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

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