JAMA Psychiatry：个性有针对性干预或有效预防酒精滥用

　　日前，一项来自英国的整群随机对照研究结果进一步支持应用个性有针对性干预方法来预防酒精滥用和经培训的学校教职员工提供的干预是有效的。这项选择性预防计划所引发的一些弱羊群效应结果尤其新颖。

　　人们发现，在那些具有兴奋性人格特征者中，以具有成瘾性人格危险因素和心理问题的青年为目标人群的选择性基于学校的酒精预防计划，能减少物质使用和滥用。

　　该研究旨在报告在物质滥用试验中，教师提供的针对物质滥用试验的个性有针对性干预。在该项研究中，研究人员培训学校教职员工对具有如下4项高危（HR）特征之一的学生施加干预，这四项分别是：焦虑敏感、绝望、冲动和寻找感觉，和检测这个计划对于更广泛的未入选干预试验的低危学生人群的间接羊群效应。

　　该研究从英国伦敦的中学中共入选了1210名HR和1433名低危（LR）的9年级学生，平均年龄13.7岁。学校经随机分配为HR青少年提供简单的个性有针对性干预或像往常一样的治疗。评估参与者在随机化前和每隔6个月共2年内的饮酒、狂饮性饮酒和酗酒情况。

　　结果显示，由两部分组成的潜在增长模型显示干预对饮酒率（P = .03）、狂饮性饮酒率（P = .03）和狂饮性饮酒增加（P = .009）和酗酒（P = .02）对HR青少年的长期影响。HR青少年也从对饮酒量（P = .04），饮酒量的增加（P = .02）和狂饮性饮酒频率的增加（P = .047）的为期24个月随访期间的干预中获益。在24个月的随访期间，（研究人员）观察到了LR青少年的一些羊群效应，尤其是在饮酒率（P = .049）和狂饮性饮酒增加（P = .001）方面。

Effectiveness of a Selective, Personality-Targeted Prevention Program for Adolescent Alcohol Use and Misuse

A Cluster Randomized Controlled Trial

Context  

Selective school-based alcohol prevention programs targeting youth with personality risk factors for addiction and mental health problems have been found to reduce substance use and misuse in those with elevated personality profiles.

Objectives  

To report 24-month outcomes of the Teacher-Delivered Personality-Targeted Interventions for Substance Misuse Trial (Adventure trial) in which school staff were trained to provide interventions to students with 1 of 4 high-risk (HR) profiles: anxiety sensitivity, hopelessness, impulsivity, and sensation seeking and to examine the indirect herd effects of this program on the broader low-risk (LR) population of students who were not selected for intervention.

Design  

Cluster randomized controlled trial.

Setting  

Secondary schools in London, United Kingdom.

Participants  

A total of 1210 HR and 1433 LR students in the ninth grade (mean [SD] age, 13.7 [0.33] years).

Intervention  

Schools were randomized to provide brief personality-targeted interventions to HR youth or treatment as usual (statutory drug education in class).

Main Outcome Measures  

Participants were assessed for drinking, binge drinking, and problem drinking before randomization and at 6-monthly intervals for 2 years.

Results  

Two-part latent growth models indicated long-term effects of the intervention on drinking rates (β = −0.320, SE = 0.145, P = .03) and binge drinking rates (β = −0.400, SE = 0.179, P = .03) and growth in binge drinking (β = −0.716, SE = 0.274, P = .009) and problem drinking (β = −0.452, SE = 0.193, P = .02) for HR youth. The HR youth were also found to benefit from the interventions during the 24-month follow-up on drinking quantity (β = −0.098, SE = 0.047, P = .04), growth in drinking quantity (β = −0.176, SE = 0.073, P = .02), and growth in binge drinking frequency (β = −0.183, SE = 0.092, P = .047). Some herd effects in LR youth were observed, specifically on drinking rates (β = −0.259, SE = 0.132, P = .049) and growth of binge drinking (β = −0.244, SE = 0.073, P = .001), during the 24-month follow-up.

Conclusions 

Findings further support the personality-targeted approach to alcohol prevention and its effectiveness when provided by trained school staff. Particularly novel are the findings of some mild herd effects that result from this selective prevention program.