TERM FOLLOW UP 2017-2019 Results at 3 years have shown the effectiveness of universal and selective approaches in preventing harmful alcohol use among low- and high-risk adolescents. The CAP long-term follow up is an opportunistic extension of the landmark CAP study, whereby follow up of this cohort will extend beyond the completion of secondary school and into the critical transition period of early adulthood. The investigators will extend longitudinal follow-up for a further 3 years, inviting the participants to take part in an two additional online surveys assessing demographic information, drinking and drug use habits, and behavioural and personality inventories
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Comparison

Control group Active

The combined Climate Schools and Preventure (CAP) Intervention will be compared to: a) A "standard treatment" control group - Students will not receive the Climate Schools or the Preventure Interventions. Participants will complete their standard Year 8 PDHPE classes, delivered by their teacher b) Climate Schools only intervention - Students will receive 12 x 40minute lessons delivered as part of the Year 8 PDHPE syllabus. Each lesson consists of computer lessons and activities from the program .... The combined Climate Schools and Preventure (CAP) Intervention will be compared to: a) A "standard treatment" control group - Students will not receive the Climate Schools or the Preventure Interventions. Participants will complete their standard Year 8 PDHPE classes, delivered by their teacher b) Climate Schools only intervention - Students will receive 12 x 40minute lessons delivered as part of the Year 8 PDHPE syllabus. Each lesson consists of computer lessons and activities from the program manual, to be administered by the teacher c) Preventure only intervention - Students will attend their standard PDHPE lessons, delivered by their teacher. Students who are identified as being 'high-risk' based on their personality profile will be invited to participate in 2 x 90minute sessions carried out by a registered Clinical Psychologist and co-facilitator. These sessions incorporate psycho-educational and cognitive behavioural components.
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Outcomes

Outcome: Uptake and harmful use of alcohol and illicit substance
Timepoint: Assessed at baseline and at 6, 12, 24 and 36 months after intervention commencement. Uptake and harmful use will be assessed by an adapted version of the School Health Alcohol Harm Reduction Project (SHAHRP) Patterns of Alcohol and Cannabis Use instrument, the Diagnostic Interview Schedule for Children (DISC-IV), the Alcohol and Lifestyle Questionnaire and nine items relating to student's current and .... Outcome: Uptake and harmful use of alcohol and illicit substance
Timepoint: Assessed at baseline and at 6, 12, 24 and 36 months after intervention commencement. Uptake and harmful use will be assessed by an adapted version of the School Health Alcohol Harm Reduction Project (SHAHRP) Patterns of Alcohol and Cannabis Use instrument, the Diagnostic Interview Schedule for Children (DISC-IV), the Alcohol and Lifestyle Questionnaire and nine items relating to student's current and intended future use of alcohol and illicit drugs. Also, 5 questions will be included to assess student's intention to use alcohol and other drugs in the future. Long-term follow-up: Primary outcomes will be assessed long-term via the administration of 2 additional follow-up surveys spanning 5, 6 and 7 years post intervention. Primary outcome 1: Drinking frequency and binge drinking will be assessed using an adapted version of the Patterns of Alcohol Index.
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Outcome: Substance use related harms
Timepoint: Assessed at baseline and at 6, 12, 24 and 36 months after intervention commencement. Harms caused by cannabis will be assessed using 12 items adapted from the SHAHRP survey instrument and a set of questions adapted from the Adolescent Cannabis Problems Questionnaire. Harms caused by alcohol will be assessed using an abbreviated version of the Rutgers Alcohol Problem Index. Long-term follow-up: Primary outcomes will be assesse .... Outcome: Substance use related harms
Timepoint: Assessed at baseline and at 6, 12, 24 and 36 months after intervention commencement. Harms caused by cannabis will be assessed using 12 items adapted from the SHAHRP survey instrument and a set of questions adapted from the Adolescent Cannabis Problems Questionnaire. Harms caused by alcohol will be assessed using an abbreviated version of the Rutgers Alcohol Problem Index. Long-term follow-up: Primary outcomes will be assessed long-term via the administration of 2 additional follow-up surveys spanning 5, 6 and 7 years post intervention. Primary outcome 2: Alcohol related harms will be measured using an abbreviated version of the Rutgers Alcohol Problem Index,
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Outcome: Alcohol and cannabis knowledge and attitudes
Timepoint: Assessed at baseline and at 6, 12, 24 and 36 months after intervention commencement, assessed by questions adapted from the SHAHRP questionnaire, and the Cannabis Quiz. Long-term follow-up: Primary outcomes will be assessed long-term via the administration of 2 additional follow-up surveys spanning 5, 6 and 7 years post intervention. Primary outcome 3: Probable diagnosis of alcohol use disorder will be measur .... Outcome: Alcohol and cannabis knowledge and attitudes
Timepoint: Assessed at baseline and at 6, 12, 24 and 36 months after intervention commencement, assessed by questions adapted from the SHAHRP questionnaire, and the Cannabis Quiz. Long-term follow-up: Primary outcomes will be assessed long-term via the administration of 2 additional follow-up surveys spanning 5, 6 and 7 years post intervention. Primary outcome 3: Probable diagnosis of alcohol use disorder will be measured using a self-report symptom checklist based on DSM-5 criteria.
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