Binge drinking is an increasing problem among young adolescents in the Netherlands. The recent use of alcohol among pupils in secondary education (12 to 16 years of age) in the Netherlands is declining, while binge drinking among these pupils is increasing. Nowadays, 75% of the Dutch 12 to 16 year olds who drink alcohol also engage in binge drinking [1
]; this implies consuming five or more alcoholic drinks on one occasion in the past month. The largest proportion of binge drinkers are found in the age category of 15 and 16 years old. In comparison to other European countries, Dutch adolescents are among the leaders in drinking frequency and binge drinking [2
In adolescents, heavy alcohol consumption is associated with premature and violent deaths, e.g. traffic accidents, having risky sexual intercourse [4
] and poor academic performance, learning difficulties and school dropout [6
]. In addition, heavy alcohol use during puberty appears to be related to damage to the development of cognitive and emotional abilities [9
] and an elevated risk of later dependence and misuse [11
]. Alcohol-related risks to cognitive functions seem to be higher in adolescents than in adults [11
]. From the point of view of public health, prevention of heavy alcohol use among adolescents is essential.
There is little scientific evidence that universal prevention programmes aimed at youngsters affect drinking behaviour. Recent meta-analyses show that such programmes have small or no effects on alcohol use and binge drinking [3
]. Exceptions to this are interventions aimed at both adolescents and their parents [15
] and integrated programmes with multiple years of intervention and professional support [13
]. Meta-analyses of school-based substance use prevention programmes have concluded that selective prevention programmes, targeting populations at increased risk, generally yield higher effects than universal programmes (e.g. [13
]). According to Cuijpers and colleagues [13
], selective prevention programmes have proved effective, but the availability of these programmes is limited. Therefore there is a recognized need in the field of substance use prevention for selective prevention programmes.
Preventure is a selective prevention programme and is one of the few school-based programmes with long-term effects on adolescents' drinking behaviour and binge drinking [16
]. In research conducted in Canadian and English samples of adolescents, effects of the programme were found on abstinence, quantity and frequency of drinking, binge drinking, and problem drinking symptoms at four months and one year after the programme [16
]. In addition to the effects on alcohol use, positive effects were found on emotional and behavioural problems, i.e. depression, panic attacks, truancy, and shoplifting [21
The Preventure programme specifically targets young adolescents who have two well-known risk factors for heavy alcohol consumption: early-onset alcohol use [22
] and personality risk for alcohol abuse (e.g. [24
]). The programme is based on the theory that personality is an important construct for understanding adolescents' alcohol use and abuse. Two personality dimensions were previously found to be predictive of heavy alcohol use and alcohol use disorders, namely (1) an impulsive sensation seeking dimension, and (2) a behavioural inhibition dimension [16
]. The first category involves young sensation seekers and young people with low impulse control, the second reflects a neurotic personality involving more anxious and negative thinking young people. Within these two dimensions, Conrod and colleagues [16
] distinguished four personality profiles at higher risk of developing alcohol problems: Sensation Seeking (SS), Impulsivity (IMP), Anxiety Sensitivity (AS) and Negative Thinking (NT).
The four personality profiles were subsequently found to be strongly related to adolescents' quantity and frequency of drinking, frequency of binge drinking, and severity of alcohol problems [25
]. Each personality profile is associated with specific substance misuse patterns, maladaptive motives for use, and vulnerability to specific forms of co-morbid psychopathology in adolescents [27
]. Impulsivity is related to an increased risk of the early onset of alcohol and drug problems [29
]. Sensation seekers drink more [30
], tend to drink in order to enhance euphoric (intoxicating) effects [28
], and are more at risk of adverse drinking outcomes (e.g. [30
]). Highly anxiety sensitive persons show increased levels of drinking [31
], are more responsive to the anxiety-reducing effect of alcohol, and are more likely to use alcohol to cope with negative feelings [28
]. Persons with high levels of hopelessness often have depression-specific motives for alcohol use [32
] and usually drink to cope with negative feelings [16
The Preventure programme screens a school population for pupils who already drink alcohol and, additionally, belong to one of the four high-risk personality profiles. The programme identifies and treats high-risk adolescents, with the aim of preventing or intervening early before the high-risk adolescents engage in risky behaviours and/or these behaviours become problematic. The selected pupils are offered a tailored intervention based on cognitive behaviour therapy (CBT) and motivational interviewing. Cognitive behavioural techniques are used to target maladaptive thinking and coping skill deficits, and motivational interviewing techniques are used to address motivation to take responsibility for one's problematic behaviours. Motivational interviewing has proven to be effective for alcohol- and drug-related behaviour, and CBT can lead to reduction in anxiety sensitivity, depressive cognitions, and impulsivity (e.g. [35
]). The manualized intervention, developed by Conrod and colleagues [35
], provides personalized feedback and personality-specific cognitive-behavioural exercises designed to facilitate more adaptive coping. The focus is not on drinking (or drug use) per se but on risky ways of coping with personality, such as avoidance, distraction, and aggressive thinking, that may lead to substance misuse or other risky behaviour.
Aims and hypotheses
In 2009, a project was started to develop and test Preventure in the Netherlands, where currently there is no selective school-based alcohol prevention available [37
]. The main objective of this project is to study the effectiveness of Preventure on drinking behaviour of young adolescents in secondary education in the Netherlands. The effectiveness of the Dutch Preventure is being assessed by conducting a clustered randomized controlled trial (RCT), with two conditions (treatment and control arms). This is the first time that Preventure has been studied outside the setting where it was developed, England and Canada, to prove its effectiveness outside this setting.
The most relevant outcomes are percentage reductions in binge drinking (≥ five drinks on one occasion in the past four weeks), weekly drinking, and drinking-related problems after 2, 6, and 12 months. The main hypothesis is that high-risk students who receive the personality targeted intervention will score lower on these outcomes relative to those in the no-treatment control group. In addition, our secondary aim is to test the effects of the programme on emotional and behavioural problems (e.g. aggression, truancy, and shoplifting). Our hypothesis is that Preventure facilitates lower depression rates, lower anxiety rates, lower delinquent behaviour rates, less problem behaviour, and lower truancy.